Behavioral Activation for Depression: What, Why, and How

​Behavioral Activation for Depression: What, Why, and How

Written by Kat Harris, PhD, LCP

What

Behavioral activation is an important component of Cognitive Behavioral Therapy (CBT). Cognitive Behavioral Therapy includes many components and is based on the principle that thoughts/beliefs (Cognitions), emotions, physical symptoms, and behaviors are all intricately related. Helping someone feel better using CBT would typically involve changing unhelpful thoughts/beliefs (Cognitions), emotions, and behaviors via a variety of tools such as cognitive restructuring, emotion regulation and distress tolerance skills, mindfulness, behavioral activation, coping skill development, interpersonal effectiveness skill refinement, trauma processing, etc. CBT is considered a Evidence-Based Practice (EBP)/an Empirically Supported Treatment and is the gold-standard treatment approach across many client concerns.

Why

Specifically, changing behaviors is one of the core goals in CBT, as it is thought that behavioral change allows for healthy corrective experiences that can alter unhealthy beliefs about the self, world (including others), and one’s future. Avoidance and withdrawal, some of the key features of depression and other disorders, inhibits an individual's opportunity and ability to obtain corrective experiences and positive reinforcement from their environment. Therefore, behavioral activation treatment involves encouraging “activation” and participation in “anti-depressant” activities…interaction with one’s environment in a way that offers opportunities for positive reinforcement and increases in self-efficacy (a person’s belief in their ability to exert control over their lives and their world). 

How

• Waiting until you feel “ready” to change may not be the best approach, as understandable as that inclination might be. You must DO first, and the readiness and motivation will follow with consistent “doing” as the “activation” builds momentum
  • Hint: Have you ever exercised or attended a social event even though you didn’t want to, and felt better or “activated” afterwards? That’s a natural activation experience. 
• Using avoidance and withdrawal as coping strategies is understandable…however, while these strategies may have been adaptive and protected you for a time, they are now keeping you stuck and perpetuating your depression and distress. And unfortunately, avoidance and withdrawal breeds avoidance and withdrawal, so you will need to break that cycle by “Doing” regardless.
• Identify “anti-depressant activities” and schedule them into your day. 
  • Try to incorporate activities that are naturally reinforcing 
  • Try to incorporate activities that are consistent with your values. 
    • Values are what we believe to be important and meaningful in our lives. These can include all kinds of things, but some examples are health, relationships, achievement, adventure, compassion, creativity, duty, fun, honesty, safety, stability, etc. 
  • Incorporate activities that fall into the following categories:
    • Pleasure: These involve activities that make us feel good and we might associate with happiness, joy, or peace. This might include taking a bath, playing a game, doing a hobby, going on a trip, planning a vacation, etc.
    • Purpose: These are activities that are consistent with what we believe to give our lives meaning and purpose. This might include volunteering, spending time with family, friends, or children, etc. 
    • Mastery: These are activities where we might work towards small or large goals such as learning a new language, sport, or skill. 
  • Do them regardless of how you feel or what your mood is (Hint: Mindfulness and establishing your “Why’s” can help with this). 
• Monitor your use of activities and your mood to establish patterns and correlations
• Start with small steps and be your own cheerleader
• Make sure you are not engaging in thoughts and behaviors that undermine your goals!
  • Use an objective lens to ensure fair and unbiased interpretations of feedback from the world
  • Reduce the tendency to ruminate (i.e., think about something over and over again in a negative and unhealthy way).
  • Use an external focus of attention and try to be fully present when engaging in activities
• Use problem-solving techniques (not worry or rumination) to work through barriers

​To learn more about depression, see our Depression Specialty Page.