I recently met with a young woman, let’s call her Jess, who explained that she was feeling low in mood, irritable and tired all the time.
She explained that it was hard for her to concentrate on her schoolwork. She struggled to fall asleep at night and had lost interest in activities and hobbies that 2 months ago she had enjoyed. Socialising with friends, reading, playing the piano, and skateboarding now felt so effortful, she wasn’t doing any of them. In fact, Jess was struggling to do very little, other than watch Netflix series and movies and spend more and more time in her bedroom.
Many young people like Jess are struggling with low mood. They are not in a crisis requiring specialist, immediate support from an NHS Crisis mental health team. Neither are they requiring an urgent assessment with a psychiatrist or needing to keep themselves safe because of high levels of risk. However, very often they may benefit from mental health support which carefully considers what may have triggered the low mood and what is keeping it going. This understanding, or ‘formulation’ as we call it in Cognitive Behaviour Therapy, informs the treatment plan. In this blog, I would like to share how a psychological intervention called Behavioural Activation, can be an effective first step or stand-alone treatment in helping young people with low mood.
So, how does it work? In their excellent book, Brief Behavioural Activation for Adolescent Depression, Dr Laura Pass and Professor Shirley Reynolds explain how when we focus on making small changes every day and doing more of what matters to us, we can naturally lift our mood. We all tend to have activities which we enjoy which provide a sense of reward. Initially, young people may find it hard to re-engage with these activities. Low motivation and energy, tiredness, feelings of hopelessness and thoughts that the activity won’t make any difference, are all common responses to an invitation to become more active. It’s therefore important to work closely with the young person, agreeing a step-by-step plan which is manageable, achievable and based not just on doing more, but on doing more of what really matters to them. Over time, the aim is for young people to discover for themselves how engaging in meaningful activities can boost their mood. They will then be more likely to repeat these activities as they work towards their goal. This is illustrated by the diagram below.
Noting down daily activities and asking them to record ratings of Achievement, Closeness, Enjoyment and Importance helps to capture the range of rewards young people experience from their activities:
This straightforward intervention helps young people to focus on how they spend their time and supports them in making small but meaningful changes in their behaviour. It’s an effective way to break the vicious cycle of low mood and to help young people to start thinking more positively. Changes in mood won’t happen overnight. It’s an approach which can take a bit of time, but once it starts, it’s very effective. If you’re interested in learning more about Behavioural Activation, here are some resources you may find helpful:
Professor Shirley Reynolds has written two books about depression in teenagers, one for young people and one for parents:
For parents: Teenage Depression: CBT Guide for Parents
For adolescents: Am I Depressed and What Can I Do About It?
She has also been interviewed about helping adolescents do more of what matters in the podcast Let’s talk about CBT
28th June 2021