Welcome to Bipolar in Focus, I'm Jane Pauley.
When you're depressed, things that gave you pleasure once don't anymore. But one kind of therapy brings those old favorite things back into your life and it seems to work.
Dr. David Miklowitz, author of the Bipolar Survival Guide is here to explain. What is behavioral activation?
Behavioral Activation treatment is a treatment that's been used with depression, but I think it has a lot of promise as a treatment for the depressed phases of bipolar disorder.
And what it is, is basically a series of guided tasks for the person with depression to gradually get them activated and reengaged with their environment.
The idea is that the person is avoiding the very things that could eventually make them feel better.
Behavioral Activation involves two components. One is trying to understand what the person is currently avoiding, how they are structuring their days,
to what extent are they stimulated by his or her environment. And then, setting little goals that gradually become bigger goals over time to reengage that person with his or her environment.
So, let me give you a scenario. A man who is severely depressed, he has just broken up with his wife. And there are two things that seem to be important to him, his animals and his garden.
Other than that, he wants to stay in bed and if left to his own devices, he will spend all day in bed.
For that person we might set very small goals. Like each day have the alarm set half an hour earlier instead of noon, we aim for 11:30.
And then we aim for 11:15 and then 11:00. And we might have him engage in the early part of the day with something he enjoys like taking his dogs for a walk.
The person gradually starts feeling more engaged with his or her environment. And then you can set the goals a little higher.
How gradual is this?
Well, for some people, it's extremely gradual. You might be working up from 10 minutes a day of activation to 20 minutes the next week to 30 minutes the next week.
It depends upon how serious their depression is and how well they're responding to medications.
What role does avoidance play in depression?
Avoidance can also occur on the emotional level.
You can have people for example who are putting a lot of mental energy into trying to avoid painful thoughts-- thoughts of loss for example, thoughts about the former relationship.
And it's partly that very avoidance that's fueling the depression.
And part of behavioral activation really is an emotional and cognitive process of bringing some of those thoughts to light. So the person can eventually gain mastery over them.
A little bit of structure can make a difference?
I think a little bit of structure can make a huge difference. When the person is seriously depressed, they're often spending their whole day in bed with no structure.
Adding even something as simple as walking the dog and gardening in the afternoon introduces a certain amount of structure.
And you start to see gradual improvement in mood and that same gradual improvement in mood makes the person drawn to want to do more of those same things that introduces more structure.
How can scheduling little doses of formerly pleasurable activities change a mood?
Because there is reward involved when a person interacts with their environment,
often that environment rewards them in little ways and reward is going to have a positive impact on mood as a structure.
You know that mood is very heavily determined by having a predictable structure particularly if you have bipolar disorder.
Dr. Mikowitz, thank you for being with us. And thank you for watching Bipolar in Focus.