Learning theories propose that depression is the result of losing touch with sources of positive reinforcement: falling into habits of inactivity (or the wrong kinds of activity) lead to a lowering of mood. Once an individual feels depressed they may lack motivation, become less active, experience less positive reinforcement – and the cycle repeats or exacerbates. A behavioral approach to overcoming this vicious cycle of depression is to increase one’s level of activity even in the absence of feelings of motivation. This approach is called behavioral activation (BA) and there is strong evidence that it is an effective treatment for depression (Ekers et al, 2014), with equivalent effect sizes to treatments such as cognitive therapy (Jacobson et al, 1996). Modern approaches to BA include Martell, Addis & Jacobson’s package Depression in context: Strategies for guided action (2001), and Lejuez, Hopko & Hopko’s package Brief Behavioral Activation Treatment For Depression (BATD: 2001).
Different behavioral activation protocols include a variety of treatment components, but all contain steps of activity monitoring and activity planning / scheduling (Kanter et al, 2010). Activity monitoring within BA can accomplish a number of goals:
- It allows the therapist and client to observe specific information about the client’s a baseline level of activity, which can by used as a comparator later in treatment.
- It can focus the client’s attention on their current level of activity.
- Ratings of mood, enjoyment, accomplishment, or connectedness collected alongside the record of activity can be used to generate hypotheses about which types of activity it might be most helpful to schedule.
- Activity diaries can form the basis for a conversation about the relationship between activity and mood, or the client’s current engagement in activity which is in line with their values.
This Behavioral Activation Activity Diary is a worksheet designed for activity monitoring. This diary is in a 7-day format and includes sections for: recording activity in the morning / afternoon / evening; prompts to help clients to record the most helpful kinds of information; and a mood rating scale.
“So that we can start to gather some ideas about why you are depressed I would like you to use this activity diary to record what you do every day for a week, even for activities that might seem trivial or unimportant. We need to find out how your mood changes as you do different activities, so rate your mood for each time slot on a scale of 0 to 10, with 0 representing feeling very depressed and 10 representing feeling very good.”
Once a client has monitored their activity for a week the information recorded can be examined for deficits in (rewarding) activity, relationships between activity and mood, breadth or restriction of activity, and consistency with values. Some helpful questions include:
- Looking at it now, what do you notice about what you recorded on your activity diary?
- What activities made you feel the best?
- What activities made you feel the worst?
- What activities made you feel most connected to other people?
- What activities gave you the biggest sense of achievement?
- What activities gave you the biggest feelings of pleasure?
- What do you notice about the relationship between your mood and how active you are?
Ekers, D., Webster, L., Van Straten, A., Cuijpers, P., Richards, D., & Gilbody, S. (2014). Behavioural activation for depression; an update of meta-analysis of effectiveness and sub group analysis. PloS one, 9(6).
Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K., Gollan, J. K., … & Prince, S. E. (1996). A component analysis of cognitive-behavioral treatment for depression. Journal of Consulting and Clinical Psychology, 64(2), 295.
Kanter, J. W., Manos, R. C., Bowe, W. M., Baruch, D. E., Busch, A. M., & Rusch, L. C. (2010). What is behavioral activation?: A review of the empirical literature. Clinical Psychology Review, 30(6), 608-620.
Lejuez, C. W., Hopko, D. R., & Hopko, S. D. (2001). A brief behavioral activation treatment for depression: Treatment manual. Behavior Modification, 25, 255−286.