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The aim of many ‘talking therapies’ is to help people understand how their unreasonable or unwanted thoughts can harm their sense of well-being. There are many such therapies, some lasting a few sessions and some a lifetime. Some are considered appropriate for minor psychological issues, while others aim to address more persistent or severe psychological problems. The recent growth in popularity of Mindfulness demonstrates that many people want access to everyday tools that can help them feel better.
There has been considerable debate about the effectiveness and appropriateness of different counseling approaches and therapies for different kinds of mental health problems. For example, my colleague Professor Keith Laws has been at the centre of debates about the inappropriate use of Cognitive Behaviour Therapy (CBT) and the state of the evidence about its effectiveness for depression and psychoses.
A key ingredient in many therapies is for the person to try out new behaviours in the world. In CBT, for example, trying out behaviours goes hand-in-hand with the cognitive restructuring that is a goal of the sessions. Different approaches place different emphasis on changing cognitions or behaviours but the positive changes are usually attributed to the interaction of the two, although the cognitive component is usually given the main focus. This does seem to us to make intuitive sense, even though we humans are animals of habit and our thoughts and behaviours are not very well connected – we often say one thing but do another, for example. In previous blogs I have argued that we believe our thoughts and willpower are important but this is often a user illusion – it is past habits that predict what we will do, not our thoughts and intentions. Of course, we find this unpalatable.
But can new behaviours alone stop us being anxious or depressed, or reduce our anxious and depressive thoughts? I would predict this to be so in many cases. Do new behaviours need to be accompanied by thought-altering therapy to have their power? Perhaps not. The Do Something Different approach can provide a test of this.
If behavioural habits are partially responsible for our mental well-being, then are the kinds of small new behaviours in a Do Something Different program – delivered digitally and without any therapy or talking – capable of breaking negative thinking patterns?
Perhaps ‘Do-fulness’ might be an alternative or supplement to Mindfulness?
But let me be very clear - I don’t want to suggest people should stop any treatments or see Do Something Different as appropriate as a therapy to deal with their anxiety or depression.
There is research that suggests new behaviours – rather than the new thinking – is what really matters for effective therapy. For example, in a review of evidence-based treatment, Glenn Waller1 from King’s College, London University, suggests that CBT often fails to work in real life (as opposed to in scientific trials) because of ‘therapist drift’. He suggests therapists may fail to ensure the patient does what they are asked to do outside the clinical setting – try new behaviours. He says therapists drift from ‘doing therapies’ to ‘talking therapies’ which is not effective.
Professor Karen Pine and I looked at data from Do Something Different to see if it provided a test of the power of doing, as opposed to thinking. Of course, thoughts and behaviours are not independent of each other. Our thoughts will influence our actions both consciously and unconsciously. And a new behavioural experience provides new thoughts (which is why habit breaking behaviours alone may have power to help). In Do Something Different the major emphasis is on new behaviours – people are promoted to try small new habit breaking behaviours that are personalised for them from a set of diagnostics. We can also see how scores change as a result of the program for those that complete diagnostics before and after. Whilst it does not play a part in personalising the program, depression and anxiety are measured before and after using the Thoughts & Feelings questionnaire.
Making changes to behaviours might result in reductions in unhealthy levels of anxiety and depression because the individual is freed from the unhelpful automatic habits that are at odds with other cognitive needs or wants (Fletcher & Pine, 2012). The small new behavioural steps serve to inhibit old habits and expand people’s experience and behavioural repertoire.
Our data source is the scores from 1,799 male and female adults, aged 18 – 78, who have participated in a Do Something Different intervention, and who fully completed the diagnostic measures both pre- and post-intervention. The ‘intervention’ refers to any of the Do Something Different programs that was delivered digitally. There are a wide range of programs that tackle many domains (e.g. diversity & inclusiveness, leadership, weight loss, healthy habits, emotional intelligence). Only one of the programs specifically targets stress (called Do Stress Less) that deals with behaviours and habits that stressed individuals report. Therefore, people’s reasons and goals varied but all were sent Do’s to try over the (commonly) 6-week program.
The Doers were a real mix of people from many countries and were either self-selected or were directed to a program by their employer.
Amongst many things, we measured general anxiety and depression using the Thoughts & Feelings scale. Everybody also completed a 10-item Habit behaviours questionnaire pre- and post-intervention. Each question asked the participant ‘How often do you…’ with the question topic relating to the target behaviour of the program goal. People answered on a sliding scale from ‘Never’ to ‘A Lot’, the system automatically converted the position to scores between 0 and 100 for data analysis.
What we found: (If interested you our can download our White Paper report which contains more detail about the results)
- Anxiety and depression levels were significantly reduced by doing something different
Scores on the Thoughts & Feelings scale correspond to one of three distinct categories for either anxiety or depression ('Clinical', 'At Risk', 'Healthy').
The Tables below shows the reductions in anxiety and depression as a result of people going through a Do Something Different program. There are many fewer Clinical and At Risk scorers and many more people are at the Healthy levels. Remember that the purpose of the programs is not to treat anxiety and depression at all. Yet these are really quite substantial reductions in negative affect. None of the programs provide any kind of talking therapy for anxiety or depression or specifically focus on thoughts or affect – all are about changing habits of behaviour.
There were significant pre-post changes in mean scores (as opposed to the score category) on both depression and anxiety for the whole sample too.
ANXIETY:
Category Before After Difference
Clinical 403 (22.4%) 175 (9.7%) -228
At Risk 350 (19.5%) 158 (8.8%) -192
Healthy 1046 (58.1%) 1466 (81.4%) +420
Table 1: Anxiety levels - the number of people in each category (Clinical, At Risk, Healthy), before and after the intervention.
DEPRESSION:
Category Before After Difference
Clinical 239 (13.3%) 109 (6.1%) -130
At Risk 241 (13.4%) 157 (8.7%) -84
Healthy 1319 (73.3%) 1533 (85.2%) +214
Table 2: Depression levels - the number of people in each category (Clinical, At Risk, Healthy), before and after the intervention.
- The reductions in depression and anxiety score were also related to changes in behavioural habits scores:
Behavioural habits were correlated with anxiety and depression, as predicted. Perhaps more importantly, as habit scores reduced, so anxiety and depression levels fell. The effects were highly significant statistically.
It seems that habits and stress levels are linked, and changes in habits can help lower levels of anxiety and depression. In a previous blog I have suggested this is because the new experiences help to make us less ‘incoherent’ – we become better connected with ourselves!
- It did not matter which program Doers completed.
Whichever of the many programs people did, all reduced anxiety and depression scores. For example, we statistically compared those on the Stress Less program with those on other programs and the same positive effects for anxiety and depression were still present, and just as strongly – the only significant difference was that, unsurprisingly, those on the Stress Less program scored higher on anxiety and depression overall.
Implications:
In some ways it is surprising to see that doing new behaviours apparently unrelated to the feelings of depression or anxiety help some people so much. On the other hand, perhaps, many of us are ‘incoherent’ in how we live our lives and might be locked in by a wide habit web of behaviours that are unhelpful to us. In my book Flex, I suggest that ‘incoherence’ can happen at many different levels (e.g. desires, motives, what we say, what we do) and is a common aspect of human existence because our brains have inbuilt inertia towards habits. The results here support the idea that people’s levels of anxiety and depression are related to their behavioural habits. When people Do Something Different and change their habits their scores for anxiety and/or depression were likely to be lower afterwards.
What does this mean? Do Something Different is not designed as a therapy but it does appear to help a lot of people. We hesitate to jump to the wrong conclusions, but it has been a consistent finding in our programs since we began. Of course the data is self-report data, and there are no control conditions and only short-form measures (because these are publicly available programs not research investigations). On the other hand, these benefits are incidental and additional to the main focus of the intervention – which might have been as varied as changes in clothing habits to developing leadership skills. The sample size is also pretty big too. The people were also living all kinds of different lives and in different situations, which I think makes the results even stronger. The programs are very scalable too and are very inexpensive compared to normal therapy. Doubtless there will be doubters, but the effects are worth considering in the light of how we can help people to manage their mental wellbeing.
1.Glenn Waller, (2009) Evidence-based treatment and therapist drift, Behaviour Research and Therapy, 47, 119–127
The research in this blog forms part of the Do CHANGE project, funded by the EU Horizon 2020 - grant 643735, which is aimed at improving health and well-being. That project is focused on coronary heart disease and depression and anxiety often result from - or exacerbates - the medical conditions.
