Keeping Your Balance

Keeping your Balance

Module 4

Behavioural Strategies for

Managing & Preventing

Depression

The Depression Cycle 2

Behavioural Activation Worksheet 4

Pleasurable Activities Catalogue 5

Weekly Activity Schedule 9

Module Summary 10

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The Depression Cycle
The symptoms of depression can bring about some drastic changes in a depressed person’s life, daily
routines, and their behaviour. Often these changes can perpetuate the depression and prevent the
depressed person from getting better.

For example, a lack of motivation or a lack of energy can result in a depressed person cutting back on
their activities, neglecting their daily tasks and responsibilities, or leaving decision-making to others. Have
you noticed these changes in yourself when you are depressed?

When your activity level decreases, you may become even less motivated and more lethargic. When you
stop doing the things you used to love, you miss out on experiencing pleasant feelings and positive
experiences. Your depression could get worse and this becomes a vicious cycle.

Similarly, when one begins neglecting a few tasks and responsibilities at work or at home, the list may
begin to pile up. As such, often when a depressed person thinks about the things they have to do, they
might feel overwhelmed by the accumulation of the things that they have neglected. This might result in
them feeling guilty or thinking that they are ineffective or even, a failure. This will also perpetuate the
depression and the depression cycle.

The Depression Cycle

Depression

Increased guilt,
hopelessness, Low energy, fatigue,
ineffectiveness decreased interest

Decreased activity,
neglect of responsibilities

Reversing the Depression Cycle

The first step in reversing depression cycle is to simply increase your activity level, especially in
pleasurable activities and tackling your list of tasks and responsibilities. However, it’s important to
remember to do this in a realistic and achievable way, so that you set yourself up to succeed. Becoming
more active has a number of advantages.

Activity helps you to feel better. At the very least, when you start engaging in some activity, it gives
your mind something else to think about—a different focus. Doing things, even a little at a time, can help
to give you a sense that you are moving forward, taking control of your life again, and achieving
something. You might even find pleasure and enjoyment in the activities you do.

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Activity helps you to feel less tired. Usually, when you are physically tired, you need rest. However,
when you are depressed, the opposite is true. Sleeping more and sitting around doing nothing will only
make you feel more lethargic and tired. Also, doing nothing leaves room for your mind to dwell on
depressive thoughts, which will make you feel even more depressed.

Activity can help you think more clearly. Once you get started, you might find that you
take a different perspective on particular problems in your life. Also, because your mind takes
a different focus as a result of the activity, your thoughts may become clearer.

This strategy of breaking or reversing the depression cycle is considered a behavioural strategy,
and includes scheduling activity into your week, such as tackling small tasks and engaging in
pleasurable activities.

Use the worksheet on the next page to set up a few pleasant or fun activities and one or two simple tasks
for yourself this coming week. Think of it as an experiment, and see if you feel better after you have
engaged in some pleasant activities.

Having a bit of difficulty thinking of fun things to do? Refer to the Pleasurable Activities Catalogue on
pages 5 and 6.

On page 7 is a Weekly Activity Schedule. You can use this worksheet to plan your schedule for a week.
Try including a few tasks you need to tackle or some errands that you need to run and remember to put
in some fun activities.

If you stick to your plan and increase your activity level, a reversed Depression Cycle will look like this:

Reversing the Depression Cycle

Increased Activity

Greater energy & Feeling hopeful, more

motivation confident, less guilty

Improved Depression

This behavioural strategy not only is able to lift your depression, but also to prevent its recurrence. Just
remember to keep a good balance between responsibilities and fun activities in your life.

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Behavioural Activation Worksheet
FUN &
ACHIEVEMENT
One way of combating depression is to prescribe some fun for yourself. By engaging in some simple,
pleasant activities, you can improve your mood and your energy level. However, because you’re feeling
depressed right now, you might not experience the same level of pleasure doing an activity as when you
were not depressed. But don’t stop after one or two activities. Keep going and you’ll find that your
mood will begin to lift. Try it and see!

You may also want to engage in some simple tasks or responsibilities that you have neglected for some
time. Often, accomplishing tasks can improve your motivation and give you a sense of achievement. Start
with tasks that are simple and achievable. BUT remember that it is important to BALANCE both
responsibilities and pleasurable activities. Try not to go overboard on one and leave out the other.

Use the following rating scale to rate your depression, pleasant feelings, and sense of achievement
BEFORE and AFTER the activity.

0 1 2 3 4 5 6 7 8
Absolutely Minimal Slight Mild Moderate Much Higher Very High Extreme
None

Depression Pleasure Achievement

Activity & Date:
Before:

After:

Activity & Date:

Before:

After:

Activity & Date:

Before:

After:

Activity & Date:

Before:

After:

What did you notice about yourself?

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Pleasurable Activities Catalogue
The following is a list of activities that might be pleasurable for you. Feel free to add your own
pleasurable activities to the list.
1. Going to a quiz or trivia night 43. Jogging, walking
2. Spending time in nature 44. Going to home opens
3. Watching the clouds drift by 45. Researching a topic of interest
4. Debating 46. Going to the beach
5. Painting my nails 47. Redecorating
6. Going ice skating, roller skating/blading 48. Volunteering for a cause I support
7. Scheduling a day with nothing to do 49. Smelling a flower
8. Giving positive feedback about something (e.g. 50. Opening the curtains and blinds to let light in
writing a letter or email about good service) 51. Going to the zoo or aquarium
9. Feeding the birds 52. Doing jigsaw puzzles
10. Spending an evening with good friends 53. Donating old clothes or items to charity
11. Making jams or preserves 54. Lying in the sun
12. Going out to dinner 55. Learning a magic trick
13. Buying gifts 56. Talking on the phone
14. Having a political discussion 57. Listening to a podcast or radio show
15. Repairing things around the house 58. Walking around my city and noticing
16. Washing my car architecture of buildings
17. Watching TV, videos 59. Doing arts and crafts
18. Sending a loved one a card in the mail 60. Going on a ghost tour
19. Baking something to share with others (e.g. 61. Sketching, painting
family, neighbours, friends, work colleagues) 62. Mowing the lawn
20. Taking a sauna, spa or a steam bath 63. Going horseback riding
21. Having a video call with someone who lives far 64. Doing the dishes
away 65. Sitting outside and listening to birds sing
22. Organising my wardrobe 66. Going to a free public lecture
23. Playing musical instruments 67. Travelling to national parks
24. Going to the ballet or opera 68. Going to a fair or fete
25. Lighting scented candles, oils or incense 69. Playing cards
26. Spending time alone 70. Putting moisturising cream on my face / body
27. Exercising 71. Volunteering at an animal shelter
28. Putting up a framed picture or artwork 72. Re-watching a favourite movie
29. Flirting 73. Gardening
30. Entertaining 74. Going camping
31. Riding a motorbike 75. Playing volleyball
32. Wine tasting 76. Going bike riding
33. Going to the planetarium or observatory 77. Entering a competition
34. Birdwatching 78. Doing crossword puzzles
35. Doing something spontaneously 79. Patting or cuddling my pet
36. Going on a picnic 80. Cooking a special meal
37. Having a warm drink 81. Soaking in the bathtub
38. Massaging hand cream into my hands 82. Having a treatment at a day spa (e.g. facial)
39. Fantasising about the future 83. Putting extra effort in to my appearance
40. Laughing 84. Playing golf
41. Flying a plane 85. Doing a favour for someone
42. Playing tennis or badminton 86. Building a bird house or feeder

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87. Clearing my email inbox 132. Looking at pictures of beautiful scenery
88. Planting a terrarium 133. Having family get-togethers
89. Playing lawn games (e.g. bowls, croquet, bocce) 134. Listening to music
90. Going to a party 135. Learning a new language
91. Getting out of debt/paying debts 136. Taking a free online class
92. Seeing and/or showing photos 137. Working
93. Going on a city tour 138. Washing my hair
94. Going to an agricultural show 139. Singing around the house
95. Flipping through old photo albums 140. Going swimming
96. Upcycling or creatively reusing old items 141. De-cluttering
97. Going sailing 142. Going rock climbing
98. Stretching muscles 143. Whittling
99. Maintaining a musical instrument (e.g. 144. Going on a ride at a theme park or fair
restringing guitar) 145. Arranging flowers
100. Playing soccer 146. Going to the gym
101. Buying clothes 147. Working on my car or bicycle
102. Going to the botanic gardens 148. Juggling or learning to juggle
103. Going to a scenic spot and enjoying the view 149. Contacting an old school friend
104. Going to the speedway 150. Calligraphy
105. Snuggling up with a soft blanket 151. Sleeping
106. Listening to an audiobook 152. Driving
107. Going to see live stand-up comedy 153. Going crabbing
108. Writing down a list of things I am grateful for 154. Playing with my pets
109. Maintaining an aquarium 155. Abseiling
110. Playing Frisbee 156. Going kayaking, canoeing or white-water
111. Teaching a special skill to someone else (e.g. rafting
knitting, woodworking, painting, language) 157. Listening to the radio
112. Playing chess (with a friend or at a local club) 158. Doing Sudoku
113. Going to a games arcade 159. Planting vegetables or flowers
114. Jumping on a trampoline 160. Walks on the riverfront/foreshore
115. Sending a text message to a friend 161. Shooting pool or playing billiards
116. Going fishing 162. Getting an indoor plant
117. Doodling 163. Surfing the internet
118. Putting a vase of fresh flowers in my house 164. Doing embroidery, cross stitching
119. Participating in a protest I support 165. Browsing a hardware store
120. Going to a movie 166. Donating blood
121. Surfing, bodyboarding or stand up paddle 167. Buying books
boarding 168. Meditating
122. Baking home-made bread 169. Training my pet to do a new trick
123. Walking barefoot on soft grass 170. Planning a day’s activities
124. Watching a movie marathon 171. Waking up early, and getting ready at a leisurely
125. Skipping/ jumping rope pace
126. Being physically intimate with someone I want 172. Going to a Bingo night
to be close to 173. Playing ping pong / table tennis
127. Going to karaoke 174. Buying an ice-cream from an ice-cream truck
128. Wearing an outfit that makes me feel good 175. Going on a hot air balloon ride
129. Cooking some meals to freeze for later 176. Sightseeing
130. Hobbies (stamp collecting, model building, etc.) 177. Organising my work space
131. Talking to an older relative and asking them 178. Dangling my feet off a jetty
questions about their life 179. Writing (e.g. poems, articles, blog, books)
180. Dancing in the dark

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181. Listening to classical music 225. Having an indoor picnic
182. Photography 226. Reading classic literature
183. Watching funny videos on YouTube 227. Going on a date
184. Doing something religious or spiritual (e.g. 228. Taking children places
going to church, praying) 229. Going whale watching
185. Seeing a movie at the drive-in or outdoor 230. Putting on perfume or cologne
cinema 231. Digging my toes in the sand
186. Making my bed with fresh sheets 232. Hitting golf balls at a driving range
187. Lifting weights 233. Reading magazines or newspapers
188. Early morning coffee and newspaper 234. Calling a friend
189. Planning a themed party (e.g. costume, murder 235. Sending a handwritten letter
mystery) 236. Going snorkelling
190. Wearing comfortable clothes 237. Going hiking, bush walking
191. Shining my shoes 238. Reading fiction
192. Acting 239. Pampering myself at home (e.g. putting on a
193. Meeting new people face mask)
194. Doing 5 minutes of calm deep breathing 240. Watching my children play
195. Buying new stationary 241. Going to a community or school play
196. Turning off electronic devices for an hour (e.g. 242. Making jewellery
computer, phone, TV) 243. Reading poetry
197. Buying music (MP3s, CDs, records) 244. Going to the hills
198. Relaxing 245. Getting/giving a massage
199. Going to a footy game (or rugby, soccer, 246. Shooting hoops at the local basketball courts
basketball, etc.) 247. Flying kites
200. Going skiing 248. Savouring a piece of fresh fruit
201. Doing woodworking 249. Playing hockey
202. Planning a nice surprise for someone else 250. Eating outside during my lunch break
203. Playing video games 251. Floating on a pool lounge
204. Holding a garage sale 252. Making a pot of tea
205. Saying “I love you” 253. Using special items (e.g. fine china, silver
206. Making a playlist of upbeat songs cutlery, jewellery, clothes, souvenir mugs)
207. Colouring in 254. Doing a DIY project (e.g. making homemade
208. Playing laser tag or paintball soap, making a mosaic)
209. Joining a community choir 255. Taking care of my plants
210. Doing a nagging task (e.g. making a phone call, 256. Telling a joke
scheduling an appointment, replying to an email) 257. Going to a public place and people watching
211. Taking a ferry ride 258. Discussing books
212. Shaping a bonsai plant 259. Going window shopping
213. Watching planes take off/ land at the airport 260. Watching boxing, wrestling
214. Planning my career 261. Giving someone a genuine compliment
215. Reading non-fiction 262. Practising yoga, Pilates
216. Writing a song or composing music 263. Walking around the block
217. Taking my dog to the park 264. Shaving
218. Borrowing books from the library 265. Genuinely listening to others
219. Having a barbecue 266. Participating in a clean-up (e.g. picking up litter
220. Sewing at the beach or park)
221. Dancing 267. Eating fish and chips at the beach
222. Having lunch with a friend 268. Rearranging the furniture in my house
223. Talking to or introducing myself to my 269. Doing water aerobics
neighbours 270. Blowing bubbles
224. Holding hands 271. Buying new furniture
272. Going to a free art exhibition

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273. Making a ‘To-Do’ list of tasks 320. Working from home
274. Travelling abroad, interstate or within the state 321. Buying a meal from a food truck or hawkers
275. Having quiet evenings market and eating outdoors
276. Geocaching 322. Operating a remote control car / plane
277. Singing in the shower 323. Playing board games (e.g. Scrabble, Monopoly)
278. Browsing at a second hand book shop 324. Savouring a piece of chocolate
279. Test driving an expensive car 325. Hunting for a bargain at an op shop, garage sale
280. Refurbishing furniture or auction
281. Exchanging emails, chatting on the internet 326. Buying, selling stocks and shares
282. Knitting/crocheting/quilting 327. Going to plays and concerts
283. Napping in a hammock 328. Buying fresh food at the market
284. Skipping stones on the water 329. Beachcombing
285. Doing ballet, jazz/tap dancing 330. Dining out at a restaurant or café
286. Archery 331. Harvesting home grown produce
287. Going on a Segway tour 332. Exploring with a metal detector
288. Visiting a grandparent 333. Giving someone a hug
289. Making a gift for someone 334. Taking a holiday
290. .Having discussions with friends 335. Going to the hairdresser or barber
291. Trying a new recipe 336. Swimming with dolphins
292. Playing cricket 337. Picking flowers
293. Signing up for a fun run 338. Sandboarding
294. Scrapbooking 339. Going to the beauty salon
295. Accepting an invitation 340. Buying myself something nice
296. Cooking an international cuisine 341. Playing squash
297. Solving riddles 342. Watching a sunset or sunrise
298. Scuba diving 343. Star gazing
299. Watching home videos 344. Watching a funny TV show or movie
300. Building a sand castle 345. Making pottery, or taking a pottery class
301. Planning a holiday 346. Playing mini golf
302. Sitting at the beach or river and watching the 347. Recycling old items
movement of the water 348. Going to a water park
303. Watching fireworks 349. Practising karate, judo
304. Making home-made pizza 350. Boxing a punching bag
305. Cheering for a sports team 351. Cleaning
306. Origami 352. Driving a Go Kart
307. Doing something nostalgic (e.g. eating a 353. Daydreaming
childhood treat, listening to music from a 354. Learning about my family tree
certain time in my life) 355. Picking berries at a farm
308. Joining a club (e.g. film, book, sewing, etc.) 356. Watching kids play sport
309. Lighting candles 357. Setting up a budget
310. Going bowling 358. Writing a positive comment on a website /blog
311. Going to museums, art galleries 359. Getting a manicure or pedicure
312. Reading comics 360. Collecting things (coins, shells, etc.)
313. Having coffee at a cafe 361. Eating something nourishing (e.g. chicken soup)
314. Trying new hairstyles 362. Babysitting for someone
315. Taking a road trip 363. Taking a class (e.g. cooking, improvisation,
316. Watching a fireplace or campfire acting, art)
317. Whistling 364. Combing or brushing my hair
318. Playing darts 365. Writing diary/journal entries
319. Going to a flea market Others:

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Weekly Activity Schedule

Use the schedule below to plan your activities for the coming week. Make sure you balance
fun and pleasurable activities with your daily responsibilities and duties.

Mon Tues Wed Thur Fri Sat Sun

8 to
9am

9 to 10

10 to
11

11 to
12pm

12 to 1

1 to 2

2 to 3

3 to 4

4 to 5

5 to 6

6 to 7

7 to 8

8 to 10

10 to
12 am

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Module Summary
• Often, the symptoms of depression can, in themselves, perpetuate the
depression and prevent the depressed person from feeling better
• A lack of motivation and energy can result in a person becoming less
• active, which can cause further problems because the person may feel
even less motivated and more lethargic, resulting in a vicious cycle
• This vicious cycle can be broken by simply increasing your activity level
• When you increase your activity levels, this helps you feel better, less
tired, and able to think more clearly
• Neglecting your daily responsibilities may lead to you feeling guilty and
• overwhelmed, especially if those responsibilities pile up
• It is important to schedule pleasurable activities as well as daily
responsibilities into your weekly schedule, and to balance these with
time for rest

Keep Going ...

In the next module, we will discuss how your thoughts

play a part in the way you feel, and how you can challenge
and change them so that you feel better and more able to
manage your moods.

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About The Modules

Contributors
Laura Smith (MPsych1) Dr Louella Lim (DPsych2)
Centre for Clinical Interventions Centre for Clinical Interventions

1 2
Masters of Psychology (Clinical Psychology) Doctor of Psychology (Clinical Psychology)

Background
The concepts and strategies in these modules have been developed from evidence based psychological practice,
primarily Cognitive Behaviour Therapy. CBT for bipolar disorder is based on the approach that adjunctive
psychological treatment is helpful to improve understanding of the illness, medication adherence, awareness of
early warning signs of mood episodes, quality of life and to reduce symptoms.

References
These are some of the professional references that informed the development of modules in this information
package.
Basco, M.R., & Rush, A.J. (2005) Cognitive Behavioral Therapy for Bipolar Disorder (Second Edition). New
York: The Guildford Press
Bauer, M.S. & McBride, L. (2003) Structured Group Psychotherapy for Bipolar Disorder: The Life Goals
Program (Second Edition). New York: Springer Publishing Company
Goodwin, F.K. & Jamison K.R. (1990) Manic Depressive Illness. Oxford; Oxford University Press
Johnson, S.L. & Leahy, R.L. (2004) Psychological Treatment of Bipolar Disorder. New York: The Guildford Press
Lam, D.H., Jones, S.H., Hayward, P., & Bright, J.A. (1999) Cognitive Therapy for Bipolar Disorder: A therapist’s
guide to concepts, methods and practice. Chichester: John Wiley & Sons Ltd
Miklowitz, D.J. (2001) Bipolar disorder. In David H. Barlow (Ed.) Clinical Handbook of Psychological Disorders
– Third Edition (pp 523-561). New York: Guilford Press
Newman, C.F., Leahy, R.L., Beck, A.T., Reilly-Harrington, N.A., & Gyulai, L. (2002) Bipolar Disorder: A cognitive
therapy approach. Washington: American Psychological Association

“KEEPING YOUR BALANCE”

This module forms part of:
Lim, L., & Smith, L. (2003). Keeping your Balance: Coping with Bipolar Disorder. Perth, Western Australia: Centre
for Clinical Interventions.

ISBN: 9780975198520 Created: March 2003

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