Behavioral Activation (A Comprehensive Guide)

Behavioral activation (BA) is one of the most commonly used therapeutic interventions for the treatment of depression.

Behavioral activation is basically based on the behavioral model of depression that creates depression within a person because of the lacking of positive reinforcement for him.

BA is a treatment on a very personal level and is highly customizable based on the person getting treated.

This article will cover a general overview of BA, how it can be implemented in treatment, the basic behavioral model it is based on, and will include some of the techniques that are used in Behavioral Activation.

What is BA and how can it be used to treat depression?

The main aim of Behavioral activation (BA) is to increase the engagement of the user in adaptive activities, it is a structured psychotherapeutic approach that tries to decrease the engagement of users in the activities that are not healthy for them and try to solve the problems that limit their access to rewards or that increase their aversive control.

The main purpose of BA is to enable people with depression to learn about the positivity around them and how they can cope with negativity.

This allows the patients with depression to learn about their negativity and the tips and settings on how they can decrease such negativity in them and how they can increase positive awareness about their development in the form of life goals whether they are medium, short, or long term life goals.

It can be considered that BA is one of the therapeutic interventions that has its main focus on the daily life of a client’s behavioral changes which are mostly focused on treatment related to depression.

BA interventions are there to help a client plan his daily routine in such a way that can end up him enjoying his daily life and helping the client to develop their skills socially or it can be just to help the client in tracking their own activities and emotions.

BA is highly customizable as it may vary with person to person as the activities that can push one into depression can vary at a personal level so BA is a highly personalized intervention.

Behaviourism: The Behaviourist Theory Behind BA

BA or behavioral activation is based on a behavioral model of depression one of which was outlined by Shaffer & Lewinsohn in 1971.

These researchers believed that because of the lack of positive reinforcement in a relationship, a typical behavioral issue arises in individuals which can be termed as depression.

Since the researchers classified it as one of the behavioral models of depression, they also suggested that the best treatment to such a behavioral issue is to focus on the activities that might bring positive reinforcement to the individual which can be achieved by either changing the patient’s environment or behavior.

Most of the modern behavioral models do not include cognitive components and are not exclusive to behaviorists while some of the psychologists still like to follow radical behaviorism.

Most of the psychological models in the modern era still include both the behavioral and cognitive aspects in general which can be exemplified by cognitive-behavioral therapy (CBT), which might be the most common therapeutic treatment nowadays.

Behavioral activation is also considered and explored as one of the basic components of CBT for different disorders involving anxiety, depression. 

Interestingly, on the other hand, the main driving force behind CBT’s efficacy can also be considered to be behavioral activation.

Another study done by Jacobson shows that the main cause of different people taking interest in Behavioral Activation can be considered as being as effective as the combination of some components of CBT and BA.

These researchers also found out during this study that people with depression who have taken both some cognitive components of CBT and BA have seen the same benefits as those who have only completed BA.

As behaviors are easier to target than thoughts, behaviorists who are still advocating the importance of behavioral treatment over cognitive treatment have at least stopped denying the importance of cognition.

The same study done by Jacobson also indicates that the main reason for CBT to be effective in cases regarding depression might be because of behavioral activity.

Hence, while after more studies and research the behaviorists might not think positive reinforcement as the only way to treat depression but they still advocate it as one of the best ways for the treatment.

Applied Behaviour Analysis: Can ABA Help Your Client?

Behavioral activation is also known as one of the types of applied behavior analysis, which is a research field that focuses on the basic principles of Skinner’s work and his findings that were related to the behavior changes in a person based on the environment.

He said that the behavior that produces a positive outcome in an individual will continue to occur and solidify the process of positive reinforcement in a given environmental context and in the meantime the behaviors that do not have a positive outcome will decrease and diminish with time.

The main strength of behavioral activation is that it is highly customizable not only in accordance with the person’s needs and values but also can be customized based on the specific type of disorder like a personality disorder or a comorbid MDD.

In short, BA intervention can be applied to a client in almost all cases of depression.

One important thing to take into account for the therapist is to make sure that he is also getting positive reinforcement from his client during their sessions and it is not draining out his own energy and having a negative impact on him.

Uses of Behavioral Model for Behavioral Activation

In order to design a behavioral activation intervention for a person, it is better to first fully understand the behavioral model related to the client’s depression and fully comprehend it.

We will be taking a case study here as an example.

Here, the case study is of Amy, who is a 16-year-old girl with depression, so in order to start her treatment the first step is to get to know her and the reason for her depression better.

The therapist, in this case, started with interviewing Amy, her mother, and other siblings to try and get an idea about the form of depression.

From the general talking and discussion, the therapist came to the conclusion that Amy’s symptoms of depression might be because of the recent death of her father, increase in academic work, her mother’s illness, or her fatigue.

Among the possible reasons, the one that really is of particular interest is her fatigue as it hinders her from doing any positive reinforcement especially related to her social life as she is not able to hang out with her friends which will result in her feeling bad and might result in low energy levels.

With this in mind, the therapist designed a behavioral activation, focused more on reinforcing positivity in her social life, for Amy which ultimately helped her in getting over her feelings of depression.

This behavioral model of depression that was conceptualized by discussion beforehand by the therapist using interaction with her mother and Amy was a crucial part in the designing of BA intervention. 

The benefits of having a BA intervention that a cognitive one is more illustrated by the clients who undergo such treatment as they are more tilted towards a practical treatment rather than having the same counseling over and over again.

They do not want to explore the same feelings again but need to find some activity or things that can help them reinforce positive feelings in their life.  

How To Behavioral Activation (BA) can be Used To Overcome Depression

1. Usually, when we are depressed or feeling down we become less active towards other things. The less active we are, the fewer opportunities we might come across for rewarding and positive things to happen towards us, and the fewer there are the more down in mood and morale we become and it ends up in a vicious cycle. One of the ways to get outside of this cycle is by using Behavioral Activation intervention which is the evidence-based and practical treatment for depression. 
2. Psychologists have found after many studies that there is a deep relationship between our mood and the activities we do. When are in a good company and spending time with people whose company we enjoy, we are usually doing activities that are adventurous and tasks that challenge us as an individual which has a positive feedback effect :
3. We can feel pleasure by doing the things we enjoy in life
4. By challenging ourselves we give ourselves a chance to develop and grow which gives us a sense of mastery
5. We can feel valued and connected by having positive relationships with other people
6. This also true in the reverse case, as the people who are depressed usually are less active which gives them fewer activities to feel pleasure and connection. Some of the tips to get out of such a situation and to get the best out of behavioral activation are:

• Don’t start too hard: Take life as a marathon and not a sprint, the level of activity in your behavioral activation intervention should be more than your depression level but it should be designed in such a way that is realistically achievable.
• Break activities down into smaller steps: It is best to break different activities into smaller independent steps which can help you reach that value with time and every step giving you a positive reinforcement towards the next one until you reach your goal.
• Reward yourself: Always make sure to acknowledge what you have achieved and done and take time to reward yourself without rushing towards the next task at hand.
• Remind yourself why you’re doing this: Always keep reminding yourself why you are doing this and force yourself to achieve the goals and become active even if you don’t feel like it, also think about the behavioral activation as one of the most effective treatments of depression so you have to pull yourself together and focus on the small steps. 

FAQ about Behavioural Activation

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