“It won’t help”: Why your depressed friend seems resistant to helping themselves.

A ten-minute walk? What’s the point?

It’s probably not a stretch to say that most of us now have a pretty good idea of some the activities which make for a healthy dose of self-care. We know that things like physical activity, mindfulness practice, gratitude and good sleep hygiene are good for our mood and mental health. So why is it that these are among the last things I want to do when my mood is low? (Ever feel borderline rage when someone suggests a “nice walk” might do the trick?). When you’re trying to lift a friend or family member out of a low mood, it can sometimes be a frustrating experience; they might seem to reject any suggestion or attempt to help or perhaps even seem to want to wallow.

Why are our brains so resistant to self-care sometimes?

Seemingly ‘simple’ solutions can seem to trivialise our feelings

Regardless of the reason for our low mood, things can often feel heavy, overwhelming, and complicated. Conversely, many effective self-care techniques are fairly simple (“a little, too simple perhaps?” my brain asks suspiciously). Sometimes, when we’re faced with big, heavy emotions, the suggestion of a simple solution can trivialise these emotions.

Particularly when someone else suggests we “get some exercise” or “improve our sleep hygiene”, it can feel downright patronising. It can feel as though the person can’t possibly understand the gravity of what we’re going through if they think something so simple as ten minutes of mindfulness or getting a good night’s sleep will help. Usually you’re trying to say “I really care about you and want to help ease your suffering”, but sometimes they hear “Go for a walk, you’re just moody, it’s not a big deal, you probably just need more sleep”.

The negative feedback-loop

The emotions we experience in a give moment influence the thoughts and memories our brain is most likely to retrieve. When we’re experiencing negative emotions, our brain is most likely to retrieve negative thoughts, beliefs, and memories, and we’re more likely to form negative evaluations of situations, opportunities, and solutions. So the worse we feel, the more likely we are to focus on the negative aspects of a given strategy, and to have negative thoughts like “what’s the point” “I hate exercise” or “that won’t work”. These negative thoughts exacerbate the negative emotions, which reinforce the negative thought processes and create a negative feedback loop.

This means we’re likely to underestimate the likely reward we might obtain from a given activity or self-care strategy. When we imagine going for a walk for instance, we’re likely to focus on the effort involved in getting out the door, or having to be around other people, or feeling uncomfortable in our workout clothes etc, and devalue or completely ignore the potential rewards. We’re also more likely to remember the times we didn’t enjoy exercise, and less likely to remember any positive exercise experiences. This negative feedback cycle can be incredibly difficult to manage.

Perceived or actual effort-to-reward ratio

Whether we’re sad, depressed, anxious, or stressed, when our mood is low things tend to feel more effortful. This is because, just like muscular energy, our brains have a finite amount of cognitive (or mental) and emotional energy. The more demands placing strain on our emotional and cognitive systems, the lower our mental and emotional reserves. Add to this the fact that emotional drain often coincides with fatigue (sometimes physical exhaustion), and suddenly we’ve very little energy left to motivate ourselves toward action. Consequently, the smallest of tasks can feel insurmountable, so things like getting dressed to exercise, rolling out the yoga mat, or opening a mood journal (let alone the effort involved in actually completing the activities) can feel overwhelming.

We’ve just mentioned that we also tend to undervalue the payoff from these activities when we’re experiencing low mood. So we end up with an effort to reward ratio that just doesn’t feel worth the effort; when we think of chatting to a friend, or doing ‘that thing’ the counsellor recommended, the small perceived reward just doesn’t feel worth the effort. It’s just not a successful cost-benefit analysis.

“How can I fix this?” “How can I take the edge of or make things a little more manageable”.

The 10% better approach: overcoming the mental resistance.

During my time as a behavioural therapist and counsellor, and after years of living with Major Depression and Generalised Anxiety, I’ve come to develop a really soft spot for the ‘10% better’ approach to mood management. So how do we utilise this approach?

Move away from all-or-nothing thinking

Firstly, it helps to remember that self-care strategies are tools, not cures. Although in the light of day the following may seem obvious, in the moment it can be easy to lose sight of the fact that we aren’t suggesting any one self-care activity is a cure-all. Going for a walk is not going to cure major depression, and ten minutes of mindfulness is not going to solve your relationship or work problems. One session filling in a behavioural analysis or cognitive-behavioural mood diary is not going to send you skipping off down the road without a care in the world. While this might seem obvious, it’s easy to descend into this kind all-or-nothing-thinking when we’re feeling negative and awful.

Conceptualise strategies as single tools

Just like when we’re fighting a virus, sometimes there is no one, easy cure for a low mood. However, as with a virus, we can still strive to reduce our suffering or make the illness more manageable. We look for small things which might provide a small amount of relief for the sufferer. We might provide a cold cloth or heat pack, create a comfortable bed, ensure they drink plenty of water, or take the edge of with pain killers. Whilst none of these is going to ‘fix’ the illness, they each provide a small amount of relief which cumulatively make it easier to manage.

Similarly, it helps to think about self-care strategies in terms of what might help us to feel 10% better, or what might take the edge off a little. A single meditation or walk or healthy meal might not make us feel hugely different, but the combination of a gratitude practice, a chat with a friend, a walk, a clean apartment, and an enjoyable activity (or the carry-on effect of consistently better sleep hygiene for a week or two for example) might result in a 20 – 50 % improvement in mood.

If you’re trying to help someone else, it might help to use phrases like “I know it probably won’t fix things, but shall we try X to take the edge off?”

Be familiar with the effort to reward ratio of different activities in advance

It can be helpful to ensure we have a good understanding of which activities have the best effort to reward ratios in advance. That is, which healthy self-care strategies provide the highest level of relief for the lowest amount of effort. Everyone is different; different activities require different levels of exertion and provide differing levels of reinforcement and relief for different people. Developing an understanding of your own self-care preferences when you feel OK, makes it easier to mentally access what you need when you’re closer to your cognitive or emotional threshold. It’s also a good idea to discuss these preferences with any trusted friends or family you’re likely to interact with when you feel low. This gives them some guidance and makes it a little easier to effectively assist you when you reach out. It’s also worth noting that these ratios can fluctuate in response to a number of factors; yoga might have worked really well last week, but we might need to try something else today.

Exercise compassion

If you're experiencing low mood, it helps to take a gentle, compassionate approach to self-care. There's no need to place pressure on yourself to fix everything right away, but similarly there's no need to abandon yourself in a pit of the maximum amount of suffering possible! If we take the 'cold cloth' approach, and gently tend to our mood the way we might gently ease the suffering of a sick family member, we accept that it's worth easing suffering a little, even when we can't fix everything. It's also worth creating the space to feel compassion for those trying to help; they don't always understand or get it right, but they're doing their best.

If you're trying to help someone else, it might require a bit of patience and compassion as well. It can be difficult to relate to the mindset of a brain experiencing low mood when you're not experiencing it yourself. It can also be difficult to stay take an empathic approach when you're struggling yourself. In either case, we're looking for gentle compassion, and progress rather than perfection.

Amy Bourke

Counsellor at Shameless Behaviour