Clinical Psychologist 20 (2016) 54–55

A clinician’s quick guide of evidence-based approaches:

Behavioural activation
Trevor G. MAZZUCCHELLI,1 Jonathan W. KANTER2 and Christopher R. MARTELL3
1
School of Psychology and Speech Pathology, Curtin University, Bentley, Western Australia, Australia, 2Department of Psychology, University of
Washington, Seattle, Washington, USA, and 3Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA

Correspondence
Trevor G. Mazzucchelli, School of Psychology and Speech Pathology, Curtin University, Kent St., Bentley, WA 6102, Australia.
Email: trevor.mazzucchelli@curtin.edu.au

doi:10.1111/cp.12086

Behavioural activation (BA) is a structured, brief, psy-
chotherapeutic approach that aims to increase engage-
ment in activities that help individuals experience
greater contact with response-contingent positive rein-
forcement in their lives and to solve life problems. The
treatment focuses directly on increasing an individual’s
engagement in pleasurable, productive, or personally
meaningful activities, thereby improving the individual’s
life circumstances and decreasing depression (Dimidjian,
Barrera, Martell, Muñoz, & Lewinsohn, 2011). The sig-
nificance of BA is that it is an effective treatment for
depression that is easy for clinicians to learn and imple-
ment, and easy for clients to understand. It has accumu-
lated an evidence base for its efficacy with a range of
disorders, client groups, settings, modalities, and inter-
vention targets (e.g., Mazzucchelli, Kane, & Rees,
2009, 2010).
Contemporary BA Approaches
Historically, many variants of BA have been developed
and there are two dominant contemporary versions
(Lejuez, Hopko, Acierno, Daughters, & Pagoto, 2011;
Martell, Dimidjian, & Herman-Dunn, 2010). Although
both emphasise the importance of context and activity in
understanding the individual’s behaviour and emotions,
they vary in terms of their degree of structure and the
extent to which they include techniques to identify and
overcome avoidance behaviours, including ruminative
thinking. Martell et al.’s approach emphasises the flexi-
ble application of techniques to both increase BA and
identify and address avoidance. In contrast, Lejuez
et al.’s approach is more structured and emphasises
creating and completing activation tasks. It is important
to note that, rather than simply encouraging individuals
to increase their participation in activities that are
generally thought to be pleasant or mood enhancing,
both approaches involve carefully tailoring the activation
tasks to each individual client’s circumstances. The role
of the BA practitioner is to assist the client to select rele-
vant and achievable activity assignments, break difficult
tasks into manageable steps, troubleshoot problems, and
help the individual maintain their motivation during the
intervention process.
Evidence-Based Treatment Manuals
• Martell, C. R., Dimidjian, S., & Herman-Dunn,
R. (2010). Behavioral activation for depression: A clini-
cian’s guide. New York, NY: Guilford Press.
• McCauley, E., Schloredt, K. A., Gudmundsen, G. R.,
Martell, C. R., & Dimidjian, S. (in press). Behavioral
activation with adolescents: A clinician’s guide. New York,
NY: Guilford Press.
• Lejuez, C. W., Hopko, D. R., Acierno, R., Daughters,
S. B., & Pagoto, S. L. (2011). Ten year revision of the
brief behavioral activation treatment for depression:
Revised treatment manual. Behavior Modification, 35,
111–161. doi:10.1177/0145445510390929
Assessment
• A baseline diagnostic interview and the ongoing use
of a measure to assess symptom severity are
recommended.
• Several self-report instruments are available to assess
client activity level and rewards available in the cli-
ent’s environment.
The Behavioral Activation for Depression Scale—
Short Form (Manos, Kanter, & Luo, 2011) is a 9-
item measure of changes in levels of activation and
avoidance over the course of BA.

54 © 2016 The Australian Psychological Society


The Environmental Reward Observation Scale
(Armento & Hopko, 2007) and the Reward Proba-
bility Index (Carvalho et al., 2011) are 10- and 20-
item measures, respectively, of response-contingent
positive reinforcement.
• Hourly or daily activity and mood monitoring
are ongoing throughout treatment in order to
identify links between activity and mood, facilitate
ongoing functional assessment, select targets for
activation, and track the success of homework
assignments.
Course of Treatment
A typical BA intervention follows the following
sequence:
• Providing an intervention rationale.
• Collaboratively developing treatment goals and select-
ing activation targets.
• Activity monitoring and graded activity scheduling.
• Repeatedly applying and troubleshooting activation
techniques with additional strategies including skills
training, contingency management, problem solving,
and strategies targeting avoidance.
• Relapse prevention by reviewing and consolidating
gains and anticipating challenges.
© 2016 The Australian Psychological Society
Clinician guide to behavioural activation
References
Armento, M. E. A., & Hopko, D. R. (2007). The Environ-
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