An Outside-In Approach to Treating Depressed Mood
Colleen Richards, Advanced Clinical Fellow
With standard talk therapy sessions, you may see your therapist for around an hour a week or in a group session perhaps two hours at the most. The rest of the week consists of another 167 hours and it is during this time that we can really implement what we are learning about in therapy sessions. In the realm of Cognitive Behavioral therapy, there is a technique called behavioral activation treatment. This is a technique I love to use with clients because it can be used in sessions or on one's own at home throughout the week. The goal is to decrease symptoms of unwanted behavior by reflecting on your values and activities day to day. One way to do this is with a simple sheet of paper I would have a client draw a circle and fill in a pie showing how big the silver is of the unwanted behavior. This can look like overeating, isolating from friends, or any other behavior that isn’t serving the person. Next, we would fill in the rest of the pie with activities that the person spends the rest of the day doing. The goal here is to look at what activities can take up more space in your chart to make the unwanted behavior a little less of the pie. This can be spending time with friends and family or finding time to explore a past hobby that brought a sense of happiness. It can be difficult for someone who has major depression or mood disturbances to push themselves to get started on the activating tasks but working with a therapist for encouragement in the process is helpful and there is plenty of research that shows that individuals who use this outside-in model see a change in the mood very quickly.
This is known as an outside-in model because we are looking at motivators and values from the person's outer world in order to understand the behavior and how it plays out internally. When people struggle with mood disorders and depression, the internal motivation may not be as strong and so this approach to activating positive change is shown to be helpful in many ways to get them activated and motivated for change. The action disrupts the negative feedback loop. Depression and low moods can be chronic for many individuals and this can be so difficult. It can lead to vicious cycles of isolation, shame, and self-doubt. To slow down the process I like to start by asking:
Do you have a sense of what is triggering your mood or anxiety? Is it situational? Are there activities that are bringing you up or down?
What gives you pleasure or meaning? If you can’t remember something now, is there something in the past that did?
How can you carry these things out throughout the week?
Are there times when you feel better or worse throughout the week?
It’s helpful to take note of mood shifts throughout the week to build awareness around certain changes in mood. The pie chart can be brought back in with a therapist or continued to work through at home on one's own to reassess the changes being made. With an approach and easy at-home assessment, activities that give one joy can begin to fill up more space in the person's life. By bringing activities that one values from the outside in, one can create meaningful change. As stated above, these tasks can be tough and that's why it is so important to do it with lots of self-compassion and find a professional to help you draw out reflections through this process.