Behavioral activation (BA) is a key component in the treatment of depression.  The focus of BA is increasing structure, activities, and social interactions to decrease isolation and avoidance, while challenging negative automatic thoughts. 

Understanding Depression

Some of the primary symptoms of depression are:

• Finding little or no joy in previously enjoyed activities
• Low motivation or drive to engage in activities
• Increase/change in sleeping patterns
• Feeling hopeless, pessimistic, worthless, or guilty
• Trouble thinking or concentrating

As one continues to engage in these behaviors, they often disengage socially and withdraw from others and from life in general.  Using the cognitive-behavioral model, we can see this actually perpetuates the depression and keeps them feeling down.  Here’s how:

• One feels depressed and doesn’t want to get out of bed (feeling)
• They stay in bed (behavior)
• Staying in bed often makes them believe themself to be lazy, worthless, not good enough (thought)
• This thought leads to more depressed feelings and then they repeat the cycle again

Here’s another example: 

• An individual believes they have no friends. They think no one cares about them and people only reach out to them out of pity or obligation (thought)
• They feel isolated, sad and rejected (feeling)
• Someone calls/texts and they don’t answer the phone (behavior). It’s too hard (thought) or they don’t want to be a burden to others (thought)
• This behavior then amplifies the thought that they aren’t “pulling their weight” in relationships. It “proves” their thoughts were right, leaving them feeling more rejected and disconnected from others

Knowing that this is how the cycle of depression works, it makes sense that we need to break or stop it.  Because our feelings are transient, meaning they will ebb and flow, we cannot just “change” them and shut down anything uncomfortable.  Nor, is this a healthy way to respond.  Similarly, our thoughts come and go as well and they are not always in our control.  Therefore, we focus on our behavior, the thing we have the most control over.  

How Behavioral Activation Helps Depression

In BA, we help you make gradual changes to your behaviors to start breaking this cycle.  Maybe, it starts with putting your feet on the floor, standing up, and getting back into bed.  From there, we continue to increase the difficulty of the tasks to build confidence and interaction back into your life.  Engaging in these behaviors repeatedly then begins to challenge the depressed thoughts and can begin lifting the “dark cloud” often felt by individuals with depression.  

In short, the goals of BA are:

• Reinforce non-depressed behaviors (i.e., socializing, leaving the house, making meals, physical movement/exercise, etc.)
• Increase more rewarding experiences (i.e., more time with others, feeling the sunshine on our face, getting a complement from others)
• Reduce avoidance of healthy routines (i.e., shower, brush teeth, run errands, etc.)
• Take action versus waiting to feel motivated

Although behavioral activation can be quite difficult to start, it can really help propel therapy forward. Once we learn how to engage in the behaviors, regardless of our thoughts and feelings, we have more agency in our treatment progress. Once basic activities of daily life are being accomplished, therapy can then focus more time and attention on the distressing and distorted thoughts.