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Doing before feeling - A core principle in therapy

Our unpleasant emotions can be a significant barrier to doing things we want or need to do. Feelings such as stress, depression, agitation and guilt can make it harder for us to feel motivated and willing to do even mildly challenging tasks. Often these emotions lead to thought cycles questioning the point of doing certain activities, or the likely success we will have in giving them a try. This further reduces our motivation to act.

When we are aware that we are doing and accomplishing less, this can add to our stress and low mood, and reduce our self-esteem. I have rarely worked with a client experiencing high levels of depression or anxiety who was not engaging in significant avoidance, whether this was avoidance of trying new things, or difficulty setting aside time for hobbies, socialising or even simple self-care activities, such as exercise.

Often these clients know that their emotional state is leading them to avoid things, and their agenda in therapy is therefore to find out ways to reduce or eliminate these negative emotional states so they can then start to re-engage with the activities they have stopped doing. It makes sense that, if these emotions have led to avoidance, that getting rid of them should fix this. However, in these cases I have noticed two common themes:

1. The person’s reliance on avoidance as a coping strategy has made the unpleasant emotions more intense and harder to manage. For example, avoiding exercise due to lack of energy and drive means the body and brain are not getting the natural endorphins from exercise that often alleviate these feelings. Learning to do before feeling better is often what these clients learn about in therapy - being able to get in touch with the value that drives them to act, to then motivate them to act while experiencing a lack of energy or high levels of stress.

2. The activities the person is avoiding are things they think they ‘should’ be doing, rather than things they actually want to do. Their lack of motivation to do these activities is viewed as a problem, and they dismiss their desire to do anything else. I have worked with many clients who believe that they should want to go to work, when they are actually doing a job that does not align with their interests and values. Many introverted clients stop socialising altogether because the activities readily available to them are not enjoyable (e.g. going out to a noisy bar for work drinks). Learning to get in touch with one's values and preferences, and the actions that stem from them, is often a focus of therapy. If we are not regularly engaging in activities that are important to us, or at least intrinsically enjoyable, life tends to feel like one big chore, and our mood and motivation will be affected.

There are certainly ways to manage emotional states so they are less distressing (e.g. mindfulness, grounding, breathing strategies), however, if we do not couple these with values-driven behaviour change, these strategies are unlikely to have much of a positive effect on the overall problems people come to therapy to address. This is why ‘doing before feeling’ is a core principle in therapy – if clients do not start to experiment with behaviour change, it is unlikely that significant, long-term emotional change will occur.

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