Many patients who suffer from depression feel tired, uninspired and worthless. They may spend hours isolated in their bedrooms with the shades drawn. They frequently sleep or lie in bed ruminating on their failures and shortcomings. Sometimes they forecast disappointment and catastrophe.
When the depression is not that severe, they may go to work or school and go through the motions without any real sense of satisfaction or pleasure. Personal hygiene drops off as the motivation to do self-care rituals wains. With depression, the inertia that usually propels us through life grinds to a halt.
The automatic thoughts associated with this routine often lead to feelings of hopelessness and the conclusion that life isn't fun or meaningful. There is little to look forward to in this daily schedule. The perception of satisfaction becomes distorted.
One of the best interventions for depression involves developing a daily schedule infused with enjoyable activities. One day at a time is all each of us really has to deal with. If we can structure a day that is enjoyable we are more likely to feel productive and optimistic. It is probably unrealistic to fill the entire day with comedy movies, popcorn or trips to theme parks. However, you could realistically incorporate hiking, day- trips on the weekend, bike rides, and pleasure reading into your schedule.
To get started, keep track of daily activities for a period of several days or a week. Then assign each activity a value based on a percentage which reflects the amount of pleasure generated by the activity. For example, lying in bed reflecting on all your failed relationships would be assigned a value of 15%. Watching daytime soap operas might earn a pleasure value of 30% and so on.
The next step involves listing the activities that have been pleasure generators in the past or activities that seem like they might generate pleasure. Then predict the amount of pleasure you believe each activity will yield. Getting up early and reading the newspaper might be assigned a pleasure score of 60%. Going on an early morning walk could receive a score of 70%. Shaving and putting on great smelling aftershave might receive a value of 40%. At first, put down anything that comes to mind and then reduce the list to fit into your schedule.
Use an hour by hour schedule format and plug in each activity. Assign each activity a predicted pleasure percentage. At the end of the day, go back over your schedule and assign a percentage that reflects the actual value of pleasure generated by each activity.
The goal of this intervention is to disprove the negative and irrational conclusions mentioned earlier, i.e.., “ Life has no meaning. I have nothing to look forward too. I don't have any fun.” If you stick to the schedule even partially for one day, you will have already done one extremely important thing. You will have taken responsibility and initiative to do something about your situation. Although it would be hard to prove anyone has zero worth, just for the sake of argument, we can conclude that worthless people don't take responsibility. More often than not people who try this, report that they actually receive more pleasure than they predicted from the activities, which again disproves that life is no fun and untwists their distorted perception.
It is really important to write the schedule out and keep it in some type of journal. Writing requires some effort but can be done by even the most depressed person. It is an opportunity to be successful which is important in the early stages of treatment. Keeping a record also gives you the advantage of being able to analyze what worked best and which activities were most enjoyable. It is also proof that you accomplished something. This will help combat the negative conclusion that you are helpless and unproductive.
Many depressed people have little or no motivation. They remain in a stagnant state of inactivity. They stop exercising which helps cleanse the body of toxins and floods the brain with chemicals that improve mood. They don't go outside and therefore don't get the exposure to sunlight they need, ultimately throwing off their sleep cycle. The biggest misconception is that motivation will come. How can it under these conditions?
Waiting for motivation is a trap. The more you wait for it the less of it you have. Action is what stirs motivation not the other way around. Taking the smallest step can lead to another. Read one paragraph of a newspaper article. Take a walk to the end of the driveway. Get cleaned and dressed daily. Having a fresh experience with an activity that is rewarding will increase the chances of repeating it. Get the ball rolling, even if it starts slowly.
Daily scheduling is not the complete and total cure from depression. Medication and therapy may be necessary components of a total treatment plan. Anyone having suicidal thoughts or urges should be evaluated immediately.. However, a rewarding daily routine that provides multiple opportunities for success is essential.