Step 1: Understanding Depression
Let’s get started by learning how kids can get stuck in a spiral of depression, and understand how they can break that cycle by choosing meaningful and enjoyable activities.
Learning about Depression
Consider the example of a boy who is depressed due to repeated failure to complete homework:
- Situation. He needs to complete his homework that is overdue. He knows he needs to complete his homework, and knows that it is meaningful to do it because it will help him with his goal of graduating high school.
- Lack of Motivation/Prior Experience. But, the boy's prior experience or beliefs make it difficult to complete the task. He may think, "It's simply too difficult". The boy cannot find the motivation to start doing it. When the child does start with the homework assignment, it is extremely difficult to maintain motivation.
- Distraction/Avoidance. The child finds that it is simply easier to choose not to do it and instead distract by playing a video game, or sleeping.
- Momentary Relief. The boy feels a bit better... in the moment. But the homework is still not done, and the boy continues to feel lousy about himself. "If I just feel motivated, I will be able to do it."
- Misguided Beliefs. With each time that he avoids doing the homework, he starts to think, "I can't even get myself to do something so simple as homework. It must be something to do with me."
- Reduced Global Activity. Over time, he just feels lousy about himself, and reduces his social activity with friends and family, and starts to coop himself up at home. He gets irritable, and relies on his family to help him with daily activities.
- Situation (Again). When it comes time to do his homework again, it becomes much more harder to do it, because he has experienced failure, and has started to have negative beliefs about his ability to complete his homework.
Sound familiar? This example illustrates the depression spiral.
Depression starts with a sustained pattern that starts with us lacking motivation to do the things that we used to enjoy. which results in us being more likely to be less active. We may start with skipping exercise, not engaging in a hobby, or deciding not to go out with friends. The problem with doing so is that reducing activities that are meaningful to us over time usually has the effect of making us feel worse. The more we choose to forego things we enjoy, we have fewer opportunities to experience positive things. Over time, lowered activity levels tend to lead to kids feeling lousier about themselves, which further perpetuates lower activity level.
The Trap of Waiting To Feel Better
Our goal is to reverse the depression spiral by behaving in the opposite manner. If we increase the frequency of valued activities, activity level increases, our mood is also likely to increase, which turns into a positive spiral. However, it is common to experience a great deal of inertia with depression. Children feel unmotivated, and the tendency is to wait to feel better in order to get activated.
The key here is “waiting to feel better”. Typically, it makes perfect sense to consult our mood as a crucial source of information. However, in depression, our mood is not working properly. Because our mood is not working the way it should, our answer is likely going to be a "no", resulting in avoidance. Avoidance makes us feel worse about ourselves, causes us to think bad things about ourselves, further results in us doing even less, and feeling even worse.
Reversing The Spiral: Act First, Feel Later.
Our job is to plan to complete valued and meaningful activities. We know that if we ask our mood, it is likely to say "No". So, we do the activities that we used to love, even if we feel unmotivated. As we engage in those activities, we learn to re-evaluate and dismantle the negative beliefs that we have gradually built up, and learn to focus on functioning better.
One of our best weapons for reversing the spiral is to create an activity schedule. As opposed to letting your mood dictate what you do, we brainstorm and schedule activities that were normal for you to do when you were not struggling with depression. Furthermore, we brainstorm and schedule a list of activities that you used to love to do.
These activities broadly fall in the following four areas:
- Values and Meaning. It is important to understand why you wish to be less depressed. What meaning would being less depressed, and functioning better mean to you?
- Physical Health. Increasing our activity level is crucial to feel better. We work on identifying and scheduling a list of activities to get you moving.
- Social/Spiritual Connectedness. Humans are social creatures, and it is essential to set up activities to spend time with your loved ones.
- Mastery Activities. Understanding your goals and what you wish to work on is essential for giving you a sense of purpose. We make a plan to work on activities that get you towards mastery of an area that you used to work on, or wish to work on.
Once we build our schedule, we get into the habit of asking, "What time is it?", and doing the planned activity instead of asking ourselves, "Am I feeling in the mood to do it?" As part of this process, we also enlist the help of our parents to keep us motivated when we need a bit of support to do so.
Understanding Our Thoughts
As mentioned, our beliefs and thoughts can further make it more difficult to accurately evaluate what is happening. As we complete more valued activities consistently, we are better able to evaluate the validity of our thoughts.
Now, let's start making a plan for valued activities.