Chapter 5. Doing Tools: Increasing Your Pleasant Events

Transcription

1 66 Chapter 5. Doing Tools: Increasing Your Pleasant Events The importance of engaging in pleasant events We think most of you would agree that doing things you like typically has a positive effect on your mood. Indeed, one popular theory about the causes of depression stresses the functional relationship between depression and everyday life events. The theory reasons that when we encounter one event or maybe a series of life events that reduces the level of pleasure we experience our mood is lowered. Remember the downward spiral we talked about earlier? It can apply here as well. When our mood is lowered, then our level of activity also goes down. When our level of activity is reduced, then we are even less likely to engage in activities that would be pleasurable. This tends to lower our mood even further, which in turn continues to reduce our activity level, and so on until we are in a vicious tailspin that leads to a prolonged mood disturbance and the development of numerous other symptoms of depression. In our work with depressed older clients over the years, we have observed this circular relationship over and over again. And just as often, we have found that if we can convince depressed clients to increase their level of pleasant activities on a daily basis, then their mood is improved and their symptoms of depression are reduced. Even more importantly, by doing this many clients begin to realize they have a tool, so to speak, to help combat their bouts of depression. At first glance you may think that just as it is with many things in life, increasing pleasurable activities is easier said then done, particularly for someone who is depressed and has lost hope that anything can be better in their life. Nevertheless, we have found that if this problem is approached systematically, depressed individuals frequently can and do develop the skill of increasing their level of pleasant activities in order to offset negative life events and the resulting lowering of mood.

2 67 Monitoring Mood The first step is to learn to monitor our mood more carefully, in order to notice subtle mood changes. Perhaps, when you focus on your mood you think of yourself as being happy or sad or maybe just so-so, without noticing the gradations in between. Noticing the in between can help you pay attention to changes in your mood or what you re doing at those times when your mood gets better or worse. Let s look at an example: Susan is a 67 year old married woman who lives with her husband, and granddaughter and 2 year old great-grandson. Her granddaughter has been living in the home for several months while she is attending graduate school. Her granddaughter s arrival coincided with Susan s partial retirement from her career as a florist. She decided to gradually stop working in order to help take care of the 2 year old boy while her granddaughter is in class. Lately, Susan has become quite depressed about the amount of her household tasks as well as the fact that baby-sitting has slowly cut off her social activities. On one particular day, Susan finds that she has the day to herself when her husband is away on business and her granddaughter is visiting her parents during a school break. On this day, she gets up preparing for a full day out in her garden. She feels refreshed and reasonably happy. As she starts to work she suddenly realizes that she does not have several supplies she needs for the tasks she wishes to complete. Slightly frustrated, she decides to go out and pick up these supplies. During these errands she gets stuck in a long traffic jam resulting from construction on a major thoroughfare. In the

3 68 nursery she feels rushed and annoyed when a young salesperson is rude to her when she asks a question regarding some supplies. As a result, she doesn't get everything that is on her list, which causes her to return to the store; thus spending more time on this unplanned errand. The traffic is once again terrible on the way home. Susan plans to immediately return to her garden upon getting in the house, but finds an upsetting phone message on her machine from her daughter who is stranded by her broken-down car. Susan gets her daughter, takes her home, and is irritated when her daughter does not acknowledge that she has disrupted the day that Susan planned for herself. Susan decides to go directly to the backyard in order to salvage whatever daylight hours remain. Susan works in her garden for 2 hours. During that time, she is able to feel less tense from the interruption in her plans, but she still believes that she had lost all control over that day, and she feels helpless in ever being able to carve out more personal time. Notice that Susan started the day feeling happy, relaxed, and focused on a task for herself. By the end of the day she was feeling sad, overwhelmed and perhaps was getting the impression that she had little control over events in her life. This was one of those days for Susan where nothing seemed to go right, and it s certainly understandable that she might be under the weather. Susan s dilemma was complicated, however, by the fact that she couldn t see how the specific events of the day had affected her mood. If Susan had been in the habit of paying closer attention to her mood, she would have seen the relationship between the different events during the day and the changes in her mood she

4 69 could then plan activities or strategies to enhance her mood or possibly prevent a dramatically lowered mood. Often, when clients become overwhelmed by their mood, and they are unaware that they may be experiencing several different moods during the day, we ask them to rate their mood at several key points during the day. If Susan had rated her mood upon awakening, at lunch time, at dinner time, and then at bedtime she would get a better sense of how her mood fluctuates and what events were related to these moods. In order to expand Susan's knowledge of the relationship between her mood and her behaviors, she completed a chart where she monitored her mood at different points during the day and identified the situations that occurred at the point of these ratings.

5 70 DAILY MOOD RATING FORM 1. Please rate your mood for each day, i.e., how good or bad you felt, using the nine-point scale shown below. If you felt good, put a high number on the chart below. If you felt "so-so," mark a 5. And if you felt low or depressed mark a lower number.! very "so-so" very depressed happy 2. On the two lines next to your mood rating for each day, please briefly give two major reasons why you think you felt that way. Try to be as specific as possible. Time of Day Mood Score Reasons why I felt this way: Average for the Day: Notice the relationship between Susan's mood and the events that she experienced. Here, Susan's low mood was related to planned personal time gone awry as well as a lack of acknowledgment from her daughter that she deserves time alone. In fact, her lowest mood scores occurred when she believed that trying to do what she wanted was a lost cause. Yet, Susan did

6 71 recognize that her mood elevated slightly as she finally engaged in her gardening. On the next page is a daily mood rating form for you to try. Pay attention to the events that surround these moods and record those events that you believe contributed to your mood score. DAILY MOOD RATING FORM Dates: From to 1. Please rate your mood for each day, i.e., how good or bad you felt, using the nine-point scale shown below. If you felt good, put a high number on the chart below. If you felt "so-so," mark a 5. And if you felt low or depressed mark a lower number.! very "so-so" very depressed happy 2. On the two lines next to your mood rating for each day, please briefly give two major reasons why you think you felt that way. Try to be as specific as possible. Time of Day Mood Score Reasons why I felt this way: Early Morning Noon Dinner Bedtime Average Daily Score:

7 72 After you are done, review this chart. Are higher moods associated with more pleasant events? Are lower moods associated with unpleasant events? And, did your mood change throughout the day? You may be beginning to see the relationship between your mood and behavior from breaking down your day into smaller components.

8 73 Introducing Pleasant Events into Your Life There may be many activities you have abandoned because of feeling down or overwhelmed. On the other hand, you may want to do more pleasant activities but are unsure about how to start. In either case, it is important for you and your therapist to learn about the kinds of activities you like as well as those you would find quite pleasurable if you had the time. In order to obtain this information, your therapist will ask you to complete a questionnaire called the Older Person's Pleasant Events Scale. This questionnaire lists 66 activities that many older people find enjoyable. We know that the list is rather long, so it is not important that you find all of these activities enjoyable. Use the list to inspire your own personal list of activities to add to your life. For each item, it is important that you consider each one in terms of a.) how often you have engaged in this activity within the past month and b.) how much you enjoyed it. If you haven t done an activity, rate how much you would like it if you did get to do it. For example, when Susan completed this questionnaire, she noticed the following:

9 74 Sample items from the Older Person's Pleasant Events Scale Please circle one number in each column for each item Column A How often in the past month? 0 = Not al all 1= 1-6 times 2 = 7 or more times Column B How pleasant was it or would have been? 0 = Not pleasant 1 = Somewhat pleasant 2 = Very pleasant Being with friends Seeing beautiful scenery Listening to music Being asked for advice or help Being praised by people who I admire As you can see from these few sample items, Susan has had little opportunity for fun activities or even some pleasant interactions with others. As you complete these items, you will probably notice that there are many activities that you have not done in a very long time. It is important that you indicate how much you would have enjoyed it had you participated in it. Mood and Activities: The Daily Plan Step 1: Your Personal Pleasant Activities Susan s distress over feelings of being trapped at home and her lack of personal time escalated to the point where she decided to see a psychologist who suggested several interventions including a new way to organize her time

10 75 to make room for her personal pleasant activities. She completed the Older Person's Pleasant Events Scale and was able to find a large number of activities that she once enjoyed and even some new ones that she would be interested in pursuing. In addition, some of the items from the questionnaire inspired Susan to think about past pleasant activities that she has enjoyed. A sample of her list is as follows: ACTIVITIES THAT INTEREST ME Susan was able to create a list of 20 pleasant events. After this task, she was asked to consider which of these activities she would like to try to introduce into her day starting right away. Susan selected the following 10 activities:

11 76 Keeping Tracking of Your Personal Pleasant Events The Older Person's Pleasant Events Scale is an exercise to help you become aware of the types of activities that you would like to build into your day. As you complete the questionnaire, make a note of the activities that caught your interest. For now, don't consider whether these activities are realistic or complicated. At this point, if it interests you, it belongs on the list. ACTIVITIES THAT INTEREST ME

12 77 Step 2: Monitoring your mood and activities By this time, we have introduced some exercises to monitor your mood and identify personal pleasant events. Let s combine these two steps: A. Tracking pleasant events: It is important for you not only to identify pleasant events that you would like to introduce into your life, but you must make a commitment to actually fitting them into your day. For this purpose, your therapist will give you a chart to check off the pleasant events you do each day. Let s look at an example of the form that Susan completed. Tracking Your Pleasant Events DAYS Pleasant Events TOTALS

13 78 B. Monitoring Mood: Daily Rating. At this point, when people start increasing their pleasant events, we have found that it is easier to do one rating of their mood at the end of the day instead of at different points throughout the day. However, if you are more comfortable with several rating points, discuss this with your therapist to devise the plan that is most personalized to you. Let s take a look at Susan s Daily Mood Rating Form that corresponds to the same days listed on her pleasant events chart. DAILY MOOD RATING FORM Dates: From to 1. Please rate your mood for each day, i.e., how good or bad you felt, using the nine-point scale shown below. If you felt good, put a high number on the chart below. If you felt "so-so," mark a 5. And if you felt low or depressed mark a lower number.! very "so-so" very depressed happy 2. On the two lines next to your mood rating for each day, please briefly give two major reasons why you think you felt that way. Try to be as specific as possible. DATE: MOOD SCORE: WHY I THINK I FELT THIS WAY:

14 In order to incorporate the previous two exercises, a graph of Susan s Pleasant Events and Mood Rating was done to illustrate the relationship between the pleasant activities and mood days of the week MOOD NUMBER OF ACTIVITIES

15 80 Look carefully at this graph. For the most part, as Susan s pleasant events increased, her mood increased. This suggests that in general, she could expect to feel better on days when she had more time for herself. Take a closer look at day 2 on this graph. Notice that there were only 2 pleasant events performed, but the mood rating is a 6. Sometimes you will find that certain pleasant activities boost your mood more than others. For Susan, visiting with her friends after being isolated for such a long time was so important that for this day, it was largely responsible for increasing her mood from the previous day. Therefore, it is not only important for you to pay attention to the number of pleasant activities you do, but also the type of activity in order to enhance your mood.

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