0:16 Hey, Carly. How you doing today? Doing
0:20 okay. You're doing okay, I guess. Yeah.
0:23 Yeah. Not sure.
0:26 I don't know. It's just the same. Yeah.
0:30 Still a little down. Yeah. I I've been
0:35 sleeping a lot. Um going to work's a
0:36 struggle. I don't really ever want to
0:39 go. Mhm.
0:42 Um just I haven't been eating
0:45 much. So Mhm. I think I've lost like 10 lbs
0:47 lbs
0:50 since past like four months or so. Past
0:56 Um just the guy. I don't know. I just haven't
0:58 haven't
1:02 really been doing anything.
1:05 You still been working? Well, yeah.
1:09 Yeah, but not much else. No, I usually
1:12 just go to work and go home. Tell me
1:14 what happens after you uh arrive at
1:17 home, like after work.
1:20 Um, well, my fiance tries to talk to me
1:24 and really I just kind of want to go to
1:28 sleep or just I don't know. I tried I
1:30 tried reading the other day cuz I used
1:33 to like that and it's just I think I got
1:35 like into two pages and put the book
1:37 down and decided to go to bed. What were
1:41 you thinking when you put the book down?
1:43 Just that I wasn't really happy doing
1:46 it. I didn't really get any enjoyment
1:54 And before you were depressed,
1:57 uh, which is, I guess, about 8 months
2:00 now, you did enjoy reading. Mhm. Oh,
2:02 yeah. All the time. So, what would you
2:03 have thought if you had to put a book
2:05 down back then? Oh, I used to fall
2:08 asleep reading. I would be up till like
2:11 2:00 in the morning just reading a book.
2:14 Something you look forward to. Yeah.
2:19 Yeah. But not now. No, I I just didn't
2:22 really get any. I just wanted to try it
2:24 and then I put it back down and was like,
2:26 like,
2:28 "Were the other things that you used to
2:30 enjoy doing
2:32 that you don't
2:35 feel motivated or comfortable to do
2:40 now?" Yeah. I used to be a runner. Mhm.
2:44 Um, and then I tried going for a run the
2:46 other morning with my dog
2:49 and I think we walked a block and that
2:50 was pretty much
2:53 it. I just couldn't wait for it to be over.
2:57 All right. So, it wasn't a pleasant
3:00 experience. Was there any part of it you
3:02 connected with when you were running?
3:05 Like when you first started? Not really.
3:06 I mean, it was the change to be
3:08 outdoors. Mhm.
3:10 And I realized I hadn't really seen the
3:13 sun in a while. So,
3:15 but other than that, I
3:18 just I I had the intention of going out
3:20 to run. I had my running shoes on and my
3:23 dog was really excited. Mhm. And then by
3:24 the time I got out there, I was like,
3:26 "Yeah, we're we're going to walk." And
3:28 then I thought about walking like our
3:30 normal route and by the time I got to
3:31 the corner, I was like, "Yeah, we're
3:37 So, what was the feeling like when you
3:40 um returned to your home after planning
3:42 to run and then kind of walking and
3:44 coming back?
3:46 Kind of a mix of like
3:50 relief just cuz it was over and then I
3:54 guess more sadness cuz I didn't do
3:56 anything. I didn't do what I had
3:59 intended to do. Sadness, maybe disappointment.
4:00 disappointment.
4:07 So, I've seen you a few times
4:12 now and based on those conversations and
4:14 of course what you've said today, it
4:18 seems like you have for variety of
4:21 reasons given up on the activities that
4:22 you used to
4:25 enjoy. You're not motivated toward them
4:27 anymore. Yeah, I guess you could say that.
4:29 that.
4:34 M and that's a common symptom of
4:36 depression, right? I think we've we've
4:39 talked about this a little bit before.
4:41 So, it's it's tough when you're
4:42 depressed to
4:47 find joy, satisfaction, happiness, and
4:49 activities that you once
4:52 enjoyed. Right? So, we've been working
4:55 with the the cognitive piece, right?
4:57 like we did last time where we talked
5:00 about the automatic thoughts that come
5:03 up and kind of how that leads to some of
5:05 the feelings of sadness and what we can
5:08 do with the selft talk but I'd like to
5:10 talk about different technique today
5:12 that approaches the problem from a
5:14 different angle and we'll we'll continue
5:16 to work the cognitive angle but I want
5:19 to add a new angle okay right and the
5:22 technique is called behavioral
5:25 activation right
5:28 So the theory behind it is
5:30 that if you
5:33 engage if you schedule and engage in the
5:35 activities that you once enjoyed even if
5:37 you kind of have to fight your way
5:39 through it a little bit right like with
5:43 the running Mhm. that that will connect
5:45 to your mood. Right? Remember we believe
5:47 in cognitive therapy that affect and
5:49 behavior and cognition are all
5:52 connected. Mhm. Right. It's what you're
5:54 thinking affects your behavior and your
5:57 mood and what you do, your behavior
5:59 affects your thinking and your mood.
6:00 Does that kind of make sense based on
6:02 what we talked about? It does. Yeah. Yeah.
6:04 Yeah.
6:07 So, you mentioned the reading was one
6:09 thing you you like to do that's that's
6:12 tough to do now. You try
6:16 unsuccessfully um with the reading and
6:19 the running. anything else you could
6:22 think of that uh maybe we could plan for
6:26 you to do even if it's just a short time
6:28 even if it's a little bit
6:30 uncomfortable that we could plan to do
6:32 that would be an activity that you used
6:34 to enjoy. Um,
6:36 Um,
6:38 well, my fiance and I used to go out
6:42 with two other couples and we used to go
6:45 out once or twice a week and even if
6:49 it's just each other's houses. Um, but
6:52 we haven't really seen them in a
6:55 while. Um, they've tried to schedule
6:58 things, but I've kind of come up with
7:01 reasons of not feeling well or to kind
7:04 of just stay home.
7:05 So, they're trying to
7:08 initiate meeting. Mhm. Going out, doing
7:11 something, and you're you're kind of
7:14 pushing them off. Yeah. I just I haven't
7:17 really wanted to see anybody lately.
7:19 All right. So, that's uh so we have
7:22 reading, running, and then going out
7:25 with these two other couples. Mhm.
7:27 Anything else you can think of that you
7:29 used to really enjoy before that you
7:33 can't can't quite motivate yourself to
7:41 Um, I mean, I used to like going for
7:44 like just walks and shopping with my
7:46 fiance. Like I we used to spend a lot of
7:48 time together and lately it's just kind
7:52 of I come home, I say hello, we eat
7:54 dinner and then I kind of do my own
7:58 thing. So spending time with your fiance
8:00 outside the house in some manner. Yeah.
8:03 Shopping was one example. Mhm. Any any
8:06 other activities?
8:09 um like movies or going out to eat or
8:13 Yeah, I would kind of put those in with
8:15 like the things that we would do outside
8:17 together. Like we would try to switch it
8:20 up every now and then. Okay. So that's
8:21 distinct from what you do with the
8:23 couples cuz that's just you and your
8:25 fiance. Yes.
8:28 So let's do this. Um what kind of books
8:31 do you like to read?
8:35 Um I like a lot of fiction. Mhm.
8:38 Um, I do a lot of reading for school, so
8:41 I usually enjoy those books, too.
8:44 Um, mystery novels. Mystery novels.
8:47 Okay. Uh, let's center on mystery
8:48 novels. How long would it take you to
8:53 read, say, a chapter of a mystery novel,
8:55 roughly? Um, depending on the size of
8:57 chapter, probably a couple minutes
9:00 normally. So, not long at all. No.
9:02 So, you could get a lot of reading done
9:05 in say 10 minutes,
9:08 like something worthwhile. Okay. And how
9:12 often would it how often would you what
9:14 was the duration of a run? Like when you
9:16 would go and run, how long would it take?
9:17 take?
9:20 Um, probably like a half hour. Half
9:22 hour. Half hour to 45 minutes. Yeah. I
9:25 used to do long distance running. So,
9:27 okay. And how often would you do that?
9:29 Uh, three to four times a week. So,
9:31 three or four times a week, half hour,
9:34 40 minutes. And you mentioned you went
9:36 out with the couple once or twice a
9:37 week. How often would you go out with
9:39 your fiance?
9:42 Um, I would say we try to do something
9:43 every day, like even if it was just
9:45 going for a walk together, like around
9:48 the park or walking the dog together.
9:51 Okay. So, I'd like to make
9:54 um collaboratively with you a
9:56 schedule that involves those four
9:59 activities. Okay. But I want to make it
10:01 realistic, right? You tried a couple
10:05 times, you weren't successful. So, we
10:08 don't want to be too ambitious. But I
10:11 want to try to plan a schedule. You can
10:13 get a habit on doing these activities
10:16 again. Okay. Right. So, let's start with
10:18 the kind of I guess the simplest in
10:20 terms of logistics, which would be
10:22 probably the reading. Mhm. Would it be possible
10:28 uh say five nights out of seven to read
10:32 for 10 or 15 minutes?
10:33 Like I know you're going to have to
10:34 force your way through it a little bit,
10:36 but I think it's something I could try
10:38 to do.
10:40 Mhm. So, you're going to have automatic
10:42 thoughts that come up, right? Like just
10:45 like you did before. Mhm. And you're
10:47 going to be tempted to give up. I want
10:49 you try to push through say just at
10:51 least 10 minutes. Okay. Okay. So, focus
10:53 on that as you go into it. It's a
10:54 behavioral exercise. Of course, it has a
10:56 cognitive component. So, kind of think,
10:58 you know, I just have to make this 10 minutes.
10:59 minutes.
11:02 Okay. All right. And again, you might
11:03 not really enjoy it the same way it did
11:05 before. We kind of know that. But over
11:08 time, that may change. Okay. All right.
11:10 So, does five nights a week seem
11:12 reasonable? It's 50 minutes a week.
11:16 Yeah, that seems fine. Okay. Then, um
11:17 let's move to the running because I just
11:19 recently tried that. You run with your
11:22 dog, you said? Yeah. Okay. How about that?
11:23 that?
11:28 Um twice a week. Would that be possible?
11:30 Yeah, I can try to do that. What days of
11:33 the week you think you could do it? Um
11:36 probably the weekends. So, probably like Saturday
11:37 Saturday
11:40 or Friday night or Saturday morning.
11:42 Okay. So, Saturday
11:44 morning and Friday night. Now, would you
11:46 would you run Friday night and then
11:48 again Saturday morning? Um no, I guess
11:50 not. So
11:53 probably I'd say maybe Wednesday night
11:55 and Saturday morning. Okay. So Wednesday
11:58 night and Saturday morning. Okay. Run
12:01 for say a minimum of a half hour.
12:04 I can track for that. Yeah. Now again
12:05 remember you're going to have these
12:07 automatic thoughts likely that will be
12:10 telling you that you should stop and but
12:13 you have to kind of talk your way
12:14 through that. Okay. Or do the best you
12:17 can. Yeah. Right.
12:20 um the the uh adaptive response maybe
12:21 being something like in the end this
12:24 will help me like it's tough now but
12:26 this will help me. Okay, so let's look
12:30 now toward the more social aspects u
12:32 logistically moving up the ladder here
12:34 to the most complex. It sounds like
12:37 going out with a fiance be the next at
12:40 the next level. Yeah, he's I don't know
12:41 if he's kind of just been mad at me
12:43 lately or if he just thinks I need to be
12:46 alone, but we've kind of been getting
12:48 some distance there.
12:50 So, I think that would out of everything
12:52 that would be the relationship I'd want
12:54 to work on the most. Focus on. All
12:56 right. So, maybe you're running
12:58 Wednesdays and Saturday mornings. Could
13:01 you go out and do something to fiance
13:04 twice a week?
13:05 Yeah, I think I think we could manage
13:08 that. Yeah, cuz sometimes you said you
13:09 just walk around the Yeah. Like the
13:11 neighborhood. So, it's not even doesn't
13:13 have to be necessarily like a lot of
13:16 time. It's just something. Mhm. All right.
13:17 right.
13:20 Uh what do you think you can do to
13:31 guess just having
13:34 like him maybe remind me or suggest it.
13:36 So you could you could tell him that
13:38 this is something that you're planning
13:40 to do and you might need a little push
13:45 to Yeah. to do it. Yeah, pretty much.
13:46 All right. Or to maintain it, right? So
13:48 you might get outside and the same thing
13:49 when you run, you might want to come
13:53 right back in. Yeah. All right. And then
13:55 moving to the most complex um but also
13:56 the one with the highest social
13:58 engagement going out with the other two
14:00 couples. Now, once or twice a week,
14:01 you'd mentioned before, how about we shoot
14:02 shoot
14:05 for How about we shoot for now once
14:07 every couple weeks?
14:09 I think I could handle that. Like maybe
14:11 a Saturday night or a Friday night.
14:15 Yeah, I think that could work. Right.
14:16 What can you see being an obstacle
14:17 there? Like what what might help you
14:20 motiv be motivated to continue that?
14:23 Just having to actually like go to their
14:25 houses or go somewhere cuz they don't
14:27 really live close to us.
14:31 They they're not far, but just the fact
14:32 that we would have to get in the car,
14:33 drive over there, and I would actually
14:36 have to like look relatively nice. I
14:39 can't just go in my pajamas. So, for
14:40 this to
14:43 work, that is for you to do it, you
14:45 really have to schedule at their house.
14:48 You can't have them come to you. Yeah.
14:49 All right. So, that's one thing we know.
14:51 You have to you have to make some time
14:54 and drive over there. Mhm. Or maybe if
14:58 your fiance drives, whichever. But you
15:00 have to Yeah, we we physically have to
15:03 go over, right? So once you're there,
15:06 like so it might be tough like to to get
15:08 in the car and make the drive over. Once
15:10 you're there, how do you think you would feel?
15:12 feel?
15:14 I don't know if it's like the run. I
15:16 probably just want to turn around and
15:17 come back.
15:19 I don't know.
15:22 Would these couples know that you're
15:24 been a little down? I think they've
15:27 noticed. And I think that's probably why
15:29 they've kind of started to back off with
15:33 asking us to do things.
15:36 Um, so I think they've noticed it, but
15:39 they don't know like any they don't know
15:45 Um, so are those relationships you're
15:47 worried about losing cuz they're backing off?
15:49 off?
15:52 Yeah. Yeah. Um, I mean they're our
15:54 closest friends, so like we've known
15:57 each other for a really long time. And
15:59 could you see this behavior being one
16:00 that brings you closer together with
16:02 them? Like restores some of that? Yeah,
16:05 I mean I think it would
16:08 definitely just us going. They might be
16:09 a little hesitant cuz the past couple
16:11 times they've invited us, we've backed
16:13 out, but I think it would probably be a
16:14 step in that
16:17 direction of restoring the relationship.
16:20 So, I mean, I would like to do that. Okay.
16:22 Okay.
16:26 So, I want to review the plan. Okay. All
16:29 right. And just make sure that we have
16:31 an agreement because we're we're
16:33 constructing this together, right? So, I
16:36 need your buy in. All right. Reading
16:39 five times a week for a minimum of 10
16:42 minutes, right? Mhm.
16:46 Um, the next level up was the running
16:48 and that was that was Wednesday night
16:52 and Saturday morning. Okay.
16:56 Going out two times with their fiance,
16:59 right? And then once every couple weeks,
17:03 driving to your friends, going to their
17:05 houses and spending an evening with
17:10 them. All that realistic?
17:13 I think so. Yeah, I mean I can try to
17:15 get accountability with my fiance just
17:19 to let him know my plan and then see if
17:21 he can help me follow through with it, I guess.
17:23 guess.
17:24 Good. All right. So, let's set that as
17:26 the plan. Okay. And I want you to be
17:29 aware that as I mentioned, the automatic
17:31 thoughts might come in, right?
17:34 And kind of tempt you in a direction
17:36 away from that. I also want to let you
17:39 know that if you are unsuccessful in any
17:42 one of those things, that doesn't mean
17:46 you have to stop and not try again,
17:48 right? Just take it as a small setback
17:50 and then the next time you know, for
17:53 example, it's time to read or go out
17:55 running, just try
17:59 again. Okay? It's not unusual uh in this
18:02 exercise that you won't be able to
18:04 complete all the behaviors that you've
18:06 planned for yourself. Sometimes life
18:08 gets in the way, things happen.
18:09 Sometimes the depression gets in the
18:12 way. So, can you appreciate that? That
18:14 might be discouraging like if you try it
18:16 and you stop like you told me in the
18:19 beginning. Yeah. Yeah. So just take that
18:24 as a um you know what it is just a small
18:27 setback and try to push forward the next
18:30 time. Okay? And I want you
18:32 to informally kind of keep a record of
18:35 it and when I see you next week we'll
18:39 see how you did and specifically I want
18:40 you to keep track of what you were
18:42 thinking and feeling through different
18:46 stages of the behavior. Okay. Can you
18:49 can you record that? Mhm.
18:52 Okay. So, we'll go from there. That'll
18:55 be your plan and I'll see you in a week.
