Using Behavioral Activation To Overcome Depression
Depression is characterized by an extended period of low mood, or a loss of interest in life activities. Although often conceptualized cognitively in terms of negative thoughts and beliefs, depression can also be effectively conceptualized and treated using a behavioural model. Early behavioral theory (e.g. Ferster, 1973) proposed that depression is developed and maintained in response to insufficiently rewarding environments. Kanter and colleagues (2009) describe the behavioral processes which can lead to depression: environments with too few positive reinforcers, environments with too many negative reinforcers, environments characterised by inescapable punishments, and other people can positively and negatively reinforce depressive behavior.
“According to BA, a meaningful life is a life filled with diverse and stable sources of positive reinforcement” (Kanter, Busch, Rusch, 2009)
The goal of Behavioral Activation (BA) is to help clients to develop routines and patterns of behavior that place them in contact with stable sources of positive reinforcement. Techniques to achieve this goal include:
- Activity monitoring: to obtain a baseline level of activity, to gather information about the association between different activities and client emotions.
- Identifying values: Values were introduced into modern behavioral theory via work on Acceptance and Commitment Therapy, have been introduced into later iterations of behavioural activation. Spending time to identify values can help the client to identify goals and behavior consistent with their values, which can help to encourage persistence in the face of adversity.
- Activity scheduling and activation: to help clients to initiate and maintain positively reinforcing behaviour.
Behavioral Activation is an empirically-supported treatment for depression. There is strong evidence from multiple RCTs and meta-anlyses that it is an effective treatment for depression, with effect sizes equivalent to those for cognitive approaches (e.g. Jacobson, et tal, 1996; Cuijpers, van Straten, Warmerdam, 2007; Sturmey, 2009). There is evidence that BA is effective across multiple population, contexts, and delivery methods including inpatients (Hopko et al, 2003), groups (Simmonds-Bucklet, 2019), and internet delivery (Nyström et al, 2017).
Using Behavioral Activation To Overcome Depression is a guide written for clients who are currently depressed. It is designed so that clients can use it as a form of guided self-help, but can also effectively be used to support face-to-face BA therapy. Using simple language, it provides clear information about depression and the ingredients for wellbeing, provides a rationale for behavioral activation, and guides the client through activity monitoring, values clarification, and activity scheduling. The guide includes a selection of concise behavioral activation worksheets.
Instructions“One of the most effective treatments for depression is called Behavioral Activation. At its core, this treatment says that by changing what we do, we can change the way we feel. The goal is to work out how to make your life feel meaningful and pleasurable. To do that we need to help you to become more active and living the life that you want to live, or working out what kind of life that might be. This guide will walk us through the steps we need to help you overcome your depression.”
- Cuijpers, P., Van Straten, A., & Warmerdam, L. (2007). Behavioral activation treatments of depression: A meta-analysis. Clinical psychology review, 27(3), 318-326.
- Ferster, C. B. (1973). A functional analysis of depression. American Psychologist, 28(10), 857.
- Hopko, D. R., Lejuez, C. W., Lepage, J. P., Hopko, S. D., & McNeil, D. W. (2003). A brief behavioral activation treatment for depression: A randomized pilot trial within an inpatient psychiatric hospital. Behavior Modification, 27(4), 458-469.
- 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., Busch, A. M., & Rusch, L. C. (2009). Behavioral activation: Distinctive features. Routledge.
- Nyström, M. B., Stenling, A., Sjöström, E., Neely, G., Lindner, P., Hassmén, P., ... & Carlbring, P. (2017). Behavioral activation versus physical activity via the internet: A randomized controlled trial. Journal of Affective Disorders, 215, 85-93.
- Simmonds-Buckley, M., Kellett, S., & Waller, G. (2019). Acceptability and efficacy of group behavioral activation for depression among adults: a meta-analysis. Behavior Therapy, 50(5), 864-885.
- Sturmey, P. (2009). Behavioral activation is an evidence-based treatment for depression. Behavior Modification, 33(6), 818-829.