Deconstructing Depression - Page 3

 She doubted this would work, but agreed to try it. I helped her make a list of discrete tasks that she could accomplish with brief interludes of work—empty the dishwasher, fold laundry, put away food, and throw out junk mail. I suggested that she pick one item from the list and work on it during commercials until that one task was done. Then, she could move on to the next task. When she returned to therapy the next week, she was amazed and feeling quite a bit more hopeful. She'd gotten both the kitchen and family room tidied up in the space of just one week of commercials! By the following week, she'd even got her son to pick up after himself, and for the first time in months, the floors were clear enough to vacuum.

Because summoning up the energy to move forward is so difficult for people with endogenous depression, they need intrinsically satisfying and meaningful goals. I then asked Charlene to list every single activity in the course of a day and then follow up with a forced-choice question about each: "Was that pleasurable or unpleasurable?" I wouldn't accept the answer, "I can't tell because I'm too depressed." I insisted she pick one or the other although I accepted a grumbled, "Okay, pleasurable. But not much!"

Next, I asked her to make a list of only the pleasurable activities and use that list to find natural motivations to enhance them. I asked her about each item, "How can you make the good moments even better?" For instance, if taking a morning shower is pleasurable, can it be even more pleasurable if you make it two minutes longer, or play music in the bathroom, or add some fancy shower gel? This enhancement technique works with almost any activity, like meeting a friend for coffee (make sure to order a specialty coffee you enjoy), taking a short walk (notice the color of the sky or the neighbor's flower garden or remind yourself how many calories you burned), talking to the kids after school (review in your mind your child's smile after the chat is over), and so on.

With these clients, the next step is to put the more-pleasure plan into effect, to do something that increases the pleasure, which is surprisingly easy if the enhancements are small steps to increase enjoyment of what depressed clients are already doing. This extended attention to what feels good is a powerful anti-depressant itself and stirs motivation to have more of that pleasure. When skillfully applied, this incremental approach enables clients to spend more time having pleasurable moments and, more important, paying attention to them, leading to a powerful shift in mood and activity level.

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