Reversing Social Distancing Depression
Lessons learned from the inpatient unit.
Posted May 13, 2020
As we begin Week 10 of social distancing, many of us are looking toward a summer with significant restrictions on our activities, social contacts, and mobility. Throughout the endless weeks of March and April, both of us have been thinking about our experiences as therapists working in inpatient settings.
Although not to the same degree, all of our opportunities to do things that normally make life feel fun and meaningful are limited. During periods of depression, people start to disconnect from those around them and do fewer enjoyable activities. When forced to disconnect from others and limit our activities due to social distancing, we are mimicking the patterns of being in a depressed state. It is almost inevitable that we will struggle with feelings of sadness, hopelessness, and isolation.
So what can we do?
For all of the constraints of social distancing, imagine being on an inpatient psychiatric or medical unit: You may be confined to the unit or even your bed, you cannot choose the food you eat, and it is a huge task to speak with anyone outside of the unit. As therapists in these settings, we sometimes surprise patients by asking them to plan and complete meaningful activities – not when they are feeling better, not when they are discharged – but today, right now.
At first, this can sound impossible. How can a patient reconnect to his brother when he finds himself in a locked ward? How can a veteran improve her physical fitness when confined to a hospital room or wheelchair?
The key is first identifying one’s values, or “ways of being” that make life feel meaningful even during difficult times. Identifying our values helps us understand why we do the things we do, and how our actions relate to our personal goals. Once we connect with a value important to us, finding a corresponding activity follows logically.
The first patient chose to write his brother a letter. The second patient recruited a nurse to help her find chair exercises to build up her strength.
These strategies are derived from Behavioral Activation, a treatment for depression with strong research support. The rationale for Behavioral Activation is counterintuitive – while we think that we first need to feel better to do activities, in fact, the more we pursue activities that are enjoyable and rooted in our values, the easier it becomes to complete them and the better we feel.
Through working with inpatients, we’ve learned that the key to success is focusing on activities that feel manageable and taking things one day at a time. Choosing one activity each day and then doing it can feel like a small victory and, over time, these victories accumulate and have the power to dampen our depression and enhance our optimism in more ways than we expect.
Here are the three steps to DIY-ing Behavioral Activation to help you feel connected to things that matter to you even while your mobility and ability to connect with others are limited:
Step 1: Values. Think about what is important to you. What makes life feel worth living? What keeps you going when things are hard? What kind of person do you want to be in the world? Possibilities include relationships, fitness, religion/spirituality, community, skills/hobbies, and career or volunteer work.
Step 2: Activities. Pick one area of your life that matters to you. What is an activity you could accomplish today that would get you closer to that value? This should be something meaningful, but easy to accomplish.
Step 3: Planning. Make a plan. When will you do the activity? Where? How? Write down your plan and, if possible, chat with someone else about the activity you are planning and tell them how it went afterward. If things don’t go as planned, that’s okay! Think of an easier way of accomplishing your goal or try to figure out what got in the way of doing the activity you originally planned.