When you’re feeling low, the natural response is to take part in activities that make you feel better.

For some, that’s a chat on the phone with a loved one or a meditation session. For others, a glass of wine or takeaway.

I fall into that second category, having spent most of my teen years and early twenties battling depression one quick-fix dopamine boost at a time.

A minor inconvenience has been enough in the past for me to justify a ‘reward’ (like a day off from chores or a retail therapy online shopping binge), and I’m known for cancelling plans to be alone during bad times – sometimes not leaving the house for weeks on end.

In these bad times it’s not unusual for me to go days without showering or cooking, neglecting myself and hiding away from the world. Whatever gets me through the day feeling the smallest number of negative emotions is what I choose to do.

‘Why are you telling on yourself for being gross and lazy?’ you may ask.

Partly because it’s the reality for many of us living with a mental health issue, and partly to show that there’s a limit to how we understand and promote recovery. I’ve been to dozens of doctors for my own issues and have written about mental health for years, but still struggle – and I think instant gratification is to blame.

Most people know about instant gratification because of the famous ‘Marshmallow Test’, an experiment where children were put in a room and given a sweet. As part of the Stanford research method, the child was then given two options; eat the sweet now, or wait 15 minutes and get two.

The landmark study followed respondents as they grew up, finding those who waited the 15 minutes went on to have better results in school, higher self-esteem, and better life outcomes overall.

Various outside factors impacted these children’s lives, but their capacity to delay gratification was seen as marker of ‘ability to cope with frustration and stress in adolescence’.

According to clinical psychologist Dr Nick Earley, people with mental health issues are less likely to be able to wait for things they find pleasurable.

He tells Metro.co.uk: ‘If somebody is feeling depressed, it can have a big impact on how our brain processes things – particularly our prefrontal cortex which deals with decision making, problem solving, and memory.

‘Symptoms of depression that affect your memory and concentration might make it harder to think back to previous times when you’ve delayed gratification and the benefits you’ve seen.

‘But it’s also means that it can be quite difficult sometimes for people to think about the future, as depression leaves them feeling more hopeless and helpless about their ability to extricate themselves from their challenges.’

Dr Nick adds that seeking instant gratification can look different from person to person: ‘It might be overeating unhealthy foods because that’s going to give us a boost in the short-term but deplete our energy – and probably add to the problem – in the long-term.

‘It could also be resorting to alcohol or drugs, which may provide a pleasurable feeling, but leave us hungover and tired the next day. Even binge-watching the same TV shows again and again can give us a bit of a respite from some of the sharper feelings, but might not be helpful long-term.’

This is what is meant by delaying gratification; prioritising things that mightn’t spike our endorphin levels in the moment but provide lasting benefits beyond that initial ‘high’.

As the struggling person goes straight to self-soothing behaviours to give themselves a quick boost, they may neglect their basic needs as a result, harming their recovery.

Therapist Sally Baker tells Metro.co.uk: ‘You’re stuck indoors; inactive, drinking energy drinks, eating crap, and making yourself feel worse. And what happens when we do all of those things, is that we get into a ruminative cycle of thought, where we either focus on past events that we can’t change or go into catastrophic thinking, which is focusing on the future.

‘And when you’re depressed or anxious and you focus on the future it’s never about great stuff happening – it always becomes catastrophic. So it’s about interrupting the ways of thinking that are deeply unhelpful.’

Looking at Maslow’s heirarchy of needs, we see how vital meeting our physiological needs (like food, sleep, and shelter) is. These needs sit at the bottom of the pyramid, and if the physiological isn’t addressed first, safety, belonging, esteem, and self-actualisation fall by the wayside.

Healthcare professionals need to ensure mentally ill people meet their basic needs, but balance this with a level of nuance when discussing treatment options with patients.

Many of us with depression have been told by doctors we’d be cured if we ‘go for a run’ or ‘eat better’, which feels glib and reductive. On the opposite end of the spectrum, we see constant messaging around ‘ending stigma’ that ignores the reality of what our lives are like. Yes, it’s okay not to be okay, but awareness will not cure us.

Wrapping mentally ill people in cotton wool feels just as patronising as an ill-thought-out recommendation. ‘Go for a run’ suggests we’re to blame for what’s going on in our heads, while cutesy soundbites strip us of agency in recovery – as if we have no part to play in it.

A more holistic approach – that considers the external with the internal – bridges that gap.

‘One of the things about mental health that people don’t get is that it doesn’t happen in isolation,’ says Sally. ‘You have to put scaffolding in place to support your mental health.

‘That means you really need to try your best to get good quality sleep, you need to eat the best nutritious food you could eat. It’s about rest. It’s about self care.’

Self care as a concept has become bastardised over the years, with corporations jumping on the bandwagon as if they can sell us wellbeing. At its core, though, it’s still defined as actions we take to ‘develop, protect, maintain and improve [our] health, wellbeing or wellness.’

It’s a harsh realisation, but self soothing does not necessarily equal self care. That’s why it’s important to assess our behaviours to see whether we’re using them as a crutch – as well as how they serve us going forward.

I’ve found it hard to find motivation to do much of anything in a low spell – and the science shows that this is common among those with low self-esteem (telling on myself again!).

But waiting for motivation is (as Hilary Duff so emotionally said of Chad Micheal-Murray in A Cinderella Story) like waiting for rain in a drought; useless and disappointing.

Sally and Dr Nick both say there are a number of ways to become a person who delays gratification and reaps the benefits, and they don’t require you to be a ‘naturally motivated person’.

Don’t wait for motivation

Research on motivation suggests that most of it is external rather than an innate desire inside us.

Happy people don’t wake up every morning buzzing to put a load of laundry on or go to the gym, but we assume they’re driven by something we just don’t ‘get’.

In the negative thought cycles of mental illness that’s understandable, but try to shift your view to see that you don’t need to wait for the want to do something – motivation to keep doing it will come in time as you see the benefits.

Seek support

Meeting your physiological needs is a sturdy base for your recovery, but can’t be the only factor in improving your wellbeing.

Both Sally and Dr Nick recommend reaching out to loved ones and professionals where possible. They’ll provide you with support, but also bring you back to the ‘real world’ outside of your own head.

Sally says that a tendency towards instant gratification is often a symptom of a deeper trauma, so therapy can unpack this and reduce impulsive behaviour as a result.

‘Find the smallest ways that you can start your journey of recovery,’ she says.

‘And if there’s any way you can access someone to help you on that journey, do – you wouldn’t do your own root canal work!

‘Sometimes when you’re in it, you’re so far in it, and you can’t find a way out on your own.’

Remember what makes you happy

In a mental health spiral, it’s easy to become defeatist about things getting better. Dr Nick says remembering past experiences and hobbies can help you tap back into the happiness they gave you.

He asks patients – specifically those who feel hopeless or can’t see a way forward – ‘If we had a magic wand and we could just take away their low mood and any nihilistic thoughts and feelings, what would they like to be doing?’

They can them begin to recall things they enjoy, which Dr Nick says ‘starts to get them already visualising something that’s a little bit different,’ adding, ‘it’s easier to get back to things you really enjoy doing.’

Start small

Sally recommends writing a life timeline that looks back on how you were feeling and acting in five-year increments. From there, you can scale down to activities that suit what you’re up to.

‘Maybe you through your life and say “actually, when I was 19, I was really really happy. But I was also running or I was also swimming, or a member of a choir, or I was having regular sex, or I was going out dancing”.

‘Those are things that you might have stopped and it might feel completely out of your league at this moment in time to, for example, go back to a club. But maybe you can do your kitchen disco – just put on some music that lifts you and dance like there’s no one watching.’

If hiking used to make you feel great but you’ve not been out in a while, you don’t have to climb Everest – a walk in the park or spending time in the garden is just as much of an achievement.

Chunk it down

Dr Earley says: ‘Breaking things down into manageable chunks is actually, for someone who’s depressed, really important.’

For example, if you used to love baking cakes but have no motivation, it could be overwhelming to simply say ‘bake a cake’. Instead, he recommends making a list of the smaller tasks that make up that big one (like buying ingredients or making some icing).

That way, you can complete your ‘big tasks’ under the guise of mini tasks. Do these as and when you feel up to it, feeling a sense of accomplishment each time – and even more so when they cumulatively add up to you doing something you never thought possible previously.

Keep a progress diary

Dr Nick says: ‘I think it can be useful to try and focus on some things that you’ve been grateful for in the week. Even if it’s been a terrible week, maybe you managed to get out in nature or you got a message from your niece or nephew.

‘As hard as it may be for somebody who’s depressed, that can be something positive to do.’

Gratitude journalling might seem fluffy, but it has proven benefits. Writing down what makes you feel good offsets the memory issues often caused by depression or anxiety, so you can go back during tough times and remember there’s a light at the end of the tunnel.

Try the Pareto Principle

This concept, says Sally, can help you make tangible changes that have big results.

The idea is that roughly 20% of what you do can affect 80% of your life, which in a mental health context translates to finding the things that’ll give you the most benefit.

Sally says: ‘Think of the 20% of the things you can do. Getting up and showering in the morning might make you feel 80% better in yourself compared to expending the same amount of energy cleaning the kitchen. So find those things for you.’

Be kind to yourself

Shame factors into why many people don’t get help for mental illness, particularly if people aren’t doing societally-expected things like washing or sleeping.

While meeting your needs is necessary to get better, you’re not to blame for having struggled with them.

Positivity around doing the ‘boring but helpful stuff’ are what’s needed here, not punishment or berating.

Feel the fear and do it anyway

Try not to mistake self compassion with staying in your comfort zone. Sometimes your brain will be giving you every reason to go for the ‘easy’ option, but pushing against that instinct can be transformative.

Sally says: If we’re struggling with depression and anxiety, one of the things we need to generate for ourselves is an endorphin or serotonin dump by our brain – the feel good hormones.

‘It takes 20 minutes of prolonged effort for them to kick in, and it doesn’t need to be high impact effort. If you go for a walk, don’t go for 15 minutes, go for 20 minutes. If you go for a swim, go for a minimum of 20 minutes.

‘Then it gives you your brain the chance to release the endorphins and all of the feel good hormones, lifting your mood for the rest of that day.’

Need support? Contact the Samaritans

For emotional support you can call the Samaritans 24-hour helpline on 116 123, email [email protected], visit a Samaritans branch in person or go to the Samaritans website.

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