When your mood is low, start with something small

In short

The loop: When you feel low, you do less, and doing less can keep you low.
The evidence: In a large study, it worked about as well as CBT a year later.
Where to start: Pick one small activity, plan it, and see how it goes.

When you feel low, it is common to start doing less. You might see people less often, move less, stop doing things you used to enjoy, or find it hard even to get dressed. Doing less can then make you feel worse, and feeling worse makes it harder to do things. Over time, this can turn into a loop.

Behavioural activation is a structured way of stepping out of that loop. It is one of the psychological treatments also used in therapy, and its core idea is simple enough to try in a gentle form yourself.

What the research says

In the COBRA trial, 440 adults with depression in England were randomly assigned to either behavioural activation or CBT. After 12 months, depression scores were about the same in both groups, so behavioural activation worked no less well than CBT.

What stood out was who delivered it. Behavioural activation was given by junior mental health workers with less intensive training, while CBT was given by trained psychological therapists. The trial did not include people who were acutely suicidal, so it says less about severe crises.

Four steps to try

Notice what you do
For a few days, write down what you do each day and rate your mood from 0 to 10 next to it. Patterns often show up in what lifts the mood and what lowers it.
Choose one small activity
Pick something small enough to do even on a bad day. Think of three kinds: things you enjoy, things that keep life running, such as washing up or a short walk to the shop, and things that matter to you, such as calling a friend.
Plan it
Decide the day, the time and the place. Act from the plan, not from the mood. Waiting until you feel like it is what keeps the loop going.
Look back and adjust
Rate your mood again afterwards. It does not have to improve every time. If the step was too big, make it smaller. If it went well, add one more.

You do not have to feel better first.

The idea is that action comes first, and the mood can follow.

Source

Richards DA, Ekers D, McMillan D, et al. Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a randomised, controlled, non-inferiority trial. Lancet 2016;388:871-880. doi:10.1016/S0140-6736(16)31140-0.