The Upward Spiral: Using Neuroscience to Reverse the Course of Depression, One Small Change at a Time

by Alex Korb

Make it simple. It’s much easier to convince yourself to do simple, easy activities. Try starting with one push-up after you check your email in the morning. If you start feeling better and want to do more, go for it. But if all you ever do is one push-up, that’s better than nothing.

A group of researchers at Northwestern University divided adults with insomnia into two groups.23 One group was instructed to exercise at a moderate intensity four days a week, while the other group did other fun things, like taking cooking classes or going to a museum. After four months, the people in the exercise group fell asleep faster and slept longer than the others. They also had improved mood, more energy, and an overall better quality of life. That’s one of the interesting things about exercise. When you start doing it, you might be more tired, but after a while, you end up with more energy overall to do other fun things.

So there I was working on the couch or sitting in traffic, aching and aging and out of shape. Around that time, my roommate started training for the LA Marathon and tried to convince me to join him. I didn’t think there was any way I could run a marathon, but seeing his energy and eagerness helped me finally recognize the downward spiral I’d gotten into. So I started making some small changes. After eating breakfast, I would go for a short walk. I didn’t plan it; I just walked out the door and meandered around a few blocks, soaking in the sun. And even though I didn’t have to, I started going to the office anyway. That meant walking to the car, from the parking lot to the building, and up some stairs. It also made me less isolated and closer to the track and the yoga studio, increasing the likelihood I would actually work out. Lastly, I made a more concerted effort to play sports, which is not only physical and social but fun too. With each little bit of exercise I did, each time I chose to move a little more, everything became easier. My brain was juicing up on all those good neurochemicals—all that serotonin, dopamine, and norepinephrine began making things happen. The BDNF was silently working away. As a result, not only did I have a bigger appetite, but food tasted better, and I wanted to eat healthier foods. I didn’t worry about things as much, and my sleep improved. I felt like I had more free time and even felt younger. Then exercise became more appealing, and slowl...

That highlights an important part of the upward spiral: once you get things going, it becomes self-sustaining. Yes, you often need to give it a few pushes, but you’ll be surprised sometimes by how your brain just starts to make things easier all on its own. While I hadn’t liked distance running before, I found after a few slow jogs that I enjoyed the simple freedom of stepping out of my door and going. I didn’t need to go to a gym. I didn’t need to coordinate with friends. I could just run.

Make an anti-laziness rule. Decide ahead of time that you’ll take the stairs for anything less than three floors. Decide that you’ll walk to do any errand that is less than a mile away or bike to any that are less than two miles away. Commit to never taking an escalator if the stairs are right next to it. Don’t circle the parking lot looking for a closer space, just take the first one you see.

In mountaineering, if you’re stuck in a bad situation and you don’t know the right way out, you just have to pick a direction and go. It doesn’t have to be the best direction; there may not even be a best direction. You certainly don’t have enough information to know for sure. So if you start down a path and end up at a cliff, you’ll just have to pick another direction from there. Because guess what? In a dire situation, you can’t be certain of the right path; what you do know is that if you sit there and do nothing, you’re screwed. Perhaps that is like the situation you find yourself in. Every decision feels wrong. But that’s just because your limbic system is overwhelming your prefrontal cortex. It is a symptom of depression. In fact, it’s one of the symptoms that makes depression so stable. If you could be decisive, then you would start living your life boldly instead of tentatively. But you can’t.

Make a good decision, not the best decision. When trying to make a decision, we tend to focus on the relative drawbacks of each option, which often makes every decision seem less appealing.1 Nor do we usually have enough information to feel confident in the decision—the world’s just too complex. But remember, it’s better to do something only partly right than do nothing at all. Trying for the best, instead of good enough, brings too much emotional ventromedial prefrontal activity into the decision-making process.2 In contrast, recognizing that good enough is good enough activates more dorsolateral prefrontal areas, which helps you feel more in control.

Figure out what’s important to you. To help reduce irrelevant details in your life, focus on what’s really important to you. Studies have found that focusing on your values reduces the brain’s stress response.5 So think about the times in your life when you were happiest. What were you doing then, and what factors contributed to your happiness? What activities make you feel most fulfilled? What achievements are you most proud of? What good qualities would you want coworkers or friends to use in describing you?

We are often under the impression that we are happy when good things happen to us. But in actuality, we are happiest when we decide to pursue a particular goal and then achieve it. One big problem with depression is that in the short term, nothing feels pleasurable. Because of frontal-limbic miscommunications, you can’t connect future happiness to today’s actions. Thus any action that isn’t immediately pleasurable becomes difficult.

If you decide to buy a cookie, it will be more enjoyable than if someone hands you a cookie. If you decide to pursue a job, it will be more rewarding than if someone offers it to you out of the blue. If you decide to get out of bed, it will be more empowering than waiting until you have to go to the bathroom.

Decide for something you want, not against something you don’t want. Focusing on potential negative outcomes makes decision making more difficult.8 Actively choosing a particular goal you want to pursue—rather than basing your decision on avoiding something you don’t want—forces you to focus on the positive, at least briefly. For example, instead of “I don’t want to do a bad job,” say, “I want to do a great job.” This type of positive thinking is more effective at changing your behavior.9