Using the 'Outside-In' Method for Tackling Depression

Medical Reviewer

During a depressive episode, activities that used to be fun and fulfilling are commonly pushed to one side. Energy levels are so depleted that it often becomes a massive effort just to undertake essential tasks. Avoiding things that have become difficult seems to help in the short term, as doing less may help to relieve symptoms. After all, slowing down is often a central part of healing.

_In the longer term, though, it’s important to take stock of the issues you may have cut out of your life. Typically these will include hobbies, interests, your friends, and your social life. How do you rebuild or regain the things you’ve lost? _

Behavioral activation

Like many therapists, I recommend something called Behavioral Activation (BA). BA is a simple and easy method used to help rebuild routines and work/life balance. It’s a way of breaking into what has probably become a vicious cycle of low mood or depression and is something that will enable you to gradually get back on your feet. BA breaks the vicious circle by putting your pattern of negative thinking and physical slow-down into reverse. The good news is that you set your goals, you set the pace, and over time you’ll feel your mood lift and the cycle break.

The 'Outside-In' methodHow do we reverse a vicious cycle? Well, the cycle of low moods and depression is pretty well known and most of us have some experience of it. It’s those times when the mere thought of having to go to work, or meet someone, or do something is just so unappealing that we avoid it. In other words, it’s the way we think or feel that determines whether or not something is done. The outside-in method of BA takes away the emphasis of how we feel inside and replaces it with an outside plan.** With this approach you set a target activity in advance and then carry it out regardless of how you feel about it on the elected day.**** Four steps to healintep 1.**

Make a list of (a) routine, (b) necessary, (c) pleasurable things you would previously have done regularly.

Step 2.

Grade the items on the list from most difficult to least difficult, but make sure you have the three types of activities in separate columns.

Step 3.

Get your diary and plan out the easier of the tasks over the next few days. Carry them out using the outside-in method.

Step 4.

Evaluate how it went. Make your next plan, and either increase the difficulty level of activities or continue with lower-difficulty issues until you are ready to move on to more difficult tasks.

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Martell, C.R., Dimidjian, S., Hermann-Dunn, R. (2013), Behavioral Activation For Depression: A Clinician’s Guide. The Guilford Press

Dr. Jerry Kennard is a Chartered Psychologist and Associate Fellow of the British Psychological Society. Jerry's clinical background is in mental health and, most recently, higher education. He is the author of various self-help books and is co-founder of