Behavioral activation is a treatment for depression that helps people focus on re-engagement with their lives and on doing things that are likely to improve their mood (Jacobson, Martell, & Dimidjian, 2001). In treatment using behavioral activation, the activities in a depressed person’s life are altered to lessen depression. The client is helped to structure their lives differently.
Rather than treat a supposed deficiency of the individual, behavioral activation takes a more practical approach to examining what is occurring in the person’s life to worsen or maintain the depression.
The role of avoidance
Very often, one of the key components of depression is avoidance. People who struggle with depression often withdraw or isolate themselves. Withdrawing and isolating may seem to the depressed person as good ways to avoid negative interactions, like getting into an argument with a parent, spouse, teacher, etc. However, this avoidance also prevents them from having any positive interactions. For example, if Sal tells me he “lays in bed all day because dealing with people is too exhausting,” then he likely will continue to feel lethargic and unmotivated to engage in work (or play). He may then begin having issues at work (e.g. tardiness, unexplained absences) that will only worsen his depressive feelings. Sal also denies himself the chance to have positive interactions with coworkers that might improve his mood. His repertoire of behaviors becomes limited as well; e.g., prior to feeling depressed he may have made social plans after work, but now he just wants to go home and sleep.
Sal’s changes in daily routines (e.g., more time spent sleeping, going to bed earlier, spending less time with friends) are another major focus of behavioral activation treatment. When healthy daily and weekly routines get disrupted, depression may worsen because we are out of sync with the larger environment. For example, Sal is now sleeping at 8pm when his friends are getting together to see a show or have dinner. These disruptions change the way Sal interacts with his environment, and thus worsen his depressive symptoms.
What does behavioral activation look like?
Using a behavioral activation approach, I would encourage Sal to examine how his behaviors are maintaining or exacerbating his depression. Once we have a clear understanding of how his behaviors might maintain and/or worsen his depression, Sal’s work is to “do something different.” Rather than continue to engage in ill-serving behaviors (isolating) and behavior patterns (waking late and being tardy to work), Sal would work toward small, day-to-day, changes that will promote more pleasurable experiences.
Additionally, behavioral activation takes the stance that behavior is directed by therapy-inspired goals, and not how Sal is feeling. In Sal’s case, he would be advised to set a routine sleep and wake time and stick to this goal regardless of how he feels. If Sal set a goal to go to bed at 10pm, but has gotten into the habit of going to bed at 8pm, we would brainstorm ways he might fill those hours with activities that ideally would be enjoyable. Regardless, Sal would be cautioned against going to bed at 8pm, even if he was having a particularly bad day. If he goes to bed early, he will miss out on the opportunity to have a mood-lifting experience.
The bottom line
This behavioral treatment of depression helps Sal focus on tangible changes he can make in his daily life that are likely to lead to improved mood. What can Sal do differently today and this week that will potentially lead to a different outcome than his previous days and weeks? Unless Sal sets a “do something different” goal, nothing will change.
Jacobson, N., Martell, C., & Dimidjian, S (2001). Behavioral activation treatment for depression: Returning to contextual roots. Clinical Psychology: Science and Practice, 8, pp. 255-270.