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Page 1
Module 4: Behavioural Strategies for Managing & Preventing Depression
Keeping Your Balance
• Psychotherapy • Research • Training
C
C
I
entre for
nterventions
Keeping your Balance
Module 4
Behavioural Strategies for
Managing & Preventing
Depression
The Depression Cycle 2
Behavioural Activation Worksheet 4
Pleasurable Activities Catalogue 5
Weekly Activity Schedule 9
Module Summary 10
The information provided in this document is for information purposes only. Please refer to the full
disclaimer and copyright statements available at www.cci.health.gov.au regarding the information on
this website before making use of such information.
Page 2
Module 4: Behavioural Strategies for Managing & Preventing Depression
Keeping Your Balance
• Psychotherapy • Research • Training
C
C
I
entre for
nterventions
The Depression Cycle
The symptoms of depression can bring about some drastic changes in a depressed person’s life, daily
routines, and their behaviour. Often these changes can perpetuate the depression and prevent the
depressed person from getting better.
For example, a lack of motivation or a lack of energy can result in a depressed person cutting back on
their activities, neglecting their daily tasks and responsibilities, or leaving decision-making to others. Have
you noticed these changes in yourself when you are depressed?
When your activity level decreases, you may become even less motivated and more lethargic. When you
stop doing the things you used to love, you miss out on experiencing pleasant feelings and positive
experiences. Your depression could get worse and this becomes a vicious cycle.
Similarly, when one begins neglecting a few tasks and responsibilities at work or at home, the list may
begin to pile up. As such, often when a depressed person thinks about the things they have to do, they
might feel overwhelmed by the accumulation of the things that they have neglected. This might result in
them feeling guilty or thinking that they are ineffective or even, a failure. This will also perpetuate the
depression and the depression cycle.
The Depression Cycle
Depression
Increased guilt,
hopelessness,
ineffectiveness
Low energy, fatigue,
decreased interest
Decreased activity,
neglect of responsibilities
Reversing the Depression Cycle
The first step in reversing depression cycle is to simply increase your activity level, especially in
pleasurable activities and tackling your list of tasks and responsibilities. However, it’s important to
remember to do this in a realistic and achievable way, so that you set yourself up to succeed. Becoming
more active has a number of advantages.
Activity helps you to feel better. At the very least, when you start engaging in some activity, it gives
your mind something else to think about—a different focus. Doing things, even a little at a time, can help
to give you a sense that you are moving forward, taking control of your life again, and achieving
something. You might even find pleasure and enjoyment in the activities you do.
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Module 4: Behavioural Strategies for Managing & Preventing Depression
Keeping Your Balance
• Psychotherapy • Research • Training
C
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nterventions
Activity helps you to feel less tired. Usually, when you are physically tired, you need rest. However,
when you are depressed, the opposite is true. Sleeping more and sitting around doing nothing will only
make you feel more lethargic and tired. Also, doing nothing leaves room for your mind to dwell on
depressive thoughts, which will make you feel even more depressed.
Activity can help you think more clearly. Once you get started, you might find that you
take a different perspective on particular problems in your life. Also, because your mind takes
a different focus as a result of the activity, your thoughts may become clearer.
This strategy of breaking or reversing the depression cycle is considered a behavioural strategy,
and includes scheduling activity into your week, such as tackling small tasks and engaging in
pleasurable activities.
Use the worksheet on the next page to set up a few pleasant or fun activities and one or two simple tasks
for yourself this coming week. Think of it as an experiment, and see if you feel better after you have
engaged in some pleasant activities.
Having a bit of difficulty thinking of fun things to do? Refer to the Pleasurable Activities Catalogue on
pages 5 and 6.
On page 7 is a Weekly Activity Schedule. You can use this worksheet to plan your schedule for a week.
Try including a few tasks you need to tackle or some errands that you need to run and remember to put
in some fun activities.
If you stick to your plan and increase your activity level, a reversed Depression Cycle will look like this:
Reversing the Depression Cycle
Increased Activity
Greater energy &
motivation
Feeling hopeful, more
confident, less guilty
Improved Depression
This behavioural strategy not only is able to lift your depression, but also to prevent its recurrence. Just
remember to keep a good balance between responsibilities and fun activities in your life.
Page 4
Module 4: Behavioural Strategies for Managing & Preventing Depression
Keeping Your Balance
• Psychotherapy • Research • Training
C
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nterventions
Behavioural Activation Worksheet
FUN &
ACHIEVEMENT
One way of combating depression is to prescribe some fun for yourself. By engaging in some simple,
pleasant activities, you can improve your mood and your energy level. However, because you’re feeling
depressed right now, you might not experience the same level of pleasure doing an activity as when you
were not depressed. But don’t stop after one or two activities. Keep going and you’ll find that your
mood will begin to lift. Try it and see!
You may also want to engage in some simple tasks or responsibilities that you have neglected for some
time. Often, accomplishing tasks can improve your motivation and give you a sense of achievement. Start
with tasks that are simple and achievable. BUT remember that it is important to BALANCE both
responsibilities and pleasurable activities. Try not to go overboard on one and leave out the other.
Use the following rating scale to rate your depression, pleasant feelings, and sense of achievement
BEFORE and AFTER the activity.
0 1 2 3 4 5 6 7 8
Absolutely
None
Minimal Slight Mild Moderate Much Higher Very High Extreme
Activity & Date:
Before:
After:
Depression Pleasure Achievement
Activity & Date:
Before:
After:
Activity & Date:
Before:
After:
Activity & Date:
Before:
After:
What did you notice about yourself?
Page 5
Module 4: Behavioural Strategies for Managing & Preventing Depression
Keeping Your Balance
• Psychotherapy • Research • Training
C
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nterventions
Pleasurable Activities Catalogue
The following is a list of activities that might be pleasurable for you. Feel free to add your own
pleasurable activities to the list.
1. Going to a quiz or trivia night
2. Spending time in nature
3. Watching the clouds drift by
4. Debating
5. Painting my nails
6. Going ice skating, roller skating/blading
7. Scheduling a day with nothing to do
8. Giving positive feedback about something (e.g.
writing a letter or email about good service)
9. Feeding the birds
10. Spending an evening with good friends
11. Making jams or preserves
12. Going out to dinner
13. Buying gifts
14. Having a political discussion
15. Repairing things around the house
16. Washing my car
17. Watching TV, videos
18. Sending a loved one a card in the mail
19. Baking something to share with others (e.g.
family, neighbours, friends, work colleagues)
20. Taking a sauna, spa or a steam bath
21. Having a video call with someone who lives far
away
22. Organising my wardrobe
23. Playing musical instruments
24. Going to the ballet or opera
25. Lighting scented candles, oils or incense
26. Spending time alone
27. Exercising
28. Putting up a framed picture or artwork
29. Flirting
30. Entertaining
31. Riding a motorbike
32. Wine tasting
33. Going to the planetarium or observatory
34. Birdwatching
35. Doing something spontaneously
36. Going on a picnic
37. Having a warm drink
38. Massaging hand cream into my hands
39. Fantasising about the future
40. Laughing
41. Flying a plane
42. Playing tennis or badminton
43. Jogging, walking
44. Going to home opens
45. Researching a topic of interest
46. Going to the beach
47. Redecorating
48. Volunteering for a cause I support
49. Smelling a flower
50. Opening the curtains and blinds to let light in
51. Going to the zoo or aquarium
52. Doing jigsaw puzzles
53. Donating old clothes or items to charity
54. Lying in the sun
55. Learning a magic trick
56. Talking on the phone
57. Listening to a podcast or radio show
58. Walking around my city and noticing
architecture of buildings
59. Doing arts and crafts
60. Going on a ghost tour
61. Sketching, painting
62. Mowing the lawn
63. Going horseback riding
64. Doing the dishes
65. Sitting outside and listening to birds sing
66. Going to a free public lecture
67. Travelling to national parks
68. Going to a fair or fete
69. Playing cards
70. Putting moisturising cream on my face / body
71. Volunteering at an animal shelter
72. Re-watching a favourite movie
73. Gardening
74. Going camping
75. Playing volleyball
76. Going bike riding
77. Entering a competition
78. Doing crossword puzzles
79. Patting or cuddling my pet
80. Cooking a special meal
81. Soaking in the bathtub
82. Having a treatment at a day spa (e.g. facial)
83. Putting extra effort in to my appearance
84. Playing golf
85. Doing a favour for someone
86. Building a bird house or feeder
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Module 4: Behavioural Strategies for Managing & Preventing Depression
Keeping Your Balance
• Psychotherapy • Research • Training
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nterventions
87. Clearing my email inbox
88. Planting a terrarium
89. Playing lawn games (e.g. bowls, croquet, bocce)
90. Going to a party
91. Getting out of debt/paying debts
92. Seeing and/or showing photos
93. Going on a city tour
94. Going to an agricultural show
95. Flipping through old photo albums
96. Upcycling or creatively reusing old items
97. Going sailing
98. Stretching muscles
99. Maintaining a musical instrument (e.g.
restringing guitar)
100. Playing soccer
101. Buying clothes
102. Going to the botanic gardens
103. Going to a scenic spot and enjoying the view
104. Going to the speedway
105. Snuggling up with a soft blanket
106. Listening to an audiobook
107. Going to see live stand-up comedy
108. Writing down a list of things I am grateful for
109. Maintaining an aquarium
110. Playing Frisbee
111. Teaching a special skill to someone else (e.g.
knitting, woodworking, painting, language)
112. Playing chess (with a friend or at a local club)
113. Going to a games arcade
114. Jumping on a trampoline
115. Sending a text message to a friend
116. Going fishing
117. Doodling
118. Putting a vase of fresh flowers in my house
119. Participating in a protest I support
120. Going to a movie
121. Surfing, bodyboarding or stand up paddle
boarding
122. Baking home-made bread
123. Walking barefoot on soft grass
124. Watching a movie marathon
125. Skipping/ jumping rope
126. Being physically intimate with someone I want
to be close to
127. Going to karaoke
128. Wearing an outfit that makes me feel good
129. Cooking some meals to freeze for later
130. Hobbies (stamp collecting, model building, etc.)
131. Talking to an older relative and asking them
questions about their life
132. Looking at pictures of beautiful scenery
133. Having family get-togethers
134. Listening to music
135. Learning a new language
136. Taking a free online class
137. Working
138. Washing my hair
139. Singing around the house
140. Going swimming
141. De-cluttering
142. Going rock climbing
143. Whittling
144. Going on a ride at a theme park or fair
145. Arranging flowers
146. Going to the gym
147. Working on my car or bicycle
148. Juggling or learning to juggle
149. Contacting an old school friend
150. Calligraphy
151. Sleeping
152. Driving
153. Going crabbing
154. Playing with my pets
155. Abseiling
156. Going kayaking, canoeing or white-water
rafting
157. Listening to the radio
158. Doing Sudoku
159. Planting vegetables or flowers
160. Walks on the riverfront/foreshore
161. Shooting pool or playing billiards
162. Getting an indoor plant
163. Surfing the internet
164. Doing embroidery, cross stitching
165. Browsing a hardware store
166. Donating blood
167. Buying books
168. Meditating
169. Training my pet to do a new trick
170. Planning a day’s activities
171. Waking up early, and getting ready at a leisurely
pace
172. Going to a Bingo night
173. Playing ping pong / table tennis
174. Buying an ice-cream from an ice-cream truck
175. Going on a hot air balloon ride
176. Sightseeing
177. Organising my work space
178. Dangling my feet off a jetty
179. Writing (e.g. poems, articles, blog, books)
180. Dancing in the dark
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Module 4: Behavioural Strategies for Managing & Preventing Depression
Keeping Your Balance
• Psychotherapy • Research • Training
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nterventions
181. Listening to classical music
182. Photography
183. Watching funny videos on YouTube
184. Doing something religious or spiritual (e.g.
going to church, praying)
185. Seeing a movie at the drive-in or outdoor
cinema
186. Making my bed with fresh sheets
187. Lifting weights
188. Early morning coffee and newspaper
189. Planning a themed party (e.g. costume, murder
mystery)
190. Wearing comfortable clothes
191. Shining my shoes
192. Acting
193. Meeting new people
194. Doing 5 minutes of calm deep breathing
195. Buying new stationary
196. Turning off electronic devices for an hour (e.g.
computer, phone, TV)
197. Buying music (MP3s, CDs, records)
198. Relaxing
199. Going to a footy game (or rugby, soccer,
basketball, etc.)
200. Going skiing
201. Doing woodworking
202. Planning a nice surprise for someone else
203. Playing video games
204. Holding a garage sale
205. Saying “I love you”
206. Making a playlist of upbeat songs
207. Colouring in
208. Playing laser tag or paintball
209. Joining a community choir
210. Doing a nagging task (e.g. making a phone call,
scheduling an appointment, replying to an email)
211. Taking a ferry ride
212. Shaping a bonsai plant
213. Watching planes take off/ land at the airport
214. Planning my career
215. Reading non-fiction
216. Writing a song or composing music
217. Taking my dog to the park
218. Borrowing books from the library
219. Having a barbecue
220. Sewing
221. Dancing
222. Having lunch with a friend
223. Talking to or introducing myself to my
neighbours
224. Holding hands
225. Having an indoor picnic
226. Reading classic literature
227. Going on a date
228. Taking children places
229. Going whale watching
230. Putting on perfume or cologne
231. Digging my toes in the sand
232. Hitting golf balls at a driving range
233. Reading magazines or newspapers
234. Calling a friend
235. Sending a handwritten letter
236. Going snorkelling
237. Going hiking, bush walking
238. Reading fiction
239. Pampering myself at home (e.g. putting on a
face mask)
240. Watching my children play
241. Going to a community or school play
242. Making jewellery
243. Reading poetry
244. Going to the hills
245. Getting/giving a massage
246. Shooting hoops at the local basketball courts
247. Flying kites
248. Savouring a piece of fresh fruit
249. Playing hockey
250. Eating outside during my lunch break
251. Floating on a pool lounge
252. Making a pot of tea
253. Using special items (e.g. fine china, silver
cutlery, jewellery, clothes, souvenir mugs)
254. Doing a DIY project (e.g. making homemade
soap, making a mosaic)
255. Taking care of my plants
256. Telling a joke
257. Going to a public place and people watching
258. Discussing books
259. Going window shopping
260. Watching boxing, wrestling
261. Giving someone a genuine compliment
262. Practising yoga, Pilates
263. Walking around the block
264. Shaving
265. Genuinely listening to others
266. Participating in a clean-up (e.g. picking up litter
at the beach or park)
267. Eating fish and chips at the beach
268. Rearranging the furniture in my house
269. Doing water aerobics
270. Blowing bubbles
271. Buying new furniture
272. Going to a free art exhibition
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Module 4: Behavioural Strategies for Managing & Preventing Depression
Keeping Your Balance
• Psychotherapy • Research • Training
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273. Making a ‘To-Do’ list of tasks
274. Travelling abroad, interstate or within the state
275. Having quiet evenings
276. Geocaching
277. Singing in the shower
278. Browsing at a second hand book shop
279. Test driving an expensive car
280. Refurbishing furniture
281. Exchanging emails, chatting on the internet
282. Knitting/crocheting/quilting
283. Napping in a hammock
284. Skipping stones on the water
285. Doing ballet, jazz/tap dancing
286. Archery
287. Going on a Segway tour
288. Visiting a grandparent
289. Making a gift for someone
290. .Having discussions with friends
291. Trying a new recipe
292. Playing cricket
293. Signing up for a fun run
294. Scrapbooking
295. Accepting an invitation
296. Cooking an international cuisine
297. Solving riddles
298. Scuba diving
299. Watching home videos
300. Building a sand castle
301. Planning a holiday
302. Sitting at the beach or river and watching the
movement of the water
303. Watching fireworks
304. Making home-made pizza
305. Cheering for a sports team
306. Origami
307. Doing something nostalgic (e.g. eating a
childhood treat, listening to music from a
certain time in my life)
308. Joining a club (e.g. film, book, sewing, etc.)
309. Lighting candles
310. Going bowling
311. Going to museums, art galleries
312. Reading comics
313. Having coffee at a cafe
314. Trying new hairstyles
315. Taking a road trip
316. Watching a fireplace or campfire
317. Whistling
318. Playing darts
319. Going to a flea market
320. Working from home
321. Buying a meal from a food truck or hawkers
market and eating outdoors
322. Operating a remote control car / plane
323. Playing board games (e.g. Scrabble, Monopoly)
324. Savouring a piece of chocolate
325. Hunting for a bargain at an op shop, garage sale
or auction
326. Buying, selling stocks and shares
327. Going to plays and concerts
328. Buying fresh food at the market
329. Beachcombing
330. Dining out at a restaurant or café
331. Harvesting home grown produce
332. Exploring with a metal detector
333. Giving someone a hug
334. Taking a holiday
335. Going to the hairdresser or barber
336. Swimming with dolphins
337. Picking flowers
338. Sandboarding
339. Going to the beauty salon
340. Buying myself something nice
341. Playing squash
342. Watching a sunset or sunrise
343. Star gazing
344. Watching a funny TV show or movie
345. Making pottery, or taking a pottery class
346. Playing mini golf
347. Recycling old items
348. Going to a water park
349. Practising karate, judo
350. Boxing a punching bag
351. Cleaning
352. Driving a Go Kart
353. Daydreaming
354. Learning about my family tree
355. Picking berries at a farm
356. Watching kids play sport
357. Setting up a budget
358. Writing a positive comment on a website /blog
359. Getting a manicure or pedicure
360. Collecting things (coins, shells, etc.)
361. Eating something nourishing (e.g. chicken soup)
362. Babysitting for someone
363. Taking a class (e.g. cooking, improvisation,
acting, art)
364. Combing or brushing my hair
365. Writing diary/journal entries
Others:
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Module 4: Behavioural Strategies for Managing & Preventing Depression
Keeping Your Balance
• Psychotherapy • Research • Training
C
C
I
entre for
nterventions
Weekly Activity Schedule
Use the schedule below to plan your activities for the coming week. Make sure you balance
fun and pleasurable activities with your daily responsibilities and duties.
Mon
Tues
Wed
Thur
Fri
Sat
Sun
8 to
9am
9 to 10
10 to
11
11 to
12pm
12 to 1
1 to 2
2 to 3
3 to 4
4 to 5
5 to 6
6 to 7
7 to 8
8 to 10
10 to
12 am
Page 10
Module 4: Behavioural Strategies for Managing & Preventing Depression
Keeping Your Balance
• Psychotherapy • Research • Training
C
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nterventions
Module Summary
•
Often, the symptoms of depression can, in themselves, perpetuate the
depression and prevent the depressed person from feeling better
•
A lack of motivation and energy can result in a person becoming less
•
active, which can cause further problems because the person may feel
even less motivated and more lethargic, resulting in a vicious cycle
•
This vicious cycle can be broken by simply increasing your activity level
•
When you increase your activity levels, this helps you feel better, less
tired, and able to think more clearly
•
Neglecting your daily responsibilities may lead to you feeling guilty and
•
overwhelmed, especially if those responsibilities pile up
•
It is important to schedule pleasurable activities as well as daily
responsibilities into your weekly schedule, and to balance these with
time
for rest
Keep Going ...
In the next module, we will discuss how your thoughts
play a part in the way you feel, and how you can challenge
and change them so that you feel better and more able to
manage your moods.
Page 11
Module 4: Behavioural Strategies for Managing & Preventing Depression
Keeping Your Balance
• Psychotherapy • Research • Training
C
C
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entre for
nterventions
About The Modules
Contributors
Laura Smith (MPsych
1
)
Centre for Clinical Interventions
Dr Louella Lim (DPsych
2
)
Centre for Clinical Interventions
1
Masters of Psychology (Clinical Psychology)
2
Doctor of Psychology (Clinical Psychology)
Background
The concepts and strategies in these modules have been developed from evidence based psychological practice,
primarily Cognitive Behaviour Therapy. CBT for bipolar disorder is based on the approach that adjunctive
psychological treatment is helpful to improve understanding of the illness, medication adherence, awareness of
early warning signs of mood episodes, quality of life and to reduce symptoms.
References
These are some of the professional references that informed the development of modules in this information
package.
Basco, M.R., & Rush, A.J. (2005) Cognitive Behavioral Therapy for Bipolar Disorder (Second Edition). New
York: The Guildford Press
Bauer, M.S. & McBride, L. (2003) Structured Group Psychotherapy for Bipolar Disorder: The Life Goals
Program (Second Edition). New York: Springer Publishing Company
Goodwin, F.K. & Jamison K.R. (1990) Manic Depressive Illness. Oxford; Oxford University Press
Johnson, S.L. & Leahy, R.L. (2004) Psychological Treatment of Bipolar Disorder. New York: The Guildford Press
Lam, D.H., Jones, S.H., Hayward, P., & Bright, J.A. (1999) Cognitive Therapy for Bipolar Disorder: A therapist’s
guide to concepts, methods and practice. Chichester: John Wiley & Sons Ltd
Miklowitz, D.J. (2001) Bipolar disorder. In David H. Barlow (Ed.) Clinical Handbook of Psychological Disorders
– Third Edition (pp 523-561). New York: Guilford Press
Newman, C.F., Leahy, R.L., Beck, A.T., Reilly-Harrington, N.A., & Gyulai, L. (2002) Bipolar Disorder: A cognitive
therapy approach. Washington: American Psychological Association
“KEEPING YOUR BALANCE”
This module forms part of:
Lim, L., & Smith, L. (2003). Keeping your Balance: Coping with Bipolar Disorder. Perth, Western Australia: Centre
for Clinical Interventions.
ISBN: 9780975198520 Created: March 2003
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