Depression and Its Terrible Idea About How To Get Better

Although depression may tell us to wait until we feel like playing, sometimes it's better to pick up your instrument first and let the music catch up with you.

I've been thinking about depression backward.

We usually assume that when people become depressed they stop doing things because they feel bad. That certainly happens. You don't feel like seeing anyone, so you stay home. You don't feel like exercising, so the shoes remain wherever you last kicked them off. Books accumulate beside the bed. The guitar sits in its case. The dog becomes increasingly concerned about your commitment to the walking arrangement. Even things you normally enjoy begin to feel strangely demanding.

It seems perfectly logical. Feel bad first, withdraw second. But what if the arrow eventually points both ways? What if depression makes us withdraw from life, and then the life we have withdrawn from gives depression fewer reasons to leave?

That's the rather simple idea behind Behavioral Activation, one of the most practical approaches we have for depression. BA doesn't deny sadness, grief, exhaustion, biology, trauma, difficult circumstances, or the distorted thinking that often accompanies depression. It simply notices something almost embarrassingly obvious: human beings are affected by what they repeatedly do, just as what they repeatedly do is affected by how they feel.

The paradox is that depression tells us to wait until we feel better before returning to life, while returning to life may be part of how feeling better eventually becomes possible.

The Things We Love Are Often the First Things to Go

Years ago, my oldest daughter and I spent a long period corresponding about poetry. We sent poems back and forth and wrote about whatever they stirred up in us. Then it started to tapper off. At one point she told me that when life became overloaded, even things she loved—poetry, guitar, crafts, getting outside—could begin to feel like chores. When she was exhausted, she didn't necessarily want to do something restorative. She wanted to do nothing.

I understood exactly what she meant. I've had periods when I knew getting outside would probably help and still didn't want to go outside. I've known I'd probably enjoy sitting somewhere with coffee and a book but preferred the chair I was already sitting in.

Music almost always makes me feel better. I've played guitar most of my life, yet there are days when I can't motivate myself to lift my Martin off its stand, much less sit down and fingerpick something I know I'd enjoy. That's one of depression's more convincing tricks: the things that might help can lose their appeal precisely when we need them most.

We naturally assume motivation comes first. When I feel like playing, I'll pick up the guitar. Behavioral activation turns that around. Sometimes I have to pick up the guitar before there is any music in me. Motivation may arrive after my fingers have already found the strings.

One of the things I've always appreciated about David Burns's approach to depression is his suspicion of our predictions. Depression doesn't merely change mood. It changes what we expect from the future. I won't enjoy it. I'll be exhausted. Nobody wants to hear from me. I won't accomplish anything anyway. It won't make any difference. These thoughts don't usually arrive sounding like hypotheses. They sound like weather reports.

Dr. Burns has often encouraged people to become more empirical about them. Instead of arguing endlessly with the thought I won't enjoy going, make a prediction and then test it. How satisfying do you expect the activity to be? How difficult? How much pleasure or accomplishment do you expect? Write the number down. Do the thing, then rate what actually happened.

I like this because it doesn't require positive thinking. You don't have to stand at the front door announcing that the walk will be magnificent and that every squirrel is waiting to participate in your recovery. You can predict a pleasure rating of twelve out of a hundred and go anyway.

Then see what happens.

Maybe twelve was right. That's information. But depressed people sometimes discover that they are surprisingly inaccurate forecasters of their own experience. The anticipation was worse than the activity. The phone call wasn't wonderful, but it wasn't dreadful. The walk didn't produce joy, but something changed after ten minutes. The task wasn't impossible once it had been started.

Depression had issued a prediction and accidentally called it a fact.

The Immediate Relief Problem

There is another side of Behavioral Activation that interests me because it overlaps with what ACT calls experiential avoidance. Some depressive behavior isn't primarily an attempt to become happy. It's an attempt to avoid feeling worse right now.

Don't answer the email because you're already embarrassed that it's late. Don't call your friend because you'll have to explain where you've been. Don't begin the project because confronting how far behind you are will feel terrible. Don't go to the gathering because someone may ask how you're doing, and you don't particularly want to answer honestly or lie convincingly.

Avoidance works beautifully for about fifteen minutes. That's the problem.

The unanswered email no longer has to be faced tonight, so anxiety drops. The gathering is canceled, so social discomfort disappears. The project remains closed, so inadequacy retreats temporarily. The brain notices the relief and learns something: Good. Do that again.

Tomorrow, however, inherits today's relief with interest. Now the email is later. The friend hasn't heard from you. The project is further behind. You feel guilty about accomplishing nothing, and that guilt becomes fresh evidence for the depressive conclusion that you can't accomplish anything.

A strategy that reduced discomfort has quietly increased suffering.

This is why depression can become self-maintaining without anyone choosing it. The person isn't lazy, weak, or secretly committed to being miserable. The nervous system is doing what nervous systems do rather well: learning what makes unpleasant experiences disappear quickly. Unfortunately, nervous systems aren't especially gifted at long-term financial planning.

I Once Walked Six Blocks Looking for a Bird

Years ago I was in Atlanta, surrounded by glass, concrete, traffic, and the general machinery of a city. At some point I realized something was missing. I couldn't hear birds. I remember walking several blocks looking for enough green space to hear birdsong again. Nothing profound happened. No bird descended carrying a psychological message. I had simply become aware that something ordinarily present in my life was absent, and once I noticed its absence, I wanted it back.

I've thought about that memory differently over the years because depression often works by subtraction. Things disappear from our lives gradually enough that we don't notice the accumulating silence.

First you haven't seen a friend lately. Then you haven't picked up the guitar. The garden goes unattended. You stop cooking. Church becomes something you'll return to eventually. The fishing gear hasn't moved. You don't read much anymore because concentration is harder. Sex disappears. Exercise disappears. Eventually showering, answering messages, opening the blinds, or getting the mail can begin requiring negotiations.

No single subtraction explains the depression. Some may be consequences rather than causes. But eventually the world contains fewer places where pleasure, accomplishment, connection, surprise, beauty, usefulness, and meaning can find us.

BA asks a question I like better than simply, How do I make myself feel better? Instead, ask What has quietly disappeared? And perhaps: What is one thing worth looking for again?

Don't Begin by Fixing Your Life

This is where well-meaning advice becomes ridiculous. Someone is barely getting out of bed, and we hand them a new life plan: exercise five days a week, reconnect socially, meditate, improve nutrition, volunteer, organize the house, rediscover hobbies, practice gratitude, and apparently become the person depression prevented them from being by Thursday. No wonder the bed looks reasonable.

Behavioral Activation works better when the unit of change is small enough to actually happen. Not clean the house, but clear one counter. Not get back in shape, but walk to the corner. Not repair my friendships, but answer one text. Not start reading again, but read two pages. Not figure out my future, but take the next concrete step required before lunch.

Dr. Burns has long emphasized breaking overwhelming tasks into smaller pieces because depression speaks fluently in global language: my whole life, everything, nothing, always, never. The behavioral response needs to become stubbornly specific.

I have spent much of my professional life interested in the space between feeling and choice. BA adds an important correction to that idea. Sometimes we can spend so long examining the feeling that the choice has been sitting patiently in the waiting room wondering whether anyone remembers it is there.

You don't have to solve the depression before doing the next thing. You can take depression with you.

But What If the Thing Doesn't Make Me Happy?

This is where I think BA becomes even more interesting when placed beside ACT. Not everything worth doing feels good.

Years ago, after Hurricane Katrina, I spent time in Biloxi working with people who were still living inside a disaster that television had already begun treating as history. One woman had avoided the beach for more than a year because the beach had become associated with everything she had lost. Eventually she wanted to go back, and I walked there with her.

I wouldn't reduce that memory to a therapeutic technique. Something human happened there that is larger than its clinical terminology. But it has stayed with me because returning to the beach did not mean the beach had suddenly become pleasant.

Sometimes movement toward life hurts.

A grieving person may cry at the family dinner and still be glad she went. Calling an estranged son may increase anxiety. Returning to church after someone dies may initially make the absence more obvious. An honest conversation with a spouse can feel considerably worse than another evening of polite avoidance.

So perhaps the BA question can't only be, What would give me pleasure? Pleasure matters, and Burns rightly emphasizes increasing rewarding experiences. Accomplishment matters too. But ACT adds another dimension: What kind of life do I want my behavior to move toward, even while my feelings are coming along reluctantly?

That might mean connection. Curiosity. Responsibility. Beauty. Faith. Service. Play. Courage. Love. It might also mean doing something wonderfully useless because you used to enjoy it.

Depression tends to shrink the territory. Activation begins reclaiming acreage.

Motivation May Have Been Following Us All Along

We put enormous stock in motivation. Once I get motivated, I'll exercise. Once I feel inspired, I'll write. Once I have more energy, I'll see people again. Depression makes these sentences especially convincing because lack of motivation feels like information: I don't want to do it, therefore I'm probably not up to doing it.

But much of ordinary human life already works in the opposite direction. We begin things before wanting to begin them. We go to work. Feed children. Walk dogs. Keep appointments. Apologize before every molecule in the body has reached enthusiastic agreement. More than forty years of marriage has taught me that loving behavior occasionally has to occur before loving feelings have finished getting dressed.

Why should depression be entirely different? Perhaps motivation isn't always the engine. Sometimes it's one of the passengers who climbs aboard after the car is already moving.

That means a depressed person doesn't have to manufacture desire before beginning. The goal isn't to pretend enthusiasm or bully yourself into doing something enormous. It is to loosen the rule that says I must feel like doing this before I can do it. That rule gives depression far too much authority.

Behavioral activation gets very practical here. Instead of asking, What do I feel like doing?, ask a different question: What is one small thing I would probably be doing if depression weren't making the decisions today? Not what would transform my life. Not what would make me happy. Just what belongs in the life I would rather be living.

Then make the beginning almost embarrassingly small. Don't decide to play guitar for an hour; take the Martin off its stand and tune it.

There is another trick here that I think matters: don't grade the activity by how you feel while doing it. If I pick up my guitar and still feel depressed ten minutes later, the experiment hasn't failed. I played the guitar. Something depression had been removing from my life was put back into it for ten minutes. Behavioral activation is less about forcing pleasure than gradually restoring contact with the activities, people, responsibilities and experiences from which depression has been separating us.

Pleasure may come, but sometimes something else arrives first: absorption, accomplishment, connection, usefulness, curiosity, even simple movement. I may notice that the first five minutes with the guitar felt like work and somewhere around the second song I stopped thinking about whether I wanted to play. My fingers remembered something before my mood did.

This is why it helps to pay attention to what happens after an activity rather than trusting depression's prediction beforehand. Before the walk: This won't help. After the walk: perhaps I still feel lousy, but I'm a little less restless. Before coffee with a friend: I don't want to talk to anybody. Afterward: I'm glad I went. Depression is allowed to make predictions. It doesn't have to be accepted as an especially reliable forecaster.

Over time, these small experiments give us data. We begin noticing which activities provide pleasure, which give us a sense of accomplishment, which reconnect us with people, and which simply get our bodies moving again. Then we deliberately put a few of those things back into the week before waiting to want them.

That is the part of behavioral activation I find both irritating and hopeful. We may have been waiting for motivation to come looking for us while motivation was waiting somewhere farther down the road.

Sometimes I have to pick up the guitar before there is any music in me. I tune it anyway, put my fingers on the strings, and play the first few notes.

Behavioral Activation isn't a pleasure button. It is more like reopening roads that haven't been traveled for a while. Some are overgrown. Some lead nowhere now and need to be abandoned. Others return us to people, places, activities, responsibilities, pleasures, and parts of ourselves we had gradually stopped visiting.

We shouldn't demand that every reopened road immediately produce happiness.

Sometimes the first evidence of change is simply that the world has become a little larger.

Maybe Happiness Isn't the Opposite of Depression

The more I think about this, the less convinced I am that happiness is the most useful opposite of depression. Happiness is a feeling, and feelings are notoriously unreliable employees. They arrive late, leave early, and apparently have never read the employee handbook.

Maybe the first opposite of depression is participation.

Participation can happen while sadness remains. Make coffee. Open the blinds. Walk the dog. Answer the message. Sit outside. Read two pages. Fix something. Make something. Pray when prayer feels empty. Meet someone for lunch and admit that you aren't very good company today. Go sit beside a river without requiring the river to cure anything.

And then pay attention.

Maybe nothing happens. Or perhaps halfway through lunch you laugh unexpectedly. The coffee is better than you predicted. You notice weather. Someone is glad you called. A dog walks past carrying a stick approximately twice its own length and seems extremely pleased with the arrangement.

Don't make the dog carry the entire burden of your recovery.

Just notice that for a few seconds something besides depression occupied the room.

I've spent more than thirty years around psychology, and increasingly I think psychology is at its best when it helps people get back to something larger than psychology. Therapy shouldn't become another room we live in forever. Eventually there is a door.

Outside it are people to love, work worth doing, things worth repairing, books not yet opened, grandchildren growing with appalling speed, dogs requiring walks, rivers continuing downstream without consulting us, and perhaps a bird singing six blocks from wherever we've been sitting.

Depression offers what sounds like a compassionate bargain: Stay here until you feel like living again. Behavioral Activation proposes something stranger. Don't wait for life to become inviting. Open the door a little. Put one foot outside. Do something small enough that depression doesn't get a veto.

You may have to go looking for the birds before you can hear them.

And sometimes, somewhere along the walk, you discover they never stopped singing.

© 2026 Thomas Kurtz. All rights reserved.

Published by Thomas Kurtz Counseling, LLC.