Depression & The Mystery Of Motivation

By Jennifer Goforth Gregory

Something changed when Sasha W. noticed the hot pink running shoes sitting in the corner of her bedroom. She was 27 at the time and struggling with the worst depressive valley of her life.

As she lay listless in bed one afternoon, the sight of those shoes reminded her of how much she used to enjoy running. She dragged herself up, tied on her shoes, and headed outside for a walk. The next day, she put on her shoes again. And then the next day, and the next.

“I kept feeling motivated to go a little further each day and run a little faster,” recalls Sasha.

That one initial effort—finding the “oomph” to simply put on her shoes—eventually turned into 10 half-marathons, three marathons, and a half Ironman. And it grew into Still I Run, a Facebook support group Sasha founded to motivate people with depression to exercise regularly.

Although “low motivation” isn’t specified in the criteria used to diagnose depressive episodes, that particular package of lethargy, apathy, and procrastination often comes with the territory.

“Depression impacts your thought process, which then impacts you physically and emotionally,” notes Lisa Ferentz, a clinical social worker and author of Finding Your Ruby Slippers: Transformative Life Lessons From the Therapist’s Couch.

“This can lead to loss of motivation to do daily living tasks, connect with other people socially, and meet responsibilities at work.”

Motivation can be narrowly defined as the desire to do something, but also has a larger meaning of making the effort required to pursue a goal. Depression can trash all of that, thanks to symptoms like fatigue, indecisiveness, and anhedonia (either an inability to feel pleasure in activities you usually enjoy or just not caring).

It may be necessary to treat a depressive episode to remission in order to get anywhere close to “want to” and “able to.” Even day to day, though, low motivation can spread its tentacles in many forms—from having trouble finishing a particular project to slumping on the couch all day.

Alicia R. has bad days when “getting out of bed and functioning at the most basic level feels impossible.”

On those days, the Ottawa resident often misses her train into work. Once there, she’ll stare at her computer, unable to focus, sometimes writing the same sentence over and over. She’ll avoid conversations with co-workers. Back home again, she’ll retreat to bed instead of doing household chores or relaxing with her partner.

To fight back, she gives extra focus to coping skills and strategies she has worked on with her therapist. She also finds that being gentle with herself makes a difference for the better.

“At work, I will prioritize and ask myself, ‘If I can only get one thing done today’—which is likely—‘then what do I really want to finish?’ ” says Alicia.  “Accepting where I am at really makes those rough days easier and more productive.”

 

Examining effort

Researchers who study “motivational deficits” in depression have sketched out some broad patterns.

One involves goal-directed behavior.

Among the findings: people with depression—or even those with no diagnosis but a high number of “negative symptoms”—are prone to set goals that aim at avoiding an undesirable outcome rather than goals targeting a positive result. In addition, they tend to be more pessimistic about their ability to achieve their goals.

Studies have shown that when you care more strongly about avoiding failure than you do about forging ahead to some accomplishment, you are more likely to give up earlier or to do what is known as “self-handicapping,” such as procrastinating or not trying your hardest.

Carol D., a longtime researcher in motivation and achievement, has found that people also will give up more easily if they believe accomplishment is based on some unchangeable quality, such as talent, rather than resulting from hard work and perseverance.

She encourages developing a “growth mindset” based on the idea that as human beings, we continually learn and can improve ourselves—the polar opposite of critical self-talk like “I’m so stupid” or “I’m worthless.”

Another line of inquiry looks at how people weigh effort versus outcome. When offered a choice between expending more effort to get a greater reward or receiving a smaller reward for less effort, both rodents with depressive-like symptoms and human participants with major depressive disorder tend to opt for the easier win.

Some researchers looking at the neuroscience behind motivation in mood disorders have zeroed in on the brain’s dopamine system. Spanish biological psychologist Mercè Correa and John Salamone, PhD, a professor at the University of Connecticut-Storrs, have shown that lab rats with lowered levels of dopamine will settle for a small pile of food which is easy to get, rather than make the effort to jump over a barrier for a bigger pile of food.

“Dopamine plays a key role in the activational aspects of motivation by getting you excited and energized. Dopamine can get you to act, and sometimes act vigorously,” says Salamone.

In recent years, dopamine dysregulation has been implicated in certain depressive symptoms, notably anhedonia and fuzzy thinking. Salmone’s research emphasizes drug interventions that act on restoring dopamine function as a way to increase “effortful activities” during depressions.

 

Building momentum

A psychotherapeutic intervention known as behavioral activation has proven effective in treating depression. In essence, this takes an “outside-in” approach based on jump-starting actions rather than analyzing thoughts or feelings.

It sounds surprisingly simple: Set a goal that is relatively easy to accomplish, plus a meaningful reward for when that task is achieved. Celebrate each small success to reinforce momentum for further goal-directed activities.

The trick is to match immediate goals to your current level of motivation. When taking a shower seems too overwhelming, the target might be simply washing your face. You might have to really push yourself to do even that, or ask someone to help you get into the bathroom and find you a washcloth.

Once you’ve done it, congratulate yourself out loud by saying, “Good job”—even if it sounds stupid or you don’t really believe it.

Making a point of embracing every victory, no matter how small, reinforces the confidence that you can do what you set out to do. In the lingo, this is labeled “self-efficacy.” Joseph Luciani, PhD, a clinical psychologist in New York City, calls it “self-trust.”

“Self-trust is the most motivating thing a person can offer themselves in terms of their own healing, because you now have the attitude of, ‘I have handled a thousand things in my life, and I know I can handle today’s and tomorrow’s problems.’ Self-trust is the ability to believe in yourself,” he explains.

For Sasha, sticking with her running routine whether she feels like it or not gives her a sense of assurance across the board.

“If I can get up to run at 5:30 a.m. … then I feel like I can do other things. I can try a new hobby. Or finish a huge proposal at work. My sense of accomplishment with running gives me the strength and motivation to do many other things I didn’t think I could do,” she says.

On the other hand, retreating from activities or other people can start a downward spiral into deeper depression.

“Low motivation tends to cause people to not interact with their environment. However, if you don’t interact, then you don’t get stimulation, which results in a negative feedback loop and a spiral into inactivity,” explains Salamone.

 

Staying engaged

In order to maintain positive engagement, Ferentz recommends keeping a gratitude journal and volunteering. Both pursuits interrupt the depressive tendency to wrap yourself inside a cocoon where you are focused on yourself and your feelings.

Ferentz says practicing gratitude actually begins to change brain chemistry. In a study published in March 2016, Indiana University researchers reported that individuals with depression and anxiety who were asked to write “gratitude letters” showed stronger activity in gratitude-related brain circuitry three months later than peers who did not write the letter. They also felt more grateful two weeks after the gratitude exercise.

As Ferentz explains it, “Gratitude makes you feel positive emotions, and you then become more motivated to look for more things that you are grateful for and proactively seek out the good things in your life. This moves you out of social isolation, which gets you more connected to the world and other people.”

The emotional and psychological payoff that comes from helping someone less fortunate than yourself has a similar effect, she says.

“When you volunteer, you step outside yourself and notice how good it feels to help another person and make a difference. This motivates you to continue to step outside yourself in other ways in your life.”

Kellen F., 61, uses long walks to get out of his head.

“I don’t think about worrisome things, but what is happening around me,” says Kellen, author of the memoir Tightrope of Depression—My Journey from Darkness, Despair and Death to Light, Love and Life. “I even use my phone to take pictures if I need to distract myself from my thoughts.”

Kellen runs a mediation practice in Edmonton, Alberta. If he’s feeling unmotivated, he tells himself that if he works on a task for 20 minutes, then he will go walk around the block. There have been days when he has taken 10 separate walks just to get through the workday.

 

Finding tools

Working from the inside-out, it’s important to look at how toxic thinking, including perfectionism and guilt, deplete your motivational energy. If you feel like nothing you do will ever be good enough, you may begin to wonder why bother at all.

Kellen came to that point in his romantic life. His mental loop went like this: Everything in this relationship should be perfect. Anything that isn’t perfect is my fault, and I should be smart enough to solve the problem so it’s never an issue again.

“Since that is unrealistic, living in this cycle left me feeling very unmotivated. I soon got to the point of, ‘Who cares? Why even try to have a relationship?’ ” says Kellen.

When low motivation keeps you from getting things done and meeting obligations, it’s not uncommon to feel guilt, shame and self-blame. While it may be common, it’s also counterproductive.

“Unfortunately, hypercritical self-talk creates a vicious cycle that actually knocks us down even further and can exacerbate or prolong a depressive episode,” Ferentz points out.

Accepting that there is an underlying cause for your behavior (or lack of action), whether biochemical or related to stressful life events, helps call an end to the blame game. Furthermore, motivation experts generally agree the nebulous quality known as “willpower” isn’t a reliable tool for many people anyway.

One recommendation: Setting up a schedule for certain activities, as Sasha did for her morning runs. This sidesteps the need to make decisions about what to get done—remember, indecision can intensify during depressive episodes—and eliminates the dangerous question of, “Do I feel like doing this?”

Another common recommendation: Enlisting an “accountability partner.” This might be a close friend, a sibling, or a spouse who knows what your goals are and can encourage you when you’re having difficulties. Or it might be someone who pairs up with you for specific activities, like a friend who picks you up to go to a show when you’re feeling reluctant to socialize.

Sasha found a running buddy who got her through during the final stretch of training for her first marathon. She was at a low point and wanted to only curl up in bed. Running 26.2 miles seemed utterly impossible. Her fellow runner, who is now her fiancé, got her outside and kept her on target during those final weeks.

The key is to map out how to move forward from where you are now, rather than beat yourself up for what you’re not doing.

“There are so many things that are possible for people with depression to do with their life. I really think it comes down to figuring out a way to live your life in a way that works for you,” says Alicia. “You can absolutely accomplish the same things as anyone else. You just might do it slightly differently.”

 

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Pattern recognition

According to clinical psychologist Joseph Luciani, PhD, author of Self Coaching: The Powerful Program to Beat Anxiety and Depression, viewing depressive behaviors as habits can be surprisingly empowering.

Since habits are learned, they can also be unlearned. This perspective puts you in the driver’s seat, giving you a proactive position.

“There is nothing more motivating than to feel you are in control of your own destiny, and nothing more debilitating than to feel you are out of control with your own life,” says Luciani.

At issue here are what’s known as “habit loops,” which consist of a cue, a routine, and a reward. To change your behavior, you have to change at least one element in that cycle.

For example: Every night after dinner (the cue), you have a bowl of ice cream (the routine), which you enjoy for its sweetness (the reward). If you decide you can’t afford the extra calories, you might replace the bowl of ice cream with an after-dinner apple—also something sweet—or maybe go for a short walk instead, focusing on how refreshed that makes you feel.

Depressive habit loops often relate to what’s called “maladaptive coping”—something that makes you feel better in the short-term but doesn’t benefit you in the long run. You’re feeling tired and stressed (the cue), so you log into Netflix and binge-watch (the routine), which is an effective way to numb you from thinking and feeling (a reward of sorts). However, that pattern makes you more isolated and keeps your brain stuck and sedated rather than constructively stimulated.

 

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Printed as “The Mystery Of Motivation”, Summer 2017