Behavioural activation is a technique used as part of cognitive-behavioural therapy or as a standalone treatment that involves using behaviour and activities to influence someone’s emotional state. It has proven successful to treat depression, especially severe depression, where the person affected finds it difficult to engage in activities or get out of bed.
The technique has its roots in the behavioural model of depression developed by Ferster in 1973. This model defends that depression originates when the person stops feeling as much pleasure as he used to when doing the activities that once were pleasant and, as such, depression is the result of the loss of positive reinforcement.
Once the activities that were previously pleasant stop feeling rewarding, the person avoids doing them, which in turn decrease even further the positive reinforcement. As a consequence, the affected person obtains short-term relief but in the long run, prevents the person from doing any activity. The outcome is that the individual engages in a small amount or no activity, stays in bed most of the day, and obtains very little or no positive reinforcement or reward.
How behavioural activation works?
From this model, behavioural activation was developed as a treatment to reverse this vicious circle. Behavioural activation therapy is rooted in operant conditioning and its basic idea is that stopping avoiding activities and gradually scheduling them can stimulate a positive emotional state. This positive emotional state can encourage the person to engage in more and more activities.
The tool focuses on creating a weekly schedule for behavioural activation, that includes a series of tasks that one has to complete. This schedule pays particular attention to the avoided tasks, and the activities are reinserted gradually.
Any activity can be scheduled in behavioural activation. For example, one can schedule doing laundry or washing the dishes, and also meeting friends or exercising. A key point in this type of treatment is the focus on increasing the activities that are aligned with one’s values in life.
Understanding what your priorities in life are, and what things you value and are important for you, are essential to realising what type of life you want to create. This self-reflection can help you to behave in a way that aligns with your values and start doing the activities that create the desired life.
Small changes in behaviour can lead to different positive results and changes tend to lead to more changes. The following are examples of positive consequences scheduling activities can have:
Increasing pleasure and mood
If you lack motivation for doing any activity, start doing small tasks can bring you a sense of pleasure and meaning that can bring your mood up slowly. For instance, someone that enjoys writing may find it difficult to do it when they are depressed. They may avoid the activity and stop writing completely, which will prevent this person from obtaining the pleasure they used to get while writing.
If this person schedules a small amount of writing each day, even if it is just writing two phrases, it will demonstrate that they can do it, they may feel the pleasure of writing, and they will reduce the sense of hopelessness. Just by introducing the avoided activity, the person can improve their overall mood and be encouraged to continue doing it.
Challenging unrealistic thoughts
People with depression often have unrealistic and unhelpful thoughts about themselves, others and the world. By not engaging in any activity, they reinforce ideas about their hopelessness and worth. For example, you may think that your friends don’t want to hang out with you. This thought may push you to stop meeting them and, eventually, they may stop reaching out, knowing that you won’t want to hang out. By doing this, you may mistakenly confirm that people don’t want to hang out with you.
Reversely, if you start reaching your friends and meeting with them every week, they will start counting on you again and call you to meet more often. Their reaching out can disconfirm the belief that your friends don’t want to hang out with you.
In the same way that not engaging in any activities can damage your relationships, scheduling small tasks and activities with other people can improve your relationships. For instance, if for you it is important to nurture your relationships with your family if you go from not doing anything to start scheduling activities with your parents, you will enhance the connection with them.
How successful is behavioural activation?
Literature on behavioural activation has focused on its effectiveness as a treatment for depression. Generally, research has proven this technique successful for depression (Soucy Chartier and Provencher, 2013). In the popular study conducted by Jacobson et al. (1996), it was shown that behavioural activation as a standalone treatment is successful for depression. A meta-analysis done by Ekers, Richards and Gilbody (2007) proved that both cognitive therapy and behavioural activation had similar effectiveness for depression. Finally, another study demonstrated higher effectiveness of behavioural activation in comparison to cognitive therapy, and similar success when compared to medication (Dimidjian et al., 2006).
Dimidjian, S., Hollon, S.D., Dobson, K.S., Schmaling, K.B., Kohlenberg, R.J., Addis, M.E., Gallop, R., McGlinchey, J.B., Markley, D.K., Gollan, J.K., Atkins, D.C., Dunner, D.L. and Jacobson, N.S. (2006). Randomized trial of behavioural activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of consulting and clinical psychology, [online] 74(4), pp.658–70. doi:10.1037/0022-006X.74.4.658.
Ekers, D., Richards, D. and Gilbody, S. (2007). A meta-analysis of randomized trials of behavioural treatment of depression. Psychological Medicine, 38(5), pp.611–623. doi:10.1017/s0033291707001614.
Jacobson, N.S., Dobson, K.S., Truax, P.A., Addis, M.E., Koerner, K., Gollan, J.K., Gortner, E. and Prince, S.E. (1996). A component analysis of cognitive-behavioural treatment for depression. Journal of Consulting and Clinical Psychology, [online] 64(2), pp.295–304. doi:10.1037/0022-006x.64.2.295.
Soucy Chartier, I. and Provencher, M.D. (2013). Behavioural activation for depression: Efficacy, effectiveness and dissemination. Journal of Affective Disorders, [online] 145(3), pp.292–299. doi:10.1016/j.jad.2012.07.023.
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