In the past few decades, mental health has become a focal point in our culture. From mental health awareness month to ground-breaking research, the topic of mental health has garnered the attention of everyone from high-level officials to grade school students. In particular, depression has been recognized as one of the most common mental disorders worldwide, affecting approximately 264 million people around the world (World Health Organization, 2020). Given its high prevalence rate and its high rate of being present with another mental disorder, researchers and practitioners have scoured for the most effective treatment. One of which is behavioral activation therapy.
You may be familiar with cognitive behavioral therapy (CBT), a common form of psychotherapy. Behavioral activation therapy is very similar to cognitive behavior therapy and is often used within CBT treatment. However, behavioral activation therapy takes on a more practical and applied approach to therapy. Essentially, behavioral activation uses activity planning and activities as positive reinforcement and as “rewards'' to help improve well-being (Forbes, 2020; Karimpour-Vazifehkhorani et al., 2020; Soucy et al., 2019; Solomonov et al., 2019; Carver & White, 1994).
While cognitive behavioral therapy is concentrated on challenging one’s negative thoughts by reframing their thinking, behavioral activation therapy is focused on activities and behaviors that challenge negative emotions. Many of us have activities and behaviors that we use to cope with emotions, whether it be positive or negative emotions. Some of us go to the gym to let out our frustration and anger. Others may curl up in bed with some snacks and a good TV show to cope with sadness. While these coping mechanisms are vital to our well-being, they can begin a vicious cycle of avoidance behavior (Forbes, 2020).
Avoidance behavior occurs when coping mechanisms become a crutch and are used excessively or to avoid uncomfortable feelings. For example, you had a bad day at school/work and you go home and just watch TV alone. You may feel better in the short-term but after a while, it will start to be routine and you may stop participating in other activities. Your performance at school/work may begin to decline and your overall well-being becomes compromised. Additionally, avoidance behaviors can “maintain” pre-existing mental disorders (e.g. depression or anxiety) (Moorey & Hollon, 2021).
Behavioral activation requires finding alternative activities and coping mechanisms that are positive and enjoyable for the individual. It typically entails a variety of small activities such as meeting a friend for coffee, going for a walk, cooking a meal for your family, or engaging in a hobby. While it is often difficult for someone suffering a mental disorder such as depression to do things, the idea is that repeatedly participating in these activities will create positive reinforcement, causing the individual to “seek” out these positive experiences and activities (Karimpour-Vazifehkhorani et al., 2020; Rohani et al., 2019; Soucy et al., 2019).
One of the best things about behavioral activation therapy is how personalized it is and how involved the person is in planning it. While most therapists and psychologists will encourage the patient to set goals that encompass a variety of activities such as socializing or physical activity, they will prioritize the patient’s individuals needs and preferences.
When partaking in behavioral activation therapy, individuals begin with identifying activities they found enjoyable and pleasurable. As mentioned previously, this is a highly personalized process. Perhaps an introverted person will choose activities such as calling a friend or going to a coffee shop to read. A more extroverted person may prefer activities such as hosting a game night with friends or going to a group exercise class. Regardless of the activities, the underlying goal of the activities is to promote positive feelings, a sense of accomplishment, and gratification (Soucy et al., 2019).
Once individuals have identified their preferred activities, they will move into the planning phase of behavioral activation therapy. This stage requires the individual to plan, engage, and monitor their selected activities. Individuals will work with their therapist or psychologist to create a plan to engage in their determined activities and how to overcome possible obstacles. Individuals will keep a weekly planner or journal, which can be an app on their phone or a physical planner, to help monitor and plan their activities. Not only does this help the therapist or psychologist track and monitor the progress of their patient, but it can also help motivate the patient to engage in their activities (Etherton & Farley, 2020; Forbes, 2020; Solomonov et al., 2019).
The overall idea of behavioral activation therapy is rather simple and straightforward. With some structure and guidance, an individual gets to decide their activities, when they do their activities, and how they track and monitor their progress. Behavioral activation therapy has been well-received by both patients and practitioners as it allows the two to work together to create a treatment plan specific to the patient.
At first glance, behavioral activation therapy seems counter-intuitive. After all, don’t people with depression find it extremely difficult to participate in pleasurable activities? Wouldn’t it just make the person’s depressive feelings worse? While it may seem like it would, behavioral activation therapy has proved itself to be just as effective as cognitive-based therapies (Etherton & Farley, 2020; Forbes, 2020; Karimpour-Vazifehkhorani et al., 2020).
One study conducted by Karimpour-Vazifehkhorani and colleagues (2019) used behavioral activation therapy to mediate feelings of depression in university students. 60 students were recruited and were equally divided into 2 groups: an intervention group, and a control group. The 30 students in the intervention group participated in educational sessions that consisted of writing down positive activities, identifying avoidance behaviors, and healthy coping skills.
All 60 participants completed a depression questionnaire before and after the study. The study took place over 4 weeks with a 5-week post-study follow-up. Students in the behavioral activation therapy group had an average 47% decrease in depressive symptoms, a considerable difference compared to students in the control group who had no change in depressive symptoms (Karimpour-Vazifehkhorani et al., 2020).
Another similar study was done by Soucy and colleagues (2019), however, the researchers added in a physical activity group. The reasoning being physical activity is known to be an effective method to improve one’s mood, but the researchers wanted to compare a physical activity-only group to a behavioral activation therapy group. Those in the behavioral activation therapy group were allowed to participate in physical activities, however, they were not restricted to those activities.
59 participants were recruited and randomly assigned to one of three groups: a behavioral activation therapy group, a physical activity group, and a control group. Those in the intervention groups were asked to keep a logbook detailing their activities. The behavioral activation intervention followed a similar structure as the study by Karimpour-Vazifehkhorani and colleagues (2019). Participants in both intervention groups were instructed to increase the intensity of their activities over the course of the 8-week experiment (e.g. adding a mile to a run every week).
Before and after the study, all participants filled out questionnaires concerning negative feelings, positive feelings, loneliness, and life satisfaction. Participants in the behavioral activation group reported a 25% decrease in the frequency of negative emotions and a 14% decrease in loneliness, while participants in the physical activity group only reported a 14% decrease and a 7% decrease respectfully. Additionally, those in the behavioral activation group reported a 21% increase in life satisfaction and a 22% increase in the frequency of positive emotions.
These two studies only scratch the surface of the effectiveness of behavioral activation therapy. This form of therapy has been quite successful and many researchers are looking at how behavioral activation therapy may be used to treat mental disorders other than depression, such as anxiety or PTSD. Whether is it used as a stand-alone treatment or used in conjunction with cognitive behavioral therapy or medication, behavioral activation therapy has proved itself as a reliable and effective treatment.
Behavioral activation therapy has been widely accepted by therapists and psychologists for multiple reasons. Although it is very structured, the practice is quite simple and customizable. This makes it an appropriate and engaging treatment for individuals of all ages and backgrounds. Additionally, this form of therapy requires few resources which makes behavioral activation therapy an affordable and accessible treatment option (Martin & Oliver, 2019).
Want to get started on practicing behavioral activation? LIFE Intelligence is a self care app that uses scientifically-proven techniques and exercises to help you identify, set, and solve problems, through prompting you to reflect and act. Through LIFE, you can track your moods, behaviors, reflect on how activities make you feel, and journal about your goals, use of time, and more. After pinpointing how you're feeling, the app provides coping exercises that can help you escape ruts and move forward. For example, if I'm feeling helpless, it'll show me an exercise that helps make me feel powerful. It explains the psychology behind that phenomenon, and then asks me to try the exercise myself. After doing one of these quick 15 minute exercises, I'm halfway to feeling better already.
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