When depression sets in, our routines become disrupted.  Many of us are familiar with the expression related to depression that it can be challenging to get out of bed.  We need to quickly adjust to how we are feeling and what we need.  One topic related to depression that is discussed less often is decision-making.    If it is difficult to maintain a routine, then it is also certainty challenging to make decisions.  Today, we are going to explore why decision-making is challenging when depression flares up, and strategies to make decision-making easier.


Decision-Making Happens Throughout the Day


Every day, we are faced with many choices that we need to make.  What you eat, what you wear, if you will spend money on various items that day, who you will choose to interact with, and what you will do that day are just some of the many decisions you will make.  Depending on your job, you may need to make choices.  If you are a caregiver, you will need to make decision on the other person’s behalf for their wellbeing.  If you have multiple obligations, you will need to decide how to budget your time.


Exercise 1: Try tracking in one day all the decisions and choices you make in one day.  A perfect place to test this out?  Try it on a day you need to go grocery shopping!  Your decision-making skills will definitely be tested any time you need to go shopping.


Exercise 2:  During a depression flareup, spend two days keeping track of decisions that are challenging for you to make.  Are you able to decide what you will eat?  Perhaps it is more difficult to make decisions involving/for others, such as caregiver responsibilities.  Keeping track of difficult decisions can help with narrowing down where you want to focus on strategizing.


Depression Symptoms Impact Decision-Making


In order to diagnose people with a mental health condition, there exist manuals that help guide clinicians appropriately and uniformly so that clients can have consistent diagnoses even if they see different therapists.  In the United States, that manual is called the Diagnostics and Statistics Manual, 5th Edition (also known as and will be referred to moving forward as the DSM-5). The DSM-5 section for depression highlights that there are eight characteristic symptoms of depressions.  Three of those are:


  • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
  • Diminished ability to think or concentrate, or indecisiveness, nearly every day.


These symptoms can contribute to why decision-making can be so challenging when depression sets in.


I am now going to discuss each of these three symptoms in terms of how they impact decision-making, as well as strategies to combat these symptoms.


Diminished Interest or Pleasure


When a person has less pleasure in the things they found enjoyable, or little interest in maintaining their routine, their energy becomes depleted and their motivation lessens.  That is why decision-making can be challenging.  How can a decision be truly made when nothing feels entirely enjoyable?


Exercise to Try


In order to practice making decisions, while also tackling diminished interest, you can begin to combine the two practices together.  Each day for one week, give yourself two options of things to try that day which you may enjoy.  You will then pick one and evaluate its effectiveness on your mood.


For example, one day you may pick a bath versus a shower, the next day pick reading versus watching a movie, the next day pick between Italian or Soul food, and so on.


The purpose of this exercise is two-fold.  On one hand, you are targeting the symptom of depression, and on the other hand, you are also practicing decision-making skills in a non-overwhelming way.


Feelings of Guilt and Worthlessness


Feelings of guilt and worthlessness can sometimes be extremely powerful.  If a person has low self-esteem in the moment, it can be hard to make decisions because they lose confidence in their decision-making abilities. If you have ever felt it was hard to make a choice because you has lowered self-image, know that you aren’t alone.


Exercise to Try


When you feel guilty or worthless, you may feel as though your choices do not matter or are not important.  When that happens I want you to try the following two-step exercise:


Step 1: Write down the things you like and the things you do not like.  Seriously.  Think back to elementary school where kids will write “all about me books.”  What hobbies, foods, music, activities, movies, books, etc. do you enjoy?  Now what are the things you do not enjoy?  Then you can deepen this practice- what are the things you value?  What are the things less important to you?  Essentially what you are creating is a list of the things that you align with. This will lead into…


Step 2: Make choices based on what you align with.  This could be as “small scale” (because no choice is ever truly small) as saying yes to food you like and no to what you don’t to a much larger scale of taking on tasks.  When you start to make choices that align with who you are and what you value, it not only sharpens your decision-making skills, but also boosts your confidence as you make them.


Difficulty Concentrating


When it is hard to concentrate, it can be difficult to make decisions.  Perhaps you feel as though you do not have enough concentration to think through the decision or you aren’t able to process all of the information behind the decisions.  We are going to practice two exercises for concentration.


Exercise to Try #1


Set up a decision that may feel easier to make, ideally with two options.  This may be a flavor of tea to drink out of two options, which one of two movies or shows to watch, or which one of two outfits to wear.  Set a timer for one minute on your phone and put your phone down so you do not watch the timer go down.  Are you able to make a decision before the timer goes off?


Of course, there will be some decisions in life that you want to take time making including, but not limited to, financial, career, and medical decisions.  This exercise should be used for routine decisions that would have roughly equal impact whichever you decide such as what to wear, what to eat, or what to watch.


Exercise to Try #2


When it is difficult to make decisions, it can be helpful to write down relevant information as you make your choice.  This may include information about the options or the pros and cons of each option in order to make a decision on what aligns with your values and what feels like a better choice.


By writing down the relevant information, you can come back and reread the necessary information, which can be much easier than memorizing a lot of information at once.


 Putting it All Together


Depression can impact our decision-making skills by a lack of concentration, lowered self-confidence, and diminished interest.  While all of these factors may feel overwhelming, they do not have to get the best of us. There are ways to target each of these symptoms with exercises tailored to the specific symptoms.


For a lack of concentration you can practice making small decisions in short amounts of times to practice concentrating on the task at hand.  You can also practice writing down relevant information including about the options and the pros and cons of each choice.


For feelings of guilt, you can write down the things you align with: what you value, what you like, and what you do not like, and then make decisions that align with those values.


To target diminished interest, you can practice making choices on potential things that you may enjoy.


For More Information


Coping with depression can be a challenge.  However, you do not need to do it alone.  Here at online-therapy, we have a staff of wonderful therapists here to assist you on your wellness journey using Cognitive Behavior Therapy.  We will provide you scientifically backed strategies with compassion and understanding.