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Behavioral Activation to Prevent Depression During COVID-19

A proven CBT technique illustrates one way to prevent depression from COVID-19.

Imagine you don't feel like going for a walk, but you go anyway, and your thoughts shift from "Ugh, I don't want to go" to "This isn't so bad" to "That actually felt good."

Behavioral activation, a proven technique from cognitive-behavioral therapy (CBT), increases your contact with positive, pleasurable, rewarding activities that are aligned with the life you want to lead. While you may not feel like doing these activities because you're already down, sad, or stressed, "faking it" (doing them anyway) can brighten your thoughts, lift your mood, and prevent you from slipping further into depression.

Steps for behavioral activation:

1. Choose specific, positive actions you can take each day to improve your mood (see examples below).

2. Notice when you feel resistance to engaging in a behavior you know will help you (e.g., "I don't feel like going for a walk," etc.).

3. Acknowledge that the resistance may be due to existing stress or depression.

4. Decide to do it anyway (fake it 'til you make it).

5. Notice how good it made you feel (how it improved your thoughts or feelings).

Some evidence-based behaviors you might benefit from activating during COVID-19 restrictions include:

1. Take a warm bath at least twice per week.

Research suggest that taking a warm bath at least twice a week may help relieve symptoms of depression, even more than physical exercise does. Research participants who took regular baths experienced significant improvement (a reduction of 6 points on the depression scale).

During bathing several actions are exerted on the body, including hyperthermic action, hydrostatic pressure, buoyancy, and viscosity of water. Studies suggest that bathing can have effects on heart rate, metabolism, nerve stimulation, and cardiac output, which can boost immune function and provide a feeling of refreshment.

One randomized controlled trial showed that taking a bath was even more beneficial than showering. Participants who bathed showed better scores for fatigue, stress, and pain, as well as overall general health, mental health, and social functioning when compared to those who showered.

2. Exercise.

Research is clear that aerobic exercise, including jogging, cycling, walking, gardening, and dancing, can reduce anxiety and depression. Improvements are attributed to an exercise-induced increase in blood circulation to the brain, which influences the hypothalamic-pituitary-adrenal (HPA) axis and shifts one's physiologic reactivity to stress. Exercise may also help mental health through distraction from negative thoughts, an increased feeling of self-efficacy, and more social interaction.

3. Engage in service.

Activating the behavior of helping others can trigger the release of brain chemicals that help us feel good. Even a small bit of service can pull us out of our own funk.

James Baraz and Shoshana Alexander from The Greater Good Science Center at the University of Berkeley write:

"We feel so good when we give because we get what researchers call a "helpers high" or a distinct physical sensation associated with helping. About half of the participants in one study reported that they feel stronger and more energetic after helping others; many also reported feeling calmer and less depressed, with increased feelings of self-worth."

These scientists explain that the "helper's high" is a literal high from a boost in neurochemicals. For example, donating money triggers a reward center in our brains that is responsible for dopamine-euphoria.

Examples of "helping" during COVID-19 restrictions include:

  • Call or face-time an elderly relative each day
  • Deliver groceries to an elderly relative or neighbor
  • Play online games or cards with an elderly relative or isolated friend
  • Write thank-you cards to health care workers or others on the "front lines" of the pandemic
  • Donate money to a fund to help people affected by COVID-19 infections or restrictions
  • Write postcards for a political campaign you believe in
  • Drop off extra food or supplies at a local food pantry

4. Read a book for 30 minutes.

Decide to read a good book instead of "vegging out" on electronics. Book reading is associated with less stress and more positive psychological outcomes, which could help prevent you from feeling worse. One study found that just 30 minutes of reading lowered participants' blood pressure, heart rate, and feelings of psychological distress (just as effectively as yoga did).

Writer Rebecca Wojno suggests that when you make a habit of reading, it's easier for your brain to relax and temporarily transport itself to another world. A blogger, Positive Kunal, put it well, writing,

"In depression, a person either keeps his/her mind inactive or occupied with negative thoughts, but when you read a positive book, you fill your mind with positive content, which further generates positive energy."

5. Call or video chat with a friend.

Friendship is an essential element in preserving mental health. Whether providing total acceptance, laughter, or an optimistic spin on things, friends help you maintain a positive state of mind.

However, when people feel down, they often don't feel like interacting with others. It's when you're depressed that it's most important to keep friendships going. Friendship can prevent isolation and help people recover from depression.

Studies show that social support has also been shown to moderate the effect of stress on depression. We're all stressed due to the COVID-19 pandemic, but if we maintain social interactions, we can prevent ourselves from becoming really depressed. Social interactions, such as Zoom meetings, Facetime, phone calls, emails, and other communication will keep us afloat during tough times.

Being intentional about filling our socially isolated days with positive behavioral activities may not be a cure-all for the intense sadness we feel right now, but it can definitely help.

Parts of this blog post have been excerpted from the book Joy Fixes for Weary Parents: 101 Quick, Research-Based Ways to Overcome Stress and Build a Life You Love.

More from Erin Leyba LCSW, Ph.D.
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