Mental Health Pastimes: Behavioral Activation

Mental health is holistic - for this reasons, there are concepts like the biopsychosocial model: biology, psychology and social or interpersonal. Therapy alone can offer significant improvements and change, but at the end of the day, we still have biology that affects psychology, we are interpersonal beings and, a concept I believe to be related to this, meaning or existential concerns.

A cognitive behavioral approach to treating depression is behavioral activation - activities that require movement and consequently affects our biology in ways beneficial to our psychology. It boosts energy, builds structure to our circadian rhythms, maintains motivation, and combats low-esteem.

Activities combat low self-esteem in two ways. People with depression are often self-critical when they struggle to complete tasks personally or societally deemed fundamental like cleaning and hygiene. Conversely, healthy pastimes can build pride and meaning, and support social needs including doing those activities in a social setting or having more meaningful things to talk about. CBT-E, for eating disorders, looks at our life as a pie-chart of meaningful, and identity and esteem building activities. For people with Anorexia, restriction and body image becomes the overwhelming or sole source of identity and esteem - adding new things innately chips away at the influence of anorexic behaviors because other things also provide meaning and identity.

Healthy Pastimes

How do we define a healthy pastime? It can contribute to one or more of the following, and has little detriment to health (for example, being a regular at the bar increases interpersonal interaction, but probably the cost of drinking outweighs the benefit).

Meaningful

Meaning-making varies by individual. From a philosophical standpoint, some argue there is no such thing as meaning - this could be nihilistic or absurdist - that humans are a happenstance and we should simply enjoy what we can in this accidental or circumstantial existence. Others think we are here for a specific reason and must fulfill specific needs related to that for a greater meaning. I personally fall in the middle - maybe humans came to be by chance and likely won't exist for ever, but while we are here, and more specifically in the tiny blip of our lives, we can find meaning in the way we conduct ourselves and connect socially: let's think small and local.

Healthy

Historically, the belief was that physically healthy activities had to be cardiovascular, raising our heart rate with intense or even strenuous activity for a period of 15+ minutes. While I'm not a medical doctor and cannot provide guidance on this, there still seems to be some merit to this belief but, as most health things go, there has been a shift in or alternative to this belief. Intense exercise can help with depression, anxiety and other health conditions for some individuals. However, it can backfire for some who are prone to Post Exertional Malaise. In my understanding, some conditions that can cause this are long-COVID and similar conditions, and sometimes autoimmune-related illnesses such as Chronic Fatigue Syndrome, also known as Myalgic Encephalomyelitis. Recent literature has indicated cardio may not be necessary for health and, in fact, has consequences when practices excessively or chronically, but simply moving your body regularly is enough. These recommendations have included something along the lines of walking for several minutes every hour. Likewise, taking a walk in the morning, evening or lunch-break during work.

Social / Interpersonal

Ideally our pastimes involve interaction. This could be collaborative such as playing squash, or parallel such as jogging together or doing art in a studio. Additionally, these pastimes can help socializing as they provide topics for discussion with family and friends outside of the pastime. Having a friend during the activity also provides motivation and accountability - AKA, the term accountabilibuddy. While some solo-pastimes have benefits of mindfulness or zen and may be preferred by people who are more introverted, these people also need to be cognizant of falling into too isolative a pattern. Others who are highly extroverted may want to practice solo pastimes to build the ability to be alone in addition to social ones. Additionally, some pastimes have social meaning such as performance or art and writing that will be shared.

Intellectually Stimulating

Challenging yourself intellectually in any way. This could be learning something new, reading, creating, doing puzzles or art and much more.

Structure and routine

These pastimes, beyond the benefit of a single occurrence / engagement, sets a structure to our daily and weekly routines. This can benefit circadian rhythms, create something to look forward to, and commitment helps maintenance of the routine.

Getting Started: The Goldilocks Rule

What is the right amount of commitment when getting started? That depends on the person and circumstance. When I worked in the hospital, we often saw two extremes when patients with depression were discharged. One extreme - family sets too-high expectations out of anxiety about immediate relapse. They don't want their loved one to fall into depressive demotivation again. The other - we don't plan a routine before discharge and the person does fall right back into depression. We would often make a routine or schedule for the first week or few weeks, setting priorities and building up to a normal routine.

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Examples

The most common recommendation that I give is joining Pittsburgh Sports League (PSL). There is a whole range of options that varying in intensity and competitiveness. Whether this is ongoing, this used to include darts. Kickball tends to be balanced in terms of physicality and competitiveness versus socializing.

A running, biking, hiking or jogging club. Many are local through neighborhoods. Other neighborhood activities can include but not limited to City Counsel, involvement in parks, and regular neighborhood clean up committees. Some cities may have groups like a bike coop. In Pittsburgh, we have the Freeride Bicycle Collective, where you can join as a member or attend volunteer night. Essentially, it offers both a social group of people who have a similar pastime and maybe like-mindedness, as well as free or affordable access to parts, making the hobby more accessible.

An art studio or performance group such as a comedy club, or acting or improvisation group.

Gardening, a local bonsai society, or local houseplant exchange.

Volunteer work can be immensely meaningful such as a big brother / big sister program, tutoring, providing services at a religious center, wildlife conservancy or at an animal shelter, at a senior living or memory care unit... the list is essentially unlimited.

Please share more ideas in the comments!