What Helps When You Are Struggling
What you can do yourself when you are struggling, and what of it has the best evidence, fits into a few points:
- regular exercise (even ordinary walking helps)
- a fixed sleep rhythm
- little to no alcohol and no smoking
- one small activity a day at a fixed time, even when you do not feel like it
- regular contact with people who are good for you
- home-cooked food more often instead of ready-made products
- a self-help programme with professional support, often online and free
That sounds unspectacular. Many guides make it more complicated, with long lists, elaborate morning routines or ice baths. For most of the points above there are large analyses of many studies. For many of the spectacular tips there are only small studies with few participants.
This article shows what lies behind each point, where you can start and how to find out what works for you. You do not have to read all of it. Each section says at the start who it is for and when you can skip it.
This article describes the situation in Germany. Guidelines, phone numbers and free services named here apply to Germany.
What helps when you are struggling: the overview
The best evidence is for exercise, a fixed daily structure, contact with other people, stopping smoking and guided self-help. The table shows how strong the evidence is in each case and where you can start.
Strong means at least one large analysis of many studies or a clear recommendation in the treatment guideline. Moderate means supported, but by small studies or only as part of a larger treatment.
| Measure | Evidence | What the research shows | First step |
|---|---|---|---|
| Exercise | strong | Analysis of 218 studies: walking, jogging, yoga and strength training measurably reduce depressive symptoms. Most of the studies are not methodologically very rigorous | Three 30-minute walks a week |
| Contact with others | strong | Analysis of 148 studies: people with stronger social relationships have a 50 per cent higher likelihood of survival. What was measured was life expectancy, not mood | One fixed, recurring appointment with a person |
| Stopping smoking | strong | Analysis of 26 studies: people who quit have less anxiety, stress and depression afterwards. Observational studies, so an association, not proof | Free advice from the German quitline on 0800 8 31 31 31. If you take psychiatric medication, tell your doctor first |
| Guided self-help and online programmes | strong | The German treatment guideline explicitly recommends both for mild depression. With guidance the evidence is better than without | A free online programme such as iFightDepression (guided, via your GP or psychotherapy practice) or moodgym (usable without guidance) |
| Daily structure | strong | Behavioural activation, meaning deliberately planned activities, is named by the German treatment guideline as an example of help for mild depression | One small activity a day, at a fixed time |
| Fixed sleep rhythm | moderate | Effective as part of cognitive behavioural therapy for insomnia (CBT-I), less well supported on its own | Get up at the same time every day, with an hour of leeway |
| Little to no alcohol | moderate | Even about two drinks disrupt dream sleep. According to the WHO, no amount is safe for health | Two fixed alcohol-free evenings, then cut down further. At larger daily amounts, see a doctor first |
| Little processed food | moderate | Review covering almost 10 million people: those who eat a lot of ultra-processed food have depression and anxiety more often. Observational studies, so an association. A small study of Mediterranean-style eating showed good results | Cook for yourself more often: vegetables, legumes, fish. No diet |
Sleep: start with a fixed wake-up time
Who this is for: people who lie awake at night, struggle to get up in the morning or get up at a different time every day. If you mostly get up at the same time and feel rested during the day, you can skip this section.
Sleep affects almost everything else: your mood, your concentration and whether you have energy for anything during the day. If your sleep is off right now, this is a good place to start.
Get up at the same time every day. Weekends included, with about an hour of leeway. You cannot force the time you fall asleep, but you can control the time you get up. A fixed wake-up time is a component of behavioural therapy for insomnia. On its own it is less well supported than the whole therapy, but it is the part you can start without guidance.
If getting up is your biggest problem right now, this step is not easy. Start smaller then: the alarm goes off at the fixed time, you sit up and open the curtain. Nothing more is needed in the first week. If you currently get up at eleven, set the alarm for half past ten, not for seven.
Get into daylight in the morning. Ten to thirty minutes outdoors, as early as possible. Even under an overcast sky it is far brighter outside than in your flat.
If you have been sleeping badly for months, the guidelines recommend a specific therapy for insomnia, cognitive behavioural therapy for insomnia (CBT-I), as the first step (European Insomnia Guideline 2023). In the short term, sleeping pills work somewhat faster. In the long term, comparison studies point to an advantage for the therapy (Mitchell et al. 2012), and what you learn stays with you. In Germany it is also available as an app on prescription, listed in the DiGA directory under sleep disorders.
Part of this therapy involves temporarily shortening the time you spend in bed. That makes you more tired for a few weeks before it gets better. If you drive or operate machinery, if you snore loudly or someone has noticed pauses in your breathing (a possible sign of sleep apnoea), or if bipolar disorder or a seizure disorder is known, only do that part with medical support.
Alcohol also disrupts sleep. More on that in the section on alcohol and smoking.
Exercise: even ordinary walking helps
Who this is for: people who feel heavy, sluggish and exhausted. If you already move regularly, for example the 150 minutes a week recommended by the WHO at a moderate pace, you can skip this section.
Exercise is the best-studied measure that is in your own hands. A large analysis in the BMJ combined 218 studies with more than 14,000 people with depression. Walking and jogging, yoga and strength training measurably reduced symptoms, across different levels of severity. The researchers themselves point out that most of these studies are not methodologically very rigorous. Even so, the results point the same way. Exercise is a good bet, but not a guarantee.
Start with a twenty-minute walk. Even ordinary walking helps, and brisker walking helps more. Many kinds of exercise work, and the more strenuous, the stronger the effect. What matters is that you keep going: three half-hour walks a week achieve more than an ambitious plan you abandon after ten days.
Find something to do with other people. A club, a class or a fixed walk with someone often beats the treadmill. You turn up because someone is counting on you, and it feels less like a chore.
In severe depression, exercise is a good addition, but not the only help you need.
Alcohol and smoking: less is better
Who this is for: people who drink or smoke regularly. If you do not smoke and rarely drink, you can skip this section.
Alcohol disrupts sleep. An analysis of 27 sleep studies found that even up to about two drinks disrupt dream sleep, and that it gets worse with every further drink. Participants only fell asleep faster after about five drinks, and their dream sleep was disrupted even then. For health overall, there is no safe amount. That is the position of the World Health Organization. The German Nutrition Society therefore recommends not drinking alcohol at all.
If you drink regularly in the evening and wake up feeling wrecked, you can change a lot here without starting anything new. A simple start is two fixed alcohol-free evenings a week. Less is better, none is best.
Important: if you drink larger amounts daily, or if you shake, sweat and feel agitated in the mornings, do not stop from one day to the next on your own. Where the body has adapted, sudden withdrawal can be dangerous. Talk to your GP practice or an addiction counselling service first. If stopping brings on shaking, sweating, a racing heart, nausea or strong agitation, have it checked by a doctor. Confusion, hallucinations or a seizure are an emergency: call 112.
Smoking is seen by many as calming. The research points the other way. An analysis in the BMJ of 26 studies found that people who quit had less anxiety, less stress and fewer depressive symptoms afterwards than people who kept smoking. This also held for people with mental illness. The authors estimate the effect as similar to that of antidepressants or larger. These are observational studies, so an association, not proof.
If you take psychiatric medication: smoking speeds up the breakdown of some drugs, especially clozapine and olanzapine. After you stop smoking their blood levels rise, sometimes considerably, even if you use a nicotine patch. It is the smoke, not the nicotine. Tell your doctor beforehand so the dose can be adjusted.
Daily structure and drive: do it first, the drive follows
Who this is for: people for whom nothing is enjoyable any more, who spend long evenings on their phone and feel emptier afterwards, or who are waiting for motivation that does not come. If your days have a rhythm and you still enjoy things, you can skip this section.
The most important sentence in this section: motivation comes after doing, not before. Anyone waiting to feel like it when their mood is low often waits in vain, because that feeling is exactly what is missing. This is why the treatment of depression starts here too: do something first, and the mood follows.
Plan one small activity a day at a fixed time. Not "get out more" but "Wednesday at 6 pm, once around the block". The fixed time is what makes the difference. If that is too much, start with three days a week.
Put limits on screens. A fixed end to the evening and no phone in the bedroom are two simple starting points.
Find one thing you get better at. It can be small: ten minutes on an instrument, a recipe that turns out better the third time. What matters is that you can see the progress. The sense of being able to make a difference yourself is considered an important protective factor for mental health.
Make some time of your own. People who decide over part of their time themselves experience strain differently. That is not possible for everyone. On shift work, when caring for relatives or with small children, free time is scarce, and it is not a failure when it does not work. For students we have described how free time comes under pressure during studies.
Contact with others: one fixed appointment counts
Who this is for: people who have barely spoken to anyone who knows them in recent weeks. If you regularly see people who are good for you, you can skip this section.
Withdrawal is often a sign of strain, not a character trait. That is why this step feels hardest exactly when it would help most.
An analysis of 148 studies from 2010 with more than 300,000 people found that those with stable social relationships had a 50 per cent higher likelihood of survival. What was measured was life expectancy, not mood, and these are observational studies. You cannot conclude from this that friendship cures depression. You can conclude that contact with others matters.
Arrange a fixed, recurring appointment with a person. The rhythm matters more than the depth of the conversation. A fixed Wednesday works better than the intention to get in touch some time. If nobody comes to mind right now, a self-help group can be that fixed appointment too, searchable at NAKOS.
Help someone with something concrete, on a scale you can easily manage. You see a result, and it depends on you. But make sure you do not lose out yourself in the process.
Diet: less heavily processed food
Who this is for: people who eat a lot of ready meals or often skip meals. If you mostly cook for yourself and eat a varied diet, you can skip this section.
Eat less heavily processed food. This means ready meals, processed meats, sweets, crisps, sugary drinks and packaged baked goods. A review in the BMJ combined analyses covering almost 10 million people. Those who eat a lot of them have anxiety and mental health problems more often. Their risk of depression is about a fifth higher. These are observational studies, so an association, not proof. Eating less of them is still a sensible step, and one that is good for your body too.
On the question of whether a better diet reduces symptoms, the evidence is thinner. In the SMILES study, people with depression received twelve weeks of dietary counselling towards Mediterranean-style eating, while a comparison group received conversations instead. After twelve weeks the group with dietary counselling was doing clearly better than the comparison group. But the study was small, with 67 participants, and most of them were also in therapy or on medication.
In practice that means more vegetables, legumes, wholegrains, fish and olive oil, and less heavily processed food. No diet and no calorie rules. If you suspect your eating itself is a problem, leave dietary experiments alone and talk to a doctor.
How to find out what helps you
Change one thing, keep everything else the same, give it four weeks and write down one to three numbers each day, ideally starting a few days before you begin. That is all it takes.
Get help in parallel if it lasts. This approach does not replace treatment. If your symptoms last longer than two weeks, the next section applies now, not only after several attempts.
Change only one thing at a time. Many people start everything at once on a Monday: no more alcohol, running every morning, phone away, healthier eating. It feels decisive. But if you feel better afterwards, you do not know what made the difference. And at the first slip, all the resolutions often fall at once.
Plan for the obstacle as well. Think ahead: what could get in my way? And what will I do then? For example: "If it rains, I will still go, with an umbrella." An analysis of 21 studies with almost 16,000 people shows that people who plan ahead like this reach their goals somewhat more often.
| Week | What you do | What to watch for |
|---|---|---|
| Before | Change nothing yet. On three evenings, note: energy (1 to 10), mood (1 to 10), hours of sleep. One number is enough too | That is your baseline |
| 1 | Start one new thing, small and at a fixed time | Keep noting it down each evening |
| 2 | Keep going, add nothing new | Is the plan too big? Then shrink it, do not give up |
| 3 | Keep going | Expect it to feel less good than at the start |
| 4 | Keep going | Compare the days before you started with week 4: keep it, shrink it or try something else |
If you forget a day, the week is not lost. Fill in the number later or leave the gap.
The early high fades, and that is normal. The first week or two often feel surprisingly good because everything is new. Then it flattens out. That does not mean the measure is not working. Many people stop at exactly this point because nobody told them it would happen. So judge only after four weeks, and compare the days before you started with the fourth week, not yesterday with today.
A slip is not a failure. A missed day shows at most that the plan was too big, not that you cannot do it.
If nothing is different after four weeks, it was the wrong measure, not the wrong person. Try another one from a different area. And if the second or third attempt changes nothing either, talk to your GP practice, if you have not done so already.
And if things get better, you will look for an explanation. Often it is not one big moment but the unspectacular things: that you got up at the same time for a few weeks, moved and talked to people. That is good news, because you can repeat those things when you feel worse again.
When to get help
Self-help is a good start, but not a substitute for treatment. Get support if
- low mood, lack of drive or loss of interest last longer than two weeks,
- your daily life is falling apart,
- you need alcohol or other substances to get through the day,
- you notice signs of an eating disorder
- or you are thinking about suicide or harming yourself.
In an acute crisis in Germany? Telefonseelsorge: 0800 111 0 111, 0800 111 0 222 or 116 123, around the clock, free and anonymous, also by chat and email at online.telefonseelsorge.de. In immediate danger to life, call 112 or go to the emergency department of the nearest psychiatric hospital. Out-of-hours medical service: 116 117. For people under 25: krisenchat.de, for children and adolescents Nummer gegen Kummer on 116 111 (Monday to Saturday, 2 to 8 pm; at night use Telefonseelsorge or krisenchat). Outside Germany, call your local emergency number or find a crisis line at findahelpline.com.
In Germany, the first places to turn are your GP practice, psychotherapy practices, the free psychosocial counselling centres run by your local authority and the out-of-hours medical service on 116 117.
The German treatment guideline for depression explicitly recommends guided self-help for mild symptoms and advises against starting with medication before such options have been tried. If the symptoms persist anyway, psychotherapy should be offered to you. In moderate depression, psychotherapy and medication are equal options. In severe depression, the guideline recommends both together.
Whether what you need right now is mainly sleep or treatment cannot be judged from a distance. A conversation will clarify it, fastest at your GP practice. Getting a therapy place in Germany often takes a long time: 142 days on average according to the Federal Chamber of Psychotherapists (2022, no more recent data is available). The first step is quicker: on 116 117, the appointment service arranges a consultation at a psychotherapy practice. More in our article on waiting times for therapy.
Never stop prescribed medication or change the dose on your own, not even when you feel markedly better. Discuss any change with your doctor.
Counselling at Psychofit
Psychofit offers psychological counselling. That is not psychotherapy, not a health insurance benefit and not medical treatment: we do not make diagnoses and we do not treat mental illness. If you are living with a mental illness, please keep actively looking for a therapy place in parallel. We explain the difference between counselling and psychotherapy here, and current prices are on our pricing page.
In counselling you can sort out what is going on and work out where to start. If a different kind of help fits better, we will tell you openly. Why we want to help early instead of making people wait is on our mission and vision page.
We aim to be the best low-threshold online psychological counselling for self-paying clients in Germany: quickly available, affordable and provided by psychologists under supervision. What we base that on is set out in our price promise.
Sources
Exercise
- Noetel, M. et al. (2024). Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ 384. doi:10.1136/bmj-2023-075847
- World Health Organization (2024). Physical activity, fact sheet: who.int
Sleep and guidelines
- Bundesärztekammer, KBV, AWMF (2022). Nationale VersorgungsLeitlinie Unipolare Depression, version 3, chapter 5: nvl-programm.de
- Riemann, D. et al. (2023). The European Insomnia Guideline: an update on the diagnosis and treatment of insomnia 2023. Journal of Sleep Research 32(6), e14035. doi:10.1111/jsr.14035
- Mitchell, M. D. et al. (2012). Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC Family Practice 13. doi:10.1186/1471-2296-13-40
Smoking
- Taylor, G. et al. (2014). Change in mental health after smoking cessation: systematic review and meta-analysis. BMJ 348. doi:10.1136/bmj.g1151
Social relationships
- Holt-Lunstad, J. et al. (2010). Social relationships and mortality risk: a meta-analytic review. PLoS Medicine 7(7). doi:10.1371/journal.pmed.1000316
Alcohol
- Gardiner, C. et al. (2025). The effect of alcohol on subsequent sleep in healthy adults: A systematic review and meta-analysis. Sleep Medicine Reviews 80, 102030. doi:10.1016/j.smrv.2024.102030
- WHO Regional Office for Europe (2023). No level of alcohol consumption is safe for our health. who.int
- German Nutrition Society (DGE) (2024). Position paper on alcohol (German). dge.de
Diet
- Jacka, F. N. et al. (2017). A randomised controlled trial of dietary improvement for adults with major depression (the SMILES trial). BMC Medicine 15. doi:10.1186/s12916-017-0791-y
- Lane, M. M. et al. (2024). Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses. BMJ 384. doi:10.1136/bmj-2023-077310
If-then plans
- Wang, G., Wang, Y. & Gai, X. (2021). A Meta-Analysis of the Effects of Mental Contrasting With Implementation Intentions on Goal Attainment. Frontiers in Psychology 12. doi:10.3389/fpsyg.2021.565202
All information in this article has been carefully researched but is provided without guarantee. Prices, waiting times, and legal regulations are subject to change. Last updated: October 2026.
