Having a clear structure to the day can be very beneficial for people who feel overwhelmed by strong feelings such as depression or anxiety. A structured program of activities can provide a sense of containment and focus when emotions are turbulent and chaotic.
Withdrawal from activity can also be a symptom or consequence of mental health problems such as depression or social anxiety.
Most young people attending youth AOD services are not participating in school or work. Young people participating in qualitative research have reported high levels of boredom and have linked a lack of meaningful activity to drug use and involvement in crime (Green, Bruun & Mitchell, in preparation).
Residential programs are ideal environments for providing a structure or clear schedule of daily activities. Young people experiencing crises that threaten their physical safety or that are associated with acute mental distress may benefit from admission to an Acute Residential Unit.
Day programs also provide organised activities, but these are less structured than in residential programs.
Most young people can benefit from more assistance aimed at helping them organise their time and schedule in a balanced mix of work-focused, leisure, social and self care activities.
There are two main types of activity scheduling that may be useful.
Pleasant event scheduling is particularly suited for clients with depression who have withdrawn from usual levels of activity. It is based in the simple idea that enjoyable activities directly increase positive affect or emotions. It involves working with the client to identify several activities that they enjoy and finding a way to schedule these activities regularly. Small things can be done daily (e.g. listening to favourite music, having a hot bath) while more elaborate things may be done several times (e.g. bike riding or playing music) or once a week (e.g. going to a movie or going bowling). Planning a special activity to look forward to in the future (e.g. several weeks or months in the future) is also part of pleasant event scheduling (e.g. planning a trip away from home or a visit from a friend).
Structuring the day or daily time management is particularly suited for clients experiencing hopelessness, regular emotional crises, and who have difficulty organising themselves and managing their time. Here it is helpful to have a goal in mind to work towards over a period of a week (or several weeks), and to be aware of factors in the environment that inhibit goal focus or time management (e.g. violence in the home) or the ability to attend appointments (e.g. lack of transport). For clients who are severely depressed or disorganised time management may start modestly with just a few easy to achieve domestic activities (e.g. going to bed and getting out of bed at a particular time, washing and preparing a reasonably healthy meal) and build up to a more demanding schedule over time (e.g. attending classes to learn new skills or planning social activities). Regular contact with the client will be necessary for monitoring and reinforcement. Problem solving strategies may be used simultaneously to help address barriers.
The activity scheduling practices described here assume that the young person possesses the basic skills to conduct the activities that are scheduled, but that they are failing to perform them due to temporary lack of motivation or chaos and disorganisation. Some young people will need additional assistance to learn life skills such as cooking or how to go about organising leisure activities.
Activity scheduling is based mainly on the concept of behavioural activation. For more in-depth information about contemporary behavioural activation treatments for depression see Hopko, Lejuez, Ruggerio, & Eifert (2003).