Behavioral Activation for Depression

Behavioral activation therapy is related to CBT, but also functions as a separate set of steps, especially useful for major depression.  Starting from the premise that a life well-lived is inherently enjoyable, behavioral activation teaches that depression is overcome, not by thinking, but by action.  The first step is to list things that give you pleasure, a feeling of mastery, or sense of engagement.  While in an episode of deep depression, you may not actually get pleasure from activities that used to please, but the experience here is that doing them anyway is the way forward.

To this end, a list of “pleasurable activities” is offered here, and you are encouraged to note a few of these that have given you pleasure in the past, even if doing them doesn’t seem like it would be pleasurable right now.  Then you set goals for small, achievable tasks and strategies that will give you a sense of progress.

Importantly, motivation is not required.  Behavioral activation posits that taking the action is what brings the positive reinforcement, thereby creating motivation for future actions.  Daily scheduling is an important part of the overall plan, making sure that sleep and waking schedules, exposure to morning light, nutritious meals, exercise and other pleasurable and positive acheivements are built into the day, so that you don’t have to make yourself do each important thing, you just have to commit to following the schedule you made.

In goal-setting, you are encouraged to keep the goals challenging, but also achievable, and to allow “wiggle room” in the achievement benchmarks, so that you don’t feel guilty if you don’t make it to each goal.  Allow yourself to fall short some of the time, and don’t let the goal drive you beyond what gives you that feeling of mastery over the skill or activity in question.

For example, when setting goals for exercise, we often want to make them hard, both because we want a challenge, but also because we don’t think what we can actually do is “good enough”.  So think carefully about your goal: is it too high, which is planning for failure, or just high enough to give satisfaction when it’s achieved?  If you think you “ought” to walk for 20 minutes every evening, then set a goal of walking for 15 minutes every other day.  Once you can achieve this, give yourself credit for reaching a goal, and then move the goal posts just a bit further on.  In this way, you develop gradually and keep on celebrating milestones along the way.

For more information, see:

Behavioral Activation.  Positive Psychology Program

Overcoming Depression One Step at a Time