Just do it! What is Behavioral Activation to treat depression?
By Charlotte Burlos
Behavioral Activation (BA) is a therapy skill that can be done with or without Cognitive Behavioral Therapy (CBT). CBT is a type of therapy highlighting how thinking, behavior, and feelings are all inter-related and directly involved with one’s mental health. BA specifically focuses on the behavior portion involved in our mental health.
Behaviors may influence emotions. Depression may involve symptoms that change our behavior, such as social isolation or withdrawal from our responsibilities. This is understandable, as a person facing depression may be going through a variety of uncomfortable emotions or physical sensations that make it more difficult to engage in rewarding activities that were previously enjoyed. The brain experiencing depression wants to protect us, which may cause us to avoid or isolate when depressed, but unfortunately this likely worsen our mood over time. Once we start to isolate ourselves and neglect responsibilities, this actually creates more stress, more loneliness, and provides us with less rewards. BA has been found to be an effective treatment for sub-threshold and clinically diagnosed depression, including in individuals who have a comorbid mental health disorder or a comorbid physical health condition (Wang & Feng, 2022).
BA was created from the idea that depression results from experiencing too little positive reinforcement (it should be noted that depression may have a variety of causes and vary for each individual). Positive reinforcement is when a behavior results in a positive reward or outcome; this therefore makes us more likely to engage in the behavior in the future. For example, a person who receives praise for baking a delicious cake may be more likely to bake that same cake in the future.
Negative reinforcement is when we engage in a behavior because it removes something negative, such as sadness or anxiety. For example, a person with depression may use drugs or alcohol to help temporarily eliminate negative feelings that come from depression. Once these negative emotions are temporarily removed by using drugs or alcohol, the person experiencing depression may be more likely to use the substance again in the future. Although these behaviors may provide relief initially, this may cause more stress long term, which worsens one’s depression. BA is used to help remove negatively reinforced behaviors that are promoting negative outcomes and begin to implement activities that provide reward, pleasure, and a sense of accomplishment, increasing levels of positive reinforcement. This process should be done by the therapist with compassion, support, and empathy, as a person experiencing depression may have relied on unhelpful behaviors for a long time to provide themselves with temporary relief.
BA involves a variety of stages during the process of therapy. BA may look different for each person and each therapist may implement BA a little differently. BA may be done by itself or alongside interventions that target a person’s thoughts and feelings, such as Cognitive Restructuring. The first step of BA typically involves psychoeducation. This means that a therapist will educate their clients on the process of BA. Clients may feel more comfortable with the process of BA if they are informed on how it works and what to expect. The second step is called “Activity Monitoring.” This may involve tracking one’s activities, mood, and other data markers throughout the week to bring awareness to which activities are beneficial versus which activities worsen symptoms. Once awareness is brought to how a person is spending their days and how their moods fluctuate throughout their daily activities, brainstorming positive behaviors would be the next step.
This next step is called “Activity Scheduling.” This will likely start out small and include activities that are easy, rewarding, and in line with one’s values. An example of some activities may be walking your dog, going for a run, or painting. Implementing too many activities too quickly into a person’s day could lead to feelings of discouragement or more stress. Multiple online resources have a sample list of activities that can be used when scheduling activities for the week. Brainstorming some new behaviors and ranking them in terms of their ease and level of reward may also help a person choose which activities they would like to start implementing. A worksheet may also be used to help plan out the week ahead and with days and times for activities. Eventually, more challenging activities can be swapped in as the process is continued. Having friends or family support the process of behavioral activation may also help with motivation and completion of activities.
There are a variety of treatments that can be used for depression that have shown to be beneficial. BA is a intervention that focuses solely on changing behaviors to influence mood positively. If we wait until our mood is better to begin engaging in activities that we value, we may be missing out on time that we could spend doing things that support our mental health and bring on meaningful change. Scheduling activities and completing them regardless of our mood allows us to feel empowered in our mental health journey and begin to experience benefits. Please note that cultivating self-compassion in this process is beneficial because at times activities may be forgotten or may feel too difficult.
The BA process may be unique for everyone, but there are trained mental health professionals who are eager to help find the most beneficial individualized treatment for depression. Consult a healthcare professional at Sweetgrass Psychiatry in Mount Pleasant, Sc, Isle of Palms, SC, or virtually to receive personalized care for your mental health.
Sources:
Therapist Aid. Behavioral Activation. https://www.therapistaid.com/therapy-guide/behavioral-activation-guide.
Wang, X., & Feng, Z. (2022). A narrative review of empirical literature of behavioral activation treatment for depression. Frontiers in Psychiatry.