Working with depressed clients has reminded me of the world’s strongest man competitions I used to watch as a child. In one event, competitors would pull heavy vehicles strapped to their waste, and living with depression can feel like we are constantly dragging a heavy weight behind us. Strength alone was not enough to shift these enormous objects – their approach mattered. The Strongmen would lean forward to take the strain, and with their first small steps they would barely move off the mark, despite great strength and determination. In fact, they might sometimes slip backwards, trying too hard without sufficient traction. But with a steady persistence they would inevitably gain forward motion. From here they would build momentum, and gradually lengthen their stride. Before long they were moving at a normal walking pace. It was an impressive feat considering the weight they were pulling. In a similar way to this, it is possible for people to progress in life despite the weight of their depressive illness.
Depression reduces motivation, draining people of energy and instilling a sense of hopelessness and pointlessness. Understandably, people often reduce their activity levels and isolate themselves socially. Unfortunately, these responses strengthen depression by eliminating the few remaining opportunities to be rewarded by life, thereby confirming negative expectations and further reducing motivation in a vicious cycle.
An evidenced based approach to treating depression, Behavioural Activation, targets these maintaining factors. Like the strength athletes in the vehicle-pull event, we can expect a slow and potentially discouraging start. It requires very small steps, and a deliberate and focused approach. Schedule activities that instil a sense of achievement, increase connection to others, or are things you’ve enjoyed in the past. At first these might involve getting out of bed before midday, making a simple meal for a significant other, or going for a coffee at your local café, and regular exercise is recommended. Trying too hard can set us up for a slip backwards, and will probably confirm thoughts of failure. As we begin to build momentum mood can lift, and it will be possible to lengthen our stride by taking on more challenges. Maintaining momentum is important, so keep scheduling a variety of rewarding activities, and commit to doing these despite low motivation. Giving in to a few bad days here and there will not bring us to a grinding halt, but returning to patterns of withdrawal and isolation will, so get back on track when you can. When depression finally lifts it is easy to become complacent, so treatment guidelines recommend a focus on relapse prevention.
We needn’t cower in the shadow of depression. If it’s managed well we can live a meaningful life, and maintaining engagement in life is part of managing a depressive illness.