Behavioral Activation for Depression

Behavioral activation is part of the ‘B’ or behavioral side of cognitive-behavioral therapy that focuses on changing what people do. I should mention that during college, I worked in the laboratory of Neil Jacobson, who studied behavioral activation. I may be biased in favor of behavioral activation.

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Behavioral activation primarily targets depression. It usually starts with activity tracking to determine which activities make a person feel better and which do not. Then a client schedules pleasant activities and achievement or mastery activities.

Pleasant activities increase positive emotions such as feeling happy or relaxed. Achievement activities promote a sense of mastery because the client accomplishes something, but it might not be pleasant. For example, one client may enjoy knitting and have to change the oil in their cars. The first activity (knitting) makes the client feel better, while the oil change provides a sense of accomplishment and mastery.

The theory behind behavioral activation is that when people become depressed, they stop activities that make them feel better. This leads to fewer positive emotions and more depression, eventually leading to clinical levels of depression. To counteract the depression and stop the cycle, a client needs to schedule pleasant activities that promote achievement and mastery.

If a client only adds pleasant activities, they might feel less depressed but also anxious about everything they are not accomplishing. If clients only add achievement and mastery activities, they might feel better about what they accomplish but could still be miserable.

Behavioral activation may seem deceptively simple. It is actually much harder to treat depression with behavioral activation than to just “start doing more things.” I frequently see advice to just start exercising as a panacea for depression. This can be misleading and discourage people with depression who struggle to feel better.

Which activities are pleasant and which provide mastery are highly individual. No one activity will alleviate depression. The therapeutic process in behavioral activation involves identifying which activities are pleasant, which provide a sense of mastery, and what balance of the two is best for that person.

This is why behavioral activation starts with activity tracking; it helps the client and therapist identify which activities might help and what is currently lacking. The tracking can also help find which activities the client can stop or do less often, so they have time for pleasant and accomplishing activities.

Behavioral activation is simpler than challenging negative automatic thoughts. It can be helpful to give a client something tangible and more immediate to address their depression than challenging automatic thoughts. For some clients, behavioral activation may be enough to treat their depression, but additional cognitive behavioral therapy techniques are needed for many.

Cognitive-behavioral therapy includes many behavioral approaches (hence the name), and behavioral activation is one of many.

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