Chapter 5. Doing Tools: Increasing Your Pleasant Events

Transcription

1 47 Chapter 5. Doing Tools: Increasing Your Pleasant Events The importance of engaging in pleasant events 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 presented in Chapter 1? It can apply here as well. When mood is lowered, then level of activity also decreases. When level of activity is reduced, then there is even less likelihood to engage in activities that would be pleasurable. This tends to lower 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. 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 48 Monitoring Mood The first step is to learn to monitor mood more carefully, in order to notice subtle mood changes. Many clients will report that their mood is just so-so, without noticing the gradations in between. This example appears on page 63 in the client workbook. 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 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.

3 49 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. Like for most of us, 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 impacted on her mood. If Susan had been in the habit of paying closer attention to her mood variations, she would have seen the relationship between the different events during the day and the changes in her mood she 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.

4 50 DAILY MOOD RATING FORM 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 "soso," 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: morning 9 I woke up refreshed and excited about my garden. lunchtime 3 I never ate lunch due to my nursery mishap and rescuing my daughter. I was hurt that my daughter was unsympathetic to having interrupted my day. dinner 5 I felt a little better after working on the garden, but I am still quite disappointed about all of the time that I lost. bedtime 3 I rarely get time for myself. My personal projects will forever go unfinished. Average for the Day: 5 I constantly take care of others, and I rarely put myself first. 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 recognize that her mood elevated slightly as

5 51 she finally engaged in her gardening. On the next page is a blank daily mood rating form that you can copy for use with your clients. Encourage your client to pay attention to the events that surround these moods and record those events that they believe contributed to their mood score.

6 52 DAILY MOOD RATING FORM Dates: From to 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 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 53 Introducing Pleasant Events into Your Client's Life Some depressed individuals often abandoned pleasant activities due to feeling down or overwhelmed. On the other hand, some people may want to do more pleasant activities, but are unsure about how to start. In either case, it is important for clients to discuss the kinds of activities they like as well as those they would find quite pleasurable if they had the time. In order to obtain this information, ask your clients 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 your client finds all of these activities enjoyable. Encourage clients to use the list to inspire their own personal list of activities to add to their life. For each item, it is important that they consider a.) how often they have engaged in this activity within the past month and b.) how much they enjoyed it. If they haven t done a particular activity, rate how much they would like it if they did get to do it. Also, you can suggest to your clients that as they complete the questionnaire, they can start a list of pleasant events that caught their interest. Remind them not to be concerned about whether these activities are realistic or complicated. At this point, if it interested them, it belongs on the list. For example, when Susan completed this questionnaire, she noticed the following:

8 54 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 Mood and Activities: The Daily Plan (Case Example from Workbook) 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 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:

9 55 ACTIVITIES THAT INTEREST ME Taking a drive in the country Being with friends Doing a job well Helping someone Listening to music Buying flowers Reading for fun Solving a crossword puzzle Baking Having a picnic Going out to lunch Being with someone I love Taking a trip Gardening Watching a sunset Shopping Visiting a museum Having peace and quiet Having spare time Reading the paper 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: Reading for fun Buying flowers Watching a sunset Going out to lunch Baking Being with friends Gardening Listening to music Shopping Visiting a museum

10 56 Step 2: Monitoring your mood and activities By this time, we have introduced some exercises to monitor mood and identify personal pleasant events. These two steps are combined: A. Tracking pleasant events: It is important for clients to not only identify pleasant events that they would like to introduce into their life, but they must make a commitment to actually fitting them into their day. For this purpose, you can provide your clients with a Pleasant Event Tracking Form (found at the end of this chapter). Let s look at an example of the form that Susan completed. Tracking Your Pleasant Events DAYS Pleasant Events Gardening 2. Watching a sunset 3. Going out to lunch 4. Visiting with friends 5. Going to a museum 6. Baking 7. Reading for fun 8. Buying flowers 9. Shopping 10. Listening to music TOTALS B. Monitoring Mood: Daily Rating. 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. Let s take a look at Susan s Daily Mood Rating Form that corresponds to the same days listed on her pleasant events chart.

11 57 DAILY MOOD RATING FORM Dates: From to 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 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: 2/18 5 2/ WHY I THINK I FELT THIS WAY: I did a few pleasant events. My friends canceled lunch. I spent the afternoon with an old friend. I started a new novel. 1. 2/ / I took myself out to lunch and went shopping. I listened to my Ella Fitzgerald CD. My great-grandson grandson was a "holy-terror" and would not take a nap. I had no time to myself. I spent the day alone. 1. 2/22 6 I spent time reading after I cleaned the house. 2.

12 58 2/23 8 2/ My granddaughter had no class and took the baby out for the day. I played with my friends all day. My granddaughter invited friends with small children over to play. I had some time to myself in the evening. 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 DAY1 DAY2 DAY3 DAY4 DAY5 DAY6 DAY7 Pleasant Events Mood 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 certain pleasant activities boost 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 clients to pay attention to the

13 59 number of pleasant activities they do, but also the type of activity in order to enhance mood. The next two pages have blank Tracking Form and Mood Monitoring Forms for you to copy and use with your clients

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