Clients with severe depression tend not to engage in a whole lot of activity that gives them a sense of mastery or a sense of pleasure. Mastery is a sense of accomplishment. Pleasure is enjoyment of things. And when we think about those two things as reinforcers for behavior. My way of thinking about it is that mastery and pleasure are kind of like your vitamins.
You need those in order to thrive and survive. And our clients with depression have a vitamin deficiency. I used to play baseball. I don't really see how I could do that right now. Well, yeah, it would be hard for you to join a baseball league or something like that right now, but is there some little semblance of that we could capture something that might be doable with the people you have around? You could see if my nephew wants to play a catch. I just don't have much of a relationship with him.
This might be a way of starting to build that relationship. I mean, 12-year-olds love to go out and play catch and they love sports and they love uncles. Activity scheduling is a major component of a CBT package called behavioral activation. So in activity scheduling, we start by surveying what the client is doing with their day, and sometimes that means hour by hour. What were you doing yesterday? And we figure out where we might plug-in some activities that involve a higher probability of master your pleasure activity.
Scheduling is one of those interventions that so important. I would not attempt to treat depression without it.