Most individuals who suffer from depression believe, "Once I feel better, I'll start calling friends again/making dinner plans/playing golf/planning a vacation/etc., but right now, I just don't have the will." Most of these people are not aware of the research, conducted in numerous Cognitive Behavior Therapy studies, that has consistently demonstrated that those who suffer with depression have to put the cart before the horse. That is, in order to feel better, depressed people need to start getting actively re-involved with life right away even though they may not want to or believe they can.
People with clinical depression might understand this concept on an intellectual level, but they frequently experience interfering thoughts such as, "I'm too tired/It won't make me feel any better/My friends will be busy/I won't enjoy the dinner/It's too much effort/Nothing will make me feel better." Cognitive Behavior Therapy helps clients grasp the idea that their thoughts may be 100 percent true, 0 percent true, or some place in the middle. In my own practice, I tell depressed patients that I don't have a crystal ball so I can't predict the validity of their predictions -- but I also gently ask them whether they, themselves, have a crystal ball.
Then I ask if they are willing to do some experiments. It's likely that they've already done the experiments of not calling friends/not making dinner plans/not playing golf/not planning a vacation. I ask them how those experiments impacted their mood. Then I ask what they're willing to try this week. I provide a low benchmark goal, such as, "It's worth doing the activity if it reduces your suffering by even 10 percent." Then, together, we predict and respond to the thoughts we think will interfere with the likelihood of their following through with the activity. We also predict and respond to the thoughts that might spoil the enjoyment or sense of achievement they could experience during and after the activity (for example, "I used to do this activity easily/I'm burdening my friend/This should be more fun."). I've found that helping patients develop robust answers to their depressed thinking greatly increases the likelihood that they will follow through with activities, which lead to an improvement in mood.
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