Tag: depression

Behavioral Activation: Acting Despite Our Feelings

Posted on by David Zerella, LCSW in anxiety, burnout, cognitive behavioral therapy

A male runner wearing a red athletic outfit and number 1950, sprinting on a dry, cracked landscape with a cloudy sky.

People often assume that “feeling better” come before doing better. We tell ourselves:

  • “I feel too anxious to go out.”
  • “I don’t feel motivated enough to exercise.”
  • “I’m too depressed (or negative) to be around others.”

Unfortunately, this approach strengthens our our negative emotions. It rarely works to wait for the emotional change to occur organically. Waiting to feel right usually means waiting indefinitely.

As much as our feelings (and thoughts) can affect our behavior; a core principle of psychology is that our behaviors can also directly affect our feelings. It’s an interactive relationship.

Behavioral activation, is a well-established psychological approach, that relies on the latter principle:

Action often precedes emotional change. We gradually increase our sense of capability as we take more action. We can rewire our perspective on the desired tasks. Instead of I can’t do this, I’m not feeling it: It’s I did this even though I wasn’t feeling it.

The Decision-Making Problem

In therapy, people frequently explain their behavior through their feelings.

  • “I didn’t go to the event because I was anxious.”
  • “I stayed in bed because I was too depressed.”
  • “I said that because I was angry.”

The reasoning feels intuitive.

But it creates a predictable cycle.

  • – Avoiding anxiety strengthens anxiety.
  • – Withdrawing from others reinforces depression.
  • – Reacting in anger escalates conflict.

When behavior is consistently organized around emotions, those emotions can grow stronger rather than weaker.

The Order of Operations

Part of the issue is what I often describe as a reversed order of operations.

Many people live according to this sequence:

Feel → Act → Think

An emotion appears.

Behavior follows quickly.

Reflection happens afterward and usually with disappointment or regret.

This pattern tends to produce impulsive decisions, avoidance, and reinforce a lack of motivation.

A more effective sequence looks different:

Stop → Think → Act → Feel

Pause.

Consider your values or long-term goals.

Decide what would be the preferred way of acting. Then do it regardless. Even if you don’t like it or feel sub-optimal, it’s allowing for your emotional state to adjust over time. The feeling does not need to change first. The behavior does.

Acting Despite How You Feel

Behavioral activation is not about ignoring emotions.

It’s about not allowing them to dictate behavior.

For example:

  • “I went to the event despite feeling anxious.”
  • “I went to the gym despite feeling unmotivated.”
  • “I didn’t react despite feeling angry.”

None of these choices guarantee an immediate improvement in mood.

But they create room for change.

Avoidance almost guarantees the feelings continue and nothing improves.

Action at least allows improvement to occur.

Why Behavior Changes Emotion

Emotions are influenced heavily by behavior and environment.

When someone withdraws, avoids, or reacts impulsively, the environment tends to confirm the original feeling.

  • Isolation reinforces depression.
  • Avoidance reinforces anxiety.
  • Conflict reinforces anger.

When behavior changes, the environment often changes as well.

New experiences create opportunities for different emotional outcomes.

Feelings Are Valid — But Not Always Useful

Acknowledging emotions is important. But it doesn’t mean feelings always win. Feeling are not always helpful for making decisions, partly because they are not always accurate.

They provide information, not necessarily direction. The feeling can be a response to a problem but it isn’t the solution.

In many situations, the most productive approach is simple:

Act according to your values, not according to your temporary emotional state. Start with identifying those values and the version of yourself you would like to be.

The positive feelings will follow.

When Behavioral Activation Helps Most

Behavioral activation is particularly helpful for:

The common theme is the same:

behavior shrinks while negative emotions expand.

Reversing that pattern is where change begins.

An Actionable Step

The next time a difficult feeling appears, pause and ask one of these questions:

“If I were feeling better, what would I do?”

“How will I feel afterwards?”

“What would success look like?”

Then try doing the behavior that most aligns with your answer.

Not because you feel like it.

But despite how you feel.

Why Insight Alone Can’t Change Your Mental Health

Posted on by David Zerella, LCSW in anxiety, cognitive behavioral therapy, psychotherapy
A 3D illustration of a human brain with mechanical gears integrated into its structure, glowing with a soft red light against a pale background.

Most of my clients have incredible insight into their mental health. Many people who attend CBT therapy for anxiety or depression already know what they’re supposed to do. They understand it intellectually but still struggle.

They know when their thoughts are irrational.

They know avoidance worsens anxiety.

They know isolation feeds depression.

And yet—nothing changes.

This gap between knowing and doing isn’t a lack of intelligence. It’s certainly not for lack of effort. It’s a misunderstanding of how psychological change actually happens.

Insight Alone Rarely Creates Change

Cognitive Behavioral Therapy (CBT) emphasizes the connection between thoughts, emotions, and behavior. Understanding your thinking patterns matters. Learning how to challenge unhelpful beliefs matters.

But insight alone rarely leads to sustainable growth.

Many people can accurately identify their cognitive distortions. They can explain why their anxiety “doesn’t make sense.” They may intellectually understand why avoidance keeps them stuck. Yet, they still feel anxious, depressed, or unmotivated. Sitting alone with your thoughts and repeatedly trying to think happy thoughts is not CBT. In fact, trying to think ourselves out of emotional distress often becomes exhausting.

Knowing what would help doesn’t automatically make it easier to do it.

Practice Over Theory

My clinical approach is grounded in Rational Emotive Behavior Therapy (REBT). This is a form of CBT that places particular emphasis on how rigid beliefs and internal demands fuel emotional distress.

From an REBT perspective, we work to replace demands (“shoulds,” “have tos,” and “musts”) with preferences. So we don’t have to do the work—we prefer to do the work, because we prefer to see progress.

But simply put, we still have to practice what we know.

Don’t just talk about it—be about it.

This applies to me as well. I can’t just preach mental health and wellness; I have to actively work at living by it. (Maybe that’s why they call it a private practice). What I practice in private tends to show up in the therapy office.

If I’m burned out, overextended, or ignoring my own limits, that doesn’t stay neatly contained outside of session. Practicing self-care isn’t just something I encourage—it’s something I actively work on. Being present, emotionally attuned, and grounded with clients requires ongoing practice, not just theoretical understanding. I am not alone, nor am I special. This is part of the human experience.

“I Give Great Advice—Just Not to Myself”

Many clients describe themselves as the wise friend—the one who gives thoughtful advice. They validate others’ emotions and see situations clearly from the outside. Yet, they struggle when it comes to their own life.

Often this happens because we:

  • Validate others’ emotions while minimizing our own
  • Apply compassion outward but demand perfection internally
  • Know what helps in theory but avoid it when it feels uncomfortable
  • Let ego convince us we “shouldn’t have to do the work”

This isn’t hypocrisy. It’s human behavior. And it reinforces the same idea: knowing is not the same as practicing.

When You Know What to Do—but Still Can’t Do It

A common frustration I hear in therapy sounds like this:

“I know I shouldn’t isolate, but when I’m depressed I don’t want to burden others.”
“I know structure or exercise would help, but I can’t get myself to start—or even get out of bed.”
“I know no one is judging me at this party, but I’m still worried I’ll look foolish.”

At this point, many people assume something is “wrong” with them. In reality, they’re encountering a very normal limitation of insight-based change.

CBT isn’t about waiting to feel better before acting. It’s about learning how to act while uncomfortable. Or, as I like to say, the beauty is in the work.

Midsteps: Acting Without Needing to Feel Ready

When anxiety or depression is present, meaningful change rarely comes from trying harder or thinking more rationally first. Instead, we focus on midsteps—small, intentional actions that are possible even when motivation is low.

For example:

You don’t go to the crowded store, but you walk to the mailbox
You don’t socialize for hours, but you step outside briefly
You don’t feel confident, but you take action anyway

These steps aren’t about eliminating discomfort. They’re about moving through it—gradually demonstrating to yourself that you can withstand it.

Experiential Knowledge Is What Changes Beliefs

In CBT and REBT, beliefs change most reliably through experience—not logic alone. While we may brainstorm cognitive reframes in session to reduce stress and anxiety, long-term growth comes from experiential learning and resilience-building.

Experiential knowledge is built by:

  • Doing difficult things while anxious
  • Acting while depressed, unmotivated, or self-critical
  • Learning firsthand that discomfort is tolerable
  • Developing resilience to frustration

Sometimes those actions feel empowering. Other times they come with sweating, self-doubt, tears, or a pit in your stomach.

It all counts.

Each experience provides evidence that:

“I can tolerate discomfort and still function. I can withstand this.”

Over time, this weakens avoidance and reshapes emotional responses—not through positive thinking, but through repeated practice.

Therapy as a Place to Practice, Not Just Understand

Therapy isn’t about convincing yourself you shouldn’t feel anxious or depressed.

It’s about learning how to act effectively while you do.

For clients seeking CBT therapy for anxiety or depression, this approach often resonates with people. It particularly appeals to those who value self-improvement. They emphasize personal responsibility and intellectually honest change.

That’s why knowing isn’t enough—and why meaningful progress comes from practice over theory.

Combating the Winter Blues: Understanding Seasonal Affective Disorder and How to Push Back

Posted on by David Zerella, LCSW in Uncategorized

As sunlight fades and winter closes in, many people begin to feel heavier, slower, and less motivated. For some, this shift goes beyond the typical “winter slump.” It becomes Seasonal Affective Disorder (SAD) or seasonal affective disturbances—a recurrent form of depression linked to changes in light exposure and circadian biology.

SAD affects millions of people each year and often presents with symptoms such as:

Lowered mood or irritability

Fatigue or increased sleep

Cravings for carbohydrates or weight gain

Difficulty concentrating

Social withdrawal or decreased interest in activities

These symptoms arise because winter disrupts three key biological systems:

Circadian Rhythm – Reduced daylight throws off the internal clock that regulates sleep, hormones, and mood.

Serotonin Function – Less sunlight can reduce serotonin activity, a neurotransmitter tied to emotional stability.

Melatonin Production – Longer nights may cause melatonin to surge at the wrong times, increasing fatigue and slowing the body.

Understanding the science behind SAD helps reinforce why small, intentional behaviors can make such a meaningful difference.

Below are five research-supported strategies to help combat seasonal affective disturbances:

1. Do One Small Thing You Don’t Want to Do

Why it works:

This technique draws directly from behavioral activation, an evidence-based treatment for depression. When mood dips, the brain reduces activity in the prefrontal cortex (responsible for planning, focus, and action). Taking even a small step—washing one dish, responding to one email, walking for five minutes—re-engages those circuits.

Action precedes motivation.

The brain receives a reward signal (dopamine) when we complete small tasks, gradually lifting energy and mood.

2. Prioritize Sunlight to Reset Your Brain

Why it works:

Sunlight triggers specialized cells in your retina called intrinsically photosensitive retinal ganglion cells (ipRGCs) that communicate directly with the brain’s circadian clock. Just 5–10 minutes of sunlight in the morning can:

Boost serotonin production

Suppress excessive melatonin

Strengthen circadian rhythm regulation

Improve alertness and mood

Sunlight also helps regulate vitamin D, which plays a role in mood and immune function.

Many people experience deficiencies in winter, which may worsen depressive symptoms.

Even brief, intentional exposure makes a measurable difference.

3. Exercise to Activate the Mind–Body System

Why it works:

Physical activity increases levels of endorphins, dopamine, and brain-derived neurotrophic factor (BDNF)—chemicals associated with mood improvement, motivation, and cognitive clarity. Exercise also:

Regulates stress hormones such as cortisol

Improves sleep quality

Enhances neuroplasticity, helping the brain adapt more effectively to stress

Mindful movement (walking, yoga, weight training, stretching) forces presence and interrupts the sedentary patterns that winter often promotes.

Even 10 minutes of daily movement can shift brain chemistry.

4. Tap Into Creative Endeavors to Engage Reward Pathways

Why it works:

Creative activities stimulate the brain’s default mode network (DMN) and enhance dopaminergic pathways, which are tied to pleasure, meaning, and motivation. Engaging in creative expression:

Reduces rumination by occupying cognitive bandwidth

Activates flow states, which increase emotional regulation

Strengthens a sense of purpose, which buffers against depressive symptoms

Writing, painting, crafting, building—these activities create tangible evidence of agency and accomplishment during a season that often feels stagnant.

5. Socialize Outside of Holiday Obligations

Why it works:

Human connection triggers the release of oxytocin, reduces stress responses, and protects the brain against depressive patterns. Social interaction also:

Increases dopamine and serotonin activity Regulates the nervous system through co-regulation

Reduces perceived isolation, a major contributor to SAD symptoms

These interactions don’t need to be deep or long.

A brief chat with a cashier, waving to a neighbor, or engaging someone at the gym can meaningfully stimulate neural pathways linked to belonging.

Micro-social interactions count.

Final Thought

Winter may dim the sunlight, but it does not have to dim you. By understanding the biological roots of seasonal affective disturbances—and pairing that knowledge with small, consistent, science-backed actions—you can build resilience, boost your emotional well-being, and stay connected through the darker months.