What is it?

This technique is mainly used to assist patients with depression. Activity scheduling is a useful strategy to teach patients who have both lost interest in doing things they enjoy and who find it difficult to do basic daily tasks.
 
It is particularly important to increase pleasurable activities when people feel depressed, as they feel less inclined to engage in activities that are a source of pleasure and satisfaction.

Similarly, when people are not involving themselves in activities they consider pleasant, this can make them feel depressed. This creates a vicious cycle and in order to break this pattern of inactivity patients need to learn how to keep active when they feel down.

Activity scheduling is a behavioural technique designed to mobilise the patient and to increase the range and frequency of pleasant activities engaged in. The overall aim is to teach patients how to increase their activities in a structured and organised manner, thereby increasing mood.

Activity is the key, and mastery of tasks, pleasant activities, or exercise should be reinforced.

Does it work?

Activity scheduling is an effective behavioural treatment for depression (see Lewinsohn & Gotlib, 1995).

How do you do it?

1. If a patient is not engaging in their usual activities, both routine (e.g., household duties) and pleasant (e.g., going to the movies), then it will be important to explain to the patient why they need to continue doing these activities.

For example, 'you've told me that you no longer have the energy or motivation to do what you need to do and you have stopped doing things you enjoy. People often don't feel motivated when they are feeling down and sometimes stop doing the things they need to do and also stop doing the things they enjoy. It is important that you don't stop doing these things as the less you do the worse you will feel, and the worse you feel the less you will do.'

2. Ask the patient to tell you what things they are doing now and write these down. Then, ask the patient to rate their sense of achievement and how much pleasure they derive from performing these activities (on a scale from 0 to 6, where 0 = no pleasure or sense of achievement, 6 = high pleasure and sense of achievement).

3. The next step is to ask the patient to list all the things they should be doing but are not doing at the moment (e.g., grocery shopping). Then ask the patient to list at least ten things they would like to be doing and used to enjoy (e.g., meeting a friend for coffee, for further suggestions refer to 'Pleasant things to do', Management of Mental Disorders (2000), page 225).

4. If possible, activities should be arranged hierarchically - easiest to hardest - and each week, beginning with the easiest items, one to two activities will be chosen. Where necessary, complex activities (e.g., starting a course) should be broken down into smaller steps.

5. Discuss with the patient that it is important to try and achieve a balance between pleasurable activities and activities that are not pleasant but must be done.

6. With the patient, show them how to plan their activities in a structured manner. You can do this by going through their day hour by hour for the coming week or use the handout in Management of Mental Disorders (2000), on page 223-224.

7. Make sure you start off slowly and only schedule 1-2 pleasant activities in the first week. Do not try and fill every hour of the day. Even if the patient only does one pleasant activity during the week, this is better than doing none at all and will help give the patient a sense of mastery. You can increase the number and range of activities in the coming weeks. Don't forget to remind the patient to rate their sense of pleasure (P) and achievement (A) after completing the activity.

8. Ask the patient to record any other activities that occur and were not pre-planned. Ask them to rate their (P) and (A) for these too.

9. Remind the patient to bring their activity schedule to their next appointment. Review what went well and what did not go so well. Provide encouragement and try to build on what was achieved the previous week.

10. Encourage the patient to continue planning their activities until they resume their normal routine.

Sample Activity Schedule [see source page.]

Tips:

encourage patient to set aside time to plan their day (e.g., the night before)
suggest that the patient start the day with activity that will provide both pleasure and achievement

explain how exercise has been shown to help alleviate depressed mood (e.g., Lane & Lovejoy, 2001) and try to encourage the patient to make time in their day for this activity

encourage the patient to be flexible - reschedule activities as needed and add other activities as they occur.

aim for quality not quantity (e.g., 15 minutes of walking is better than aiming for a 1 hour run).

References and recommended reading:

1. Lewinsohn, P. M. & Gotlib, I. H. (1995). Behavioral theory and treatment of depression. In E. E. Becker & W. R. Leber (Eds.), Handbook of depression (pp. 352-375). New York: Guilford Press.

2. Lewinsohn, P. M., Munoz, R. F., Youngren, M., & Zeiss, A. M. (1978). Control Your Depression. New York: Prentice Hall Press.

3. Lane, A. M. & Lovejoy, D. J. (2001). The effects of exercise on mood changes: the moderating effect of depressed mood. Journal of Sports Medicine & Physical Fitness. 41(4):539-45.

4. Tanner, S. & Ball, J. (2000). Beating the Blues. A Self-Help Approach to Overcoming Depression. Southwood Press.

5. Treatment Protocol Project (2000). Management of Mental Disorders (Third Edition). Sydney: World Health Organization Collaborating Centre for Mental Health and Substance Abuse.

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Source: Evidence-based Focussed Psychological Interventions
http://www.crufad.com/phc/fps.htm