If a disaster-impacted individual is reporting lowered or depressed mood likely as a result of a drop in physical and social activity.
If a disaster impacted individual is not ready to try more advanced or demanding psychological interventions in order to improve mood.
If an individual’s score on the depression subscale of the DASS-21 is 5 or above (using the 0-1-2-3 rating for questions).
When clinical depression is suspected, referral to a general practitioner or specialist mental health practitioner is recommended. Suicide risk assessments should also be considered.
Provide psychoeducation about the nature of depression, and the relationship between activity and mood.
Increasing pleasant events: encourage the individual to monitor mood and engage in a predefined number of pleasant activities each day. Aim to achieve a balance between activities that have the potential to result in a sense of mastery or achievement and those that have the potential to be enjoyable. Gradually aim to increase the number of activities engaged in.
Encourage completion of Behavioural activation monitoring form. This monitoring form charts daily mood and engagement with activities associated with both pleasure and mastery e.g., a sense of competence. Completed along with the Pleasant events schedule, it allows for nomination of a range of activities that may help lift mood. Encouraging monitoring throughout the intervention period to gauge the success or otherwise of the strategy. Adjust interventions or consider referral if improvement does not occur. If mood deteriorates refer to a general practitioner or specialist mental health practitioner.
2. Identify and plan two or more activities
Ask the disaster impacted individual to generate a list of activities they currently engage in, to get a sense of how much ‘fun’ and/or satisfaction they are gaining at present. Probe for activities that the individual has not engaged in since the disaster for whatever reason e.g., they were depressed or traumatised, too busy or local venues have been destroyed etc. Also explore those activities they have not tried but might like to.
It may also be helpful to use the Activity Menu below (inset link) to aid the identification of possible activities, particularly if the individual struggles to come up with any they used to enjoy or could try. If they still find it difficult to come up with activities, consider using the Pleasant Events Schedule (insert link), which provides a much more detailed list of possible activities.
Allow some time for the individual to review the activities generated through this process. Highlight the difference between categories of activities that are pleasure based and those that are responsibility/task based. The distinction is made with the aim of ensuring a balance between the two, to encourage participation in activities that, if completed, might produce feelings of pleasure as well as mastery. In considering this balance, it can be helpful to plan for activities that
Your role in helping the disaster impacted individual select activities is to encourage a choice of activities that the individual might enjoy (pleasurable), might actually be able to do (achievable) and will be relatively easy to set up (practical). It may be necessary to be creative and flexible, and to problem-solve around possible barriers like transportation, money, or safety concerns. It may also be useful to include activities that provide a breather from everyday stressors, as well as activities that foster family time if possible, noting that the concept of family can also extend beyond blood ties – for example, to ‘community’.
Further, be mindful of potential safety issues surrounding activities. Individuals may be aware of the pre-existing risks in their environment, but their surroundings may have changed greatly since the disaster. For example, after a bushfire it would be wise to exercise caution when walking in bush land where damaged trees might fall over after being burnt.
Once activities are identified and discussed, work towards helping the individual select five activities and operationalising at least two of these in a plan for the week. These are written down in the Activity Monitoring Sheet (link). Encourage commitment to the two activities. Explain that scheduling the activities into the monitoring form can help “unstick” and motivate behaviour. Encourage awareness of mood before and after the activity, and ascribe SUDS ratings. This will allow the individual to observe the benefits or otherwise of having performed the activity. It also allows for barriers or issues to be explored if they do not experience any change in mood or increase in pleasure while completing the activity, with an eventual view to selecting different activities.
Also be aware that making time and creating space for activities can be quite challenging. When determining a time and place for activities, be sensitive to the impact of disaster-related reminders. Some activities may involve locations linked to the disaster or may bring up memories of a person who used to do the activities with the individual.
3. Follow up the activity scheduling
Follow up the activity scheduling exercise with the individual in the following session. You need to determine whether the activity was attempted, and if so, what happened and what was the impact on mood. The discussions should include:
Monitor the effectiveness of the intervention by tracking changes in mood relative to activities initiated. Increase engagement in satisfaction/mastery and pleasurable activities gradually. Continue monitoring, reassess as necessary and consider other interventions or referral to mental health specialists if increase in activity does not result in improvements in mood, or if mood deteriorates.
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