SMART HEALTH

Get Up, Get Out, Get Active!

Improve your physical and mental health through behavioral activation.

We’ve all been there. You told yourself all day that you were going for a walk in the park or a workout at the gym. But then you come up with every excuse in the book as to why you should stay home. Somehow, you finally convince yourself to get off the couch and go out to exercise. After just 15 minutes of activity you feel better, and by the time you’re done, you feel pretty damn good.

As it turns out, this isn’t just about endorphins. The phenomenon at work here, called behavioral activation, can greatly improve both physical and mental health, and is a key strategy in reducing depression and anxiety, as well as improving overall mental health and wellness.

What Is Behavioral Activation?

First introduced by neuroscientists in the 1960s, the concept of behavioral activation originally referred to a method for conceptualizing how antidepressant medications worked. For example, antidepressants were thought to alleviate depression by lifting your mood and improving sleep, but also by increasing your motivation to participate in activities. Behavioral activation in the brain was thought to be a core component of the pharmacological treatment of depression.

In the 1990s, behavioral activation was more narrowly defined to focus on its role in cognitive-behavioral therapy (CBT), which is used to treat a variety of mental-health conditions, including depression. Not only does CBT focus on changing patterns of thinking, but it also encourages people to participate in activities directly aimed at reducing negative feelings and low mood.

More recently, behavioral activation has been studied as a stand-alone treatment for depression. In these cases, behavioral activation is used to increase involvement in positive, rewarding activities that can alleviate depression.

While there’s still some debate about using behavioral activation techniques outside of the therapeutic concept, there is general agreement that getting active and participating in “antidepressant behaviors” can reduce feelings of sadness and negative patterns of thinking.

Why Does It Work?

There are a number of biological and psychological reasons that explain why behavioral activation works. As mentioned earlier, endorphins are released when we participate in vigorous exercise. Endorphins are endogenous opioid neuropeptides, or chemicals in the brain that stimulate the opioid receptors. These neurochemicals contribute to an overall sense of reward by creating feelings of well-being and mild euphoria. The term “runner’s high” isn’t entirely a misnomer. Your brain actually creates chemicals that encourage you to participate in activities that are good for you. Plus, exercise can make it easier to fall asleep and stay asleep throughout the night.

We can also benefit from behavioral activation from a psychological standpoint. Setting concrete goals is a great way of providing structure to your day. While we all need time to relax and veg out, constantly moving through your day without any sense of structure can make you feel listless. Also, creating structure can reduce the chronic distractions of social media or Netflix. Meeting goals and expectations makes you feel good by creating a sense of accomplishment. Frankly, who couldn’t use that winning feeling every now and again?

Participating in positive activities can also decrease participation in negative ones that worsen feelings of depression. Exploring hobbies, spending time in the park, or exercising at the gym may reduce time spent consuming alcohol (a central nervous system depressant) or other substances that can negatively impact mood. Activities also provide opportunities to create community and develop healthier relationships with likeminded individuals.

In some clinical trials, behavioral activation was as effective as antidepressant medication or psychotherapy in treating depression. While psychotherapy and medication is an important (and, for many, vital) component of an overall treatment approach, the potential positive impact of simply getting up and moving around cannot be overstated. ➝

If you have diabetes and are overweight, you could have silent liver disease too.

Learn about fatty liver disease and NASH, and see if you may qualify for a clinical trial.

About NASH

If you have diabetes or struggle with your weight, you may have fatty liver disease. A severe form of fatty liver disease, called nonalcoholic steatohepatitis (NASH), often has no symptoms but can cause significant damage to your liver if not diagnosed early. While there are no medications approved for NASH (as of May 2020), a clinical trial may be an option for you.

About the Clinical Trial

The MK-3655 Clinical Trial is evaluating the safety and effectiveness of MK-3655, an investigational medication for people with NASH. This trial will test MK-3655 compared to placebo. A placebo looks like the study medication but contains no active ingredient.

You may be able to participate if you:* If you qualify and decide to participate:

• Are a male or postmenopausal female, 18 to 80 years of age [in Japan: 20 to 80 years of age] • Have NASH confirmed by a liver biopsy • Do not have type 2 diabetes OR have type 2 diabetes that is well controlled by diet or a stable dose of diabetes medication • Have had a stable weight for at least 3 months • Your liver and your overall health will be monitored closely by an experienced study team • You will receive the investigational medication and study-related doctor visits at no charge • The information gathered may help advance medical knowledge about NASH and may improve patient care in the future • Participation is voluntary, and you are free to withdraw from the study at any time. Your privacy will be maintained throughout the clinical trial

*There may be additional requirements to participate. The study doctor can provide you with more information. Additional potential risks and benefits of participation will be fully described to you by your study team.

To learn more, including the possible risks and benefits of participation contact: The Crofoot Research Center at ResearchVolunteer@CrofootMD.com or (713) 526-0005.

Get Up, Get Out, Get Active

Now that COVID restrictions have begun to lift, it’s a great time to consider how you might get more active. First, begin by setting some achievable goals and creating a plan of action.

Perhaps you can resume a few activities that may have dropped off over the last two years. As they say, “it’s like riding a bike.” Rediscovering old hobbies is an excellent place to start.

Set alarm clocks and timers to help provide structure. Alarms can remind you when an activity can optimally begin and end. Also, setting your smartphone to alert you about excessive screen time can create more time to participate in activities that provide connection rather than distraction.

Maybe you don’t know which activities to choose. Consider that uncertainty to be an opportunity for exploration and adventure. There’s an entire world of activities that you could get involved with. Maybe you can start with walking while listening to music, podcasts, or audiobooks. Perhaps you can take on an art project to explore your creative side.

It can be especially nice to pick something that you won’t try to force yourself to be good at. Remember, it’s about the process rather than the product.

And remember that two is sometimes better than one. Grab a friend to participate in activities with you. You can tag-team and hold each other accountable, making it more likely that you’ll adhere to your plan of action.

What If Exercise Isn’t Enough?

In some cases, activity and exercise is not enough to effectively manage depression and anxiety. The effects of working out may not lift your mood or reduce worry long enough to reduce thoughts of self-harm or combat feelings of worthlessness.

While exercise and hobbies are an important part of overall health that can simply enhance your feeling of being alive, there are other mental-health conditions such as bipolar disorder or schizophrenia where new activities alone might not be an effective treatment. In those cases, seeking help from your primary-care clinician or a trained mental-health professional is a next, important step in promoting optimal mental wellness.

Daryl Shorter, MD, is a Diplomate of the American Board of Psychiatry and Neurology and is board certifi ed in both general and addiction psychiatry. His clinical practice focuses on veteran care, and he lectures widely on LGBTQ mental health. Dr. Shorter can be reached at dr.darylshorter@gmail.com.