Small Steps, Big Change: Behavioral Activation for Depression
Behavioral activation is based on the premise that depressive behavioral patterns can be interrupted by incorporating activities and moments that offer joy
Symptoms of depression can affect multiple aspects of our lives. The most apparent symptoms include behavioral changes, such as withdrawal from people, activities, and pleasurable moments. There might be plenty of reasons behind this withdrawal, such as lack of energy, motivation, or pleasure, which lead us to avoid being around other people and specific situations. Or we might want to “protect” ourselves from further feelings of distress. Although this withdrawal may offer temporary relief, the disengagement from activities reinforces negative patterns of thinking and a lowered mood. Negative changes in activity levels can support cycles of depression because our behaviors influence how we think and feel. By disengaging from things that once brought joy, we are conditioning ourselves to stay in this negative headspace. A persistent low mood is an internal sign that our current routine is not working for us, and one way to combat these feelings of depression is through behavioral activation. Behavioral activation is the concept that positively altering activity levels can also improve mood. This is based on the premise that depressive behavioral patterns can be interrupted by incorporating activities and moments that offer joy. This therapeutic intervention helps break the cycle of depression by directly targeting avoidant behavior and encouraging engagement in mood-boosting activities. We promote a more balanced routine that supports a positive mood by engaging in rewarding and fulfilling activities. This action-oriented tool helps address how our emotions can guide our behaviors. In this therapy sketch, we will explore the concept of behavioral activation.
What is Behavioral Activation?
Behavioral Activation is an intervention that aims to boost positive mood and break the cycle of avoidance by encouraging individuals to participate in activities they enjoy, find productive, and personally meaningful. Behavioral activation is recognized as an evidence-based method in depression intervention, focusing on functionally analyzing activity planning and avoidance processes to enable individuals to reengage in activities they previously enjoyed (Beck, 2011). As a result, it helps individuals to refocus on the valuable aspects of their lives. The rationale behind the behavioral activation is essentially to interrupt the cycle of depression. To better understand behavioral activation, let's explain the cycle of depression:
Cycle of Depression
When we take a closer look at the thoughts of individuals with depressive moods, it is possible to see that the cognitive triad, which includes themselves, their environment, and the future, is dominated by negative thoughts. They may evaluate themselves, such as, “This situation is my fault, or I am guilty.” They may assess their environment as “Everything is terrible, or the world is no longer a place to live in.” They may see the future as “Nothing will get better, and everything will get worse.” Any triggering event or events may cause these thoughts to arise automatically. As a result, these thoughts may lead to unhappiness, lack of joy, and sadness, and consequently to behavioral symptoms such as reduced action and social withdrawal. However, after a while, these behavioral symptoms, such as reduced action and social withdrawal, become a source of unhappiness, lack of joy, and sadness. This becomes a vicious circle over time. Behavioral activation is designed to break this vicious circle by reminding individuals that they have the self-efficacy to challenge maladaptive thoughts and choose more adaptive ways to take action (Freeman & Oster, 1998). The following section outlines key strategies that can be used to effectively initiate behavioral activation in practice.
How to Engage in Behavioral Activation?
Many mental health professionals use behavioral activation for depression, anxiety, and post-traumatic stress disorder. It is known to be an effective tool in adults, teens, and children. Even outside of a clinical setting, behavioral activation offers a practical framework that you can try in your daily life to improve your mood or break a depressive cycle.
The first step is to assess current activity levels. Keeping track of daily activities makes it easier to identify the joyful moments that are missing from your routine. You can ask yourself which activity you have engaged in less recently. You can assess these activities in terms of competence or pleasure. These activities can include occupational, school, family, social, and recreational pursuits, such as hobbies.
To determine this, you can use a daily activity log to track your progress. An activity log helps draw connections between your behavior and mood. This provides a deeper understanding of how these activities affect you. For example, you might be pressuring yourself to complete activities in a way that prevents you from enjoying them, or finishing them might make you feel incompetent, leading you to avoid them altogether. An activity log helps you take a conscious look at your daily activities.
The next step is to identify where pleasurable activities can be incorporated into your week and take action on them. The goal is that these activities are aligned with your values and offer greater feelings of pleasure or fulfillment. This promotes identifying what healthy activities can be focused on and incorporated into a daily routine. To do that, you can list several activities and rank them from easiest to most challenging. For example, this can range from texting your friends to skydiving.
The final step is to evaluate your progress and celebrate your accomplishments. To do that, you can reflect on these questions: Which activity benefited you, and which did not? Why? Should you raise your goals for next week or maintain them as they are? When evaluating your week, please don't forget to celebrate your achievements; even minor improvements are worth celebrating. This step is helpful in identifying where you're having difficulties and adjusting your plan accordingly (Beck, 2011).
Although we have provided an outline above, this intervention can be tailored to meet each individual’s specific needs. The core principle of all the applications is to keep individuals active, with a focus on participating in life. Behavioral activation focuses on finding out which behavioral patterns contribute to the maintenance of depressive mood and which changes would improve individuals' mood, and making changes in these areas repeatedly and persistently (Martel et al., 2022).
To sum up, cognitive Behavioral activation is a therapeutic intervention that emphasizes how our feelings, thoughts, and behaviors are interconnected. By adopting behaviors that we enjoy and feel competent in during depression, we begin to notice an improvement in mood and more positive thinking patterns. This helps support the incorporation of moments of self-care, offering a greater balance throughout the day.
Tips For Behavioral Activation
Even though we provided an outline of how behavioral activation works, here are more tips to support you during the process if you decide to give this technique a try:
Start Simply: Taking action might not be easy initially, but it can also help prevent procrastination. Therefore, it is essential to start with something small and achievable, such as going for a walk, to prevent procrastination.
Move Forward Step by Step: Create a list starting with what you used to enjoy doing, and take action by choosing the most straightforward or most feasible option. However, this may not stop you from procrastinating. The action you will take may still seem like a big step. For these reasons, breaking this big step into smaller and smaller steps is essential. Because with the motivation and mood change from the first step, the other steps would be completed. For example, if you used to enjoy traveling to new cities with your friends, your first step could be to meet your friends at a café or somewhere nearby.
Remind Yourself of Your Purpose: The process may not be easy, and at times, you may want to stay still or feel demotivated. In such cases, remembering why you are doing it and the impact of your behavior on your mood and the cycle of depression can help you stay motivated.
Seek Help from a Mental Health Professional: Even though engaging in behavioral activation seems straightforward and easy to apply, it can be really challenging when individuals feel depressed. A mental health professional helps you understand which activities induce which thoughts and emotions, allowing you to recognize how your behavior influences your mood by providing a cognitive behavioral framework and psychoeducation.
Takeaways:
Behavioral activation is an evidence-based intervention that has been used for improving individuals’ mood and leading them to take action to break the cycle of depression.
The cycle of depression starts with negative automatic thoughts about oneself, the world, and the future, causing feelings of sadness, guilt, and hopelessness. These feelings lead to withdrawal and avoidance behaviors, which reduce positive experiences, reinforce negative thoughts, and create a vicious cycle.
Behavioral activation aims to break this cycle at the behavioral level, where the person begins to develop positive feelings and thoughts by re-engaging in activities that they have been avoiding but that were enjoyable.
You can engage in behavioral activation by assessing your activity levels and tracking your daily activity in terms of competency and enjoyment, adding pleasurable activities to daily life, and evaluating performance.
Practical points in behavioral activation are starting simple, moving forward step by step, and reminding yourself when you are demotivated and seeking professional help when further guidance is needed.
References:
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). The Guilford Press.
Freeman, A., & Oster, C. L. (1998). Cognitive therapy and depression. In Elsevier eBooks (pp. 489–520). https://doi.org/10.1016/b978-008043433-9/50018-3
Martell, C. R., Dimidjian, S., & Herman-Dunn, R. (2022). Behavioral Activation for Depression (2nd ed.). The Guilford Press.