Behavioral Activation: a therapeutic intervention for depression

Author: Kari Kagan, Psy.D.

What is Behavioral Activation?
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Behavioral Activation (BA) is an evidence-based treatment approach for depression. One of the hallmark symptoms of depression is experiencing little interest or enjoyment in activities that used to be considered enjoyable. When we look at patterns that maintain depression, dis-engagement in our lives is one of the most significant contributing factors to getting stuck.
 
BA operates on the understanding that what we do and how we feel are directly related. When people are feeling depressed or down, they tend to lack motivation to engage in their life in the way they do when they are feeling neutral or happy. When depressed, people simply don’t find enjoyment in activities that they usually do enjoy. As such, it can be difficult to find the motivation to engage in those activities, which contributes to the negative feedback loop that maintains depression. Behavioral activation is a treatment approach that works from the outside-in, meaning it focuses on getting people to do more as a means of helping them to feel better. The method behind behavioral activation is “act first, motivation follows”. Although much easier said than done, it is not much different than taking medicine. When we are feeling sick, we take medicine to help us feel better; we don’t wait to feel better to start taking medicine. In depression, people often “wait” to feel better in order to start re-engaging in their lives. However, it is this waiting period that actually contributes to the vicious cycle of depression. BA is like taking medicine, doing it when you are feeling depressed is the way to start feeling better. 

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How Behavioral Activation Works:
 
On a biological level, BA works similarly to antidepressants. As people become more active, it affects the same chemicals in the brain that antidepressants do.* On a behavioral level, engaging in more activities gives a person who is depressed more opportunities for positive reinforcement. For example, when staying at home isolated, someone might think that they have no friends and that no one likes them. And of course, the more that person stays at home, the more they will believe that thought. However, if that person were to go out and spend time with friends (even when they don’t feel like it) they would have the opportunity to learn that maybe they are more likeable than they think!
 
*Please note that while research supports BA as an effective treatment approach for depression, there are smany cases in which a combination of BA (and other forms of therapy) and medications is the most effective treatment approach.  We encourage you to consult with your doctor and/or therapist about the best options for you. 

Behavioral Activation Tips:
 
Given that some of the symptoms of depression are low motivation and little interest in previously enjoyed activities, BA is much easier said than done. However, here are some tips that could help you meet your BA goals, regardless of motivation.

1. Start with simply tracking your daily activities. Write down exactly how you are spending your time throughout the day, including as many details as possible. For example, if you woke up, took a shower, ate breakfast, and watched TV, write down all of those details. You could also try rating your mood (on a scale of 1-10) as you do each activity to help you learn more about the relationship between what you do and how you feel.

2. Identify activities you can start to engage in. Consider picking activities in two categories: activities of mastery and activities of pleasure.

• Mastery activities are those that give you a feeling of relief and accomplishment after you do them, even if they aren’t the most enjoyable activities. For example, I don’t enjoy folding laundry, but I do feel a sense of accomplishment and relief after completing that task.
• Pleasure activities are those that you usually enjoy. For example, spending time with a friend or reading a book.

If you are having difficulty identifying activities, try using your values, or what is most important to you, as a guide. For example, if you value maintaining good health, taking a walk might be an activity to try. If you value being a supportive friend, calling a friend to check in on them might be an activity for you.

3. Create a schedule and put it in a calendar. Research shows that writing down goals and creating a plan increases the likelihood that we will actually stick to them.  Try scheduling in each activity, even if it seems like a given (i.e., wake up at 8am, brush teeth at 8:15am, call friend at 9am).  

4. Set small, realistic goals. Part of what can contribute to feeling stuck is falling into an “all-or-nothing” state of mind. This might sound like saying, “I don’t even want to start responding to emails until I have time to respond to all of them”. This kind of thinking can keep us paralyzed as we may never have enough time or energy. We can be more productive when we set smaller goals. For example, you could set a goal of responding to two emails per day, or you could set a time-limit goal and set aside 10 minutes to respond to however many emails you can in that time period. In BA, what helps people to feel better is not doing things perfectly or completely, but just doing something.  

5. Reward yourself after completing goals. All goals, no matter how big or small, are deserving of a reward. If you went for a walk, call/text a friend letting them know you did it. If you finally cleaned the dishes, reward yourself with a kind and encouraging statement (“way to go! You did it!”). Notice the urge you might have to minimize these accomplishments (i.e., “I should have done that weeks ago”) and recognize those as unhelpful and unproductive thoughts. Acknowledging, rather than minimizing, our accomplishments is what helps to maintain momentum.  

6. Problem solve when goals aren’t met. Of course, we should expect that there will be many times that we set certain goals for ourselves that we aren’t able to meet. When this happens, instead of beating yourself up, try solving the problem. Examine what got in the way from a place of non-judgmental curiosity, and see if you can come up with some solutions to that barrier in the future. This helps to empower and encourage us to try again.  
Following the tips above can help you to be successful in using behavioral activation as an intervention for depression. If you would like to additional support, feel free to contact us for a free consultation.
 

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