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Inability to complete daily tasks or chores
By the time a depressed individual seeks therapy, she has often reached a place of depleted functional capability: i.e. she is no longer managing to apply herself to everyday tasks that she once could do with little difficulty. It may be that she is no longer able to function properly in her workplace, or if she is a student, she may find that she is no longer able to concentrate on studying. Perhaps she used to manage the affairs of the house and no longer can muster energy to perform tasks such as cleaning or cooking. Secondly, she may have begun to find that she does not derive pleasure from activities that used to bring her joy and satisfaction.
Unfortunately, this predicament is self-perpetuating. The depressed individual realises that she feels incapable of completing mundane, yet basic and important tasks. The realisation that she is unable to complete such simple tasks leaves convinces her that she is no longer a normal person: she has become ill or defective in some way. This realisation then increases her feelings of inadequacy in incapability and has a major impact in terms of increasing her unhappiness further. This then makes the possibility of completing tasks even more unlikely, and so the cycle of incapabity = low-self-esteem = further incapability… continues. Eventually it not uncommon for depressed individuals to find it impossibly difficult to concentrate, muster up enough mental energy to hold a conversation and to become extremely tired and fatigued.
Inactivity increases feelings of depression
It is typical that when depressed individuals are sitting alone doing nothing, self-defeating thoughts begin to increase. These moments are sometimes the moments at which the emotional weight of depression is at its highest. And it is at these times that the depressed individual may become increasingly convinced that she has such a severe condition that there is no hope for her to ever be happy again. And it is not uncommon that in these moments, the individual feels the least able to muster up energy to do anything.
With the aforementioned in mind, the cognitive therapist sometimes utilises what is known as and activity schedule. This is simply a page with a box representing each hour of each day during the week. Together, the depressed individual decides upon activities/tasks that she will attempt to engage in during the week, and tasks can be placed into the boxes corresponding to each hour of the day. The patient is asked to monitor and record thoughts and feelings she experienced whilst engaging in these tasks. Four principles are followed:-
- Since we do not usually complete everything we plan to do in life, the patient is encouraged not to worry if she does not do everything she writes on her activity schedule.
- Only the activity should be chosen; the quantity of that activity that will be completed should not be stated. Many factors come into play when we attempt to engage in a task. E.g. Perhaps we choose to wash the car and a huge downpour of rain begins just as we were about to attempt the task. Perhaps the task is schedules later in the day but we didn’t sleep well the night before and are particularly tired, and so the task becomes particularly difficult on that day. The aim should be simply to begin the task. It is only after engaging in the task on a number of occasions that we can begin to determine how much of this task we might expect to do in an hour.
- Tying to engage in the task is the important aspect: the depressed individual is encouraged not to worry if she does not manage to do a task: if she fails to do a task after trying, this can provide useful feedback in order to plan attempting the task in future.
- Time should be allocated at the end of each day in order to plan the activities of the next day. These should be placed on the activity schedule for the following day.
The therapist’s aim is initially not that the client necessarily achieves much, but her attempts at completing the activity schedule tasks enable her to begin to assess the individual’s level of functioning and the kinds of thoughts and emotions the depressed person is experiencing when she attempts to engage in these tasks.
Learning to notice that some activities cheer you up
Sometimes when depressed individuals attempt to engage in planned activities, they report experiencing little pleasure. Depressed individuals may not find it easy to think of activities that they will find pleasurable. It is also not uncommon for depressed individuals to have adopted the attitude that they do not deserve to participate in pleasurable activities. In the latter instance the therapist may explain to the individual that engaging in something pleasurable may in fact help to alleviate the improve the individual’s mood and that it may therefore play an important part in the recovery process.
Initially the therapist may ask the depressed individual to attempt to partake in activities for a few minutes each. The therapist may then ask the individual to rate each activity using 2 rating scales: a Mastery (M) and Pleasure (P) scale. Each activity is rated out of 5 using both scales. The Mastery scale represents to what extent the individual feels that she was able to accomplish the task, and the Pleasure scale represents the level of pleasure that she felt she derived from the activity.
It is important that the individual rate her level of mastery with her present condition in mind. It is typical for depressed individuals to attempt to evaluate their performance in comparison to their level of competence prior to the onset of her depression. Doing housework, for example, may have been a routine and simple task prior to depression, however since the onset of depression this task may have become near impossible. The Mastery rating should therefore be in relation to how difficult the individual is currently finding the task, and improvements recorded in light of this condition. In relation to Pleasure, even a mild experience of pleasure may begin to help the individual to feel a little better and increase morale. Importantly, the observation that pleasure is being experienced, even at a limited level, is an opportunity for the client to re-learn what kinds of activity provide pleasure, and to begin to partake in these activities more often.
The individual may also utilise the aforementioned ‘selective abstraction’ tendency in evaluating her level of mastery. She may choose to focus on some small failure regarding the task, for example ‘I only managed to clean the bath and didn’t manage to clean anything else in the bathroom: this task was a complete failure’. The therapist can use such examples of abstraction to draw the client’s attention to the fact that, for example, in the aforementioned example, she did achieve something, and that she is choosing to ignore the positive elements of her achievement and magnifying the failures.