Areas › Low mood and hard feelings › When everything feels flat
Put something in before you take something out. Removing the only way a person has of coping leaves them with nothing, which is not safer.
In practice this looks like smaller steps than a promise to stop: cutting the frequency, changing what is used, agreeing to wait ten minutes and do one other thing first, keeping one route while a second is being built. Progress here is measured in less harm rather than in none, and that is real progress. Demanding an immediate stop tends to produce either refusal or a secret, and both leave the person further away from you.
Qur’an and Sunnah
God does not burden any soul with more than He has given it (Quran 65:7). Asking someone to give up the only thing holding them together is exactly that kind of burden.
لِيُنفِقۡ ذُو سَعَةࣲ مِّن سَعَتِهِۦۖ وَمَن قُدِرَ عَلَيۡهِ رِزۡقُهُۥ فَلۡيُنفِقۡ مِمَّآ ءَاتَىٰهُ ٱللَّهُۚ لَا يُكَلِّفُ ٱللَّهُ نَفۡسًا إِلَّا مَآ ءَاتَىٰهَاۚ سَيَجۡعَلُ ٱللَّهُ بَعۡدَ عُسۡرࣲ يُسۡرࣰ ا
and let the wealthy man spend according to his wealth. But let him whose provision is restricted spend according to what God has given him: God does not burden any soul with more than He has given it- after hardship, God will bring ease
Qur’an 65:7read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
What the research says
Adding is often the more workable half of change. In sixteen randomised studies, scheduling and increasing pleasant and purposeful activity produced large reductions in depression, comparable to cognitive therapy. What was tested was putting things in, not taking things away.
Cuijpers P, van Straten A, Warmerdam L. (2007). Behavioral activation treatments of depression: a meta-analysis.. Clinical psychology review doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Why it works
A coping strategy has to be replaced before it can safely be given up.
When not to
Substitution is for reducing harm over time and does not apply where injuries are severe or getting worse; that needs urgent clinical involvement.
This one is still a draft. It is waiting on a scholar and a clinician to read it before it is published.
Near this one
If you are the therapist, hand the prescriber the profile and leave them the pick. What you hold that they do not is what this person is like across a week, and what they will absolutely not tolerate.
If the worst part of low mood is that your thinking has gone foggy, say so specifically. Concentration can be treated as a target of its own rather than as something that will tidy itself up later.
With the fast acting treatments, the plan for what happens afterwards matters as much as the treatment itself.