What is Behavioural Activation (BA) And How Is It Used

To Treat Depression?
Behavioral activation (BA) is “a structured, brief psychotherapeutic approach that
aims to (a) increase engagement in adaptive activities (which often are those
associated with the experience of pleasure or mastery), (b) decrease engagement in
activities that maintain depression or increase risk for depression, and (c) solve
problems that limit access to reward or that maintain or increase aversive control”
(Dimidjian et al., 2011).

The main idea behind BA as a treatment for depression is “to allow patients with
depressive symptoms to learn to cope with their negativity” and to “increase
positive awareness through the re-development of personal goals in the form of
short, medium and long-term life goals” (Chan et al., 2017).

In other words, BA is a type of therapeutic intervention (most often used to treat

depression) that focuses on behavioral changes in a client’s daily life. BA
interventions might involve helping the client plan more activities they actually
enjoy doing, helping the client develop their social skills, or just generally having
the client track their own emotions and activities.

Behavioural Activation is a highly-personalized intervention that targets one’s

depression by targeting the behaviors that feed into that depression.

Behaviourism: The Behaviourist Theory Behind BA

Behavioral activation is informed by a behavioral model of depression, such as the

one outlined by Lewinsohn & Shaffer (1971).
These researchers believed that depression was a behavioral issue (as opposed to a
cognitive issue) that arose from a lack of positive reinforcement, particularly in
social relationships.

Since they subscribed to a behavioral model of depression, the authors believed

that the best way to treat depression was to “restore an adequate schedule of
positive reinforcement for the individual by changing the patient’s behavior and/or
the environment”.

While some psychologists still subscribe to radical behaviorism, most modern

behavioral models are not exclusively behaviorist and do include cognitive
components.

Most modern psychological models, in general, include both cognitive and

behavioral aspects, exemplified by cognitive-behavioral therapy (CBT), perhaps
the most common therapeutic treatment today. In fact, behavioral activation has
begun to be explored as a component of CBT for disorders beyond depression,
such as anxiety (Boswell et al., 2017).

Interestingly, behavioral activation may even be the driving force behind the
efficacy of CBT. A study by Jacobson et al. (1996) which found that to be the case
is one of the main reasons people are interested in Behavioural Activation today.
Specifically, those researchers found that people with depression who completed
BA saw as many benefits as people with depression who completed both BA and
some cognitive components of CBT.

While behaviorists no longer deny the importance of cognition, they still advocate
for behavioral treatments over cognitive treatments, since behaviors are easy to
target than thoughts.

The paper cited above (Jacobson et al., 1996) indicates that behavioral activation
may even be the reason CBT is so effective.

Thus, while behaviorists no longer necessarily think that positive reinforcement is

the only way to treat depression, they still believe it is one of the best ways.

Applied Behaviour Analysis: Can ABA Help Your Client?

Behavioral activation is a type of applied behavior analysis, which is a field of
research based on the principles of B.F. Skinner’s work, and particularly his
findings that “in a given environmental context, behaviors that produce favorable
outcomes will continue to occur through the process of reinforcement and those
behaviors that do not produce favorable consequences will decrease over time, or
extinguish” (Roane et al., 2016).

One of the strengths of behavioral activation is that it can be customized according

to a person’s “values and abilities”, and can also be customized for specific types
of MDD, such as comorbid MDD and a personality disorder (Cannity & Hopko,
2017; Kanter et al., 2010). In other words, in almost all cases of depression, some
sort of BA intervention is appropriate.

One thing to keep in mind about BA interventions is that the therapist must be
mindful of their own reinforcement of the client’s behaviors (Pass et al, 2016).
That is, the therapist should make sure to reinforce healthy behavior from their
client during their sessions.

The Use Of A Behavioural Model For Behavioural

Activation
In order to develop a behavioral activation intervention for a client, one must first
conceptualize a behavioral model of that client’s depression.

Take the case study of a 16-year-old girl named Amy with depression (Pass et al.,
2016). In order to begin treating her depression, her therapist interviewed both
Amy and her mother in order to figure out what her depression looked like.

From their input, the therapist determined that Amy’s depressive symptoms likely
stemmed from her father’s recent death, her mother’s recent illness, her symptoms
of fatigue, and her increased academic workload. Her fatigue was of particular
interest, as it kept her from positive reinforcement, particularly in her social life.

That is, since she felt tired, she would not go hang out with her friends. Since she
was not hanging out with her friends, she would feel bad, and this bad feeling
would lead her to have low energy levels. This “vicious” cycle is presented here
(reprinted from the article), along with an alternative cycle which Behavioural
Activation interventions aim to put in place:
BA was ultimately able to help Amy get over her feelings of depression, in part by
helping her find more positive reinforcement in her social life. The personalized
behavioral model of Amy’s depression conceptualized by Amy, her mom, and her
therapist was a crucial aspect of this improvement.

The benefits of a behavioral approach (as opposed to a cognitive approach) like

this are illustrated by a comment from Amy, as the paper notes that “Amy had
stated in her assessment that she wanted something more ‘practical’ than the
bereavement counseling she had received previously. She felt that she had already
had an opportunity to explore her feelings toward her father’s death, and this was
not her aim for the current work”.

10+ Techniques For Behavioural Activation

Some of the techniques used in behavioral activation include (Dimidjian et al.,
2011; Lejuez et al., 2001a):

 Self-monitoring of activities and mood

 Activity scheduling
 Activity structuring
 Problem-solving
 Social skill training
 Hierarchy construction (ranking how easy certain activities are to
accomplish)
 Shaping (training healthy behaviors)
 Reward
 Persuasion
  Behavior contract (signing a contract with friends and family so that they
will only reinforce healthy behaviors)
 Life area assessment (determining in which areas of life one desire success)

4+ Behavioral Activation Worksheets & Activities

If some of the above techniques sound interesting, here are some behavioral
activation worksheets which can be used to work through some of those
techniques, with the final worksheet actually being a full Behavioural Activation
treatment manual:

Positive Activities for Behavioral Activation

This worksheet will help someone figure out some of the activities that they find
rewarding, and how rewarding they find those activities. The worksheet simply
asks for a list of activities, then asks how rewarding each of those activities is. This
worksheet is a good way for someone to figure out which activities they actually
find rewarding in life.
You can increase the line according to you.

Behavioral Activation Worksheet Fun & Achievement

This is a basic activity scheduling worksheet. Activity scheduling helps people

follow through on their responsibilities, but also helps people plan more positively-
reinforcing activities (such as spending time with friends). As the worksheet states,
the best effects are achieved by scheduling a balance of responsibilities and fun
activities.
Behavioral Strategies for Managing Depression

The above worksheet is part of a larger packet, and this is that larger packet. Aside
from the activity scheduling worksheet, it also includes a more rigid activity
schedule that can help someone plan out their days, rather than just plan a few
activities for the near future.

Besides those two worksheets, this packet also includes information on how
behavioral techniques can help depression, and how one can use these behavioral
techniques to their advantage. This is a deep resource that can help someone both
understand why BA is helpful and start practicing it in their lives.
A Brief Behavioral Activation Treatment for Depression Treatment
Manual

Finally, this is an entire treatment manual for a brief behavioral activation

treatment for depression (BATD), as outlined by Lejuez et al. (2001b).

It can “be used as a complete treatment, or as a component of therapy that may

include other therapeutic techniques and possibly medications”. It includes a
discussion of BA and BATD as well as justifications for these treatments and also
includes worksheets and other resources to help someone follow a BA program.

This manual is deep and will take a while to work through but is likely the most
complete resource available for someone interested in Behavioural Activation.