Combatting Depression with Behavioral Activation
February 14th, 2022
CBT, or cognitive behavioral therapy, is the most widely practiced evidence-based therapeutic model in the treatment of depression. It’s possible for therapists to focus either on cognition or behavior. ‘B’ represents behavior-based motivations, including behavioral activation. Very often, when people slide into depression, they let go of the things which make them feel good. This is because depression creates apathy. Just getting out of bed can be a challenge, let alone carving time for extracurricular activities.
Behavioral activation involves reconnecting with things that bring joy, purpose, and meaning. It might include very small daily tasks. If these bring a sense of achievement, then they’re relevant as treatment. As a therapist, it’s your job to help your client work out what makes them feel good. And, what doesn’t. This might mean remembering a hobby from childhood. It could involve tackling something which has always been tempting, but challenging. It might also mean exploring something entirely new. This can help your client see how they can grow through the things they engage with, as they slowly rebuild their capacity for joy.
Creating a Program of Meaningful and Supportive Motivations
The research shows that behavioral activation is as effective as medication. It’s also slightly superior to cognitive therapy in the treatment of depression. But it needs to be managed carefully. To identify and encourage activities that are the most beneficial, you need to work with your client to strike the right balance. Behavioral activation should balance activities that spark joy with tasks that require mastery. Everyone will have a unique combination of activities that can be used to target depression. These should build positive reinforcement and shift the focus from cognition and feelings, to behavior and environment.
To develop a program of behavioral activation, work with your client to track what activities make them feel better and which make them feel worse. You can have them keep a journal to note their mood before and after different activities. The journal will help you both to recognize moments of growth and strength. It will also help you identify moments of disconnection and negativity.
Behavioral activation is essentially a twofold process. Over time, you’ll be able to define a schedule of activities that cultivate a greater sense of mastery and enjoyment. You’ll also be able to clearly define what makes feelings of depression worse, and consciously avoid these. That will help make time for more activating behaviors. You increase positive reinforcement through supportive activities and replace negative avoidant behaviors with rewarding behaviors.
Recruiting Support: Social Circles and Feedback Informed Progress
Of course, this doesn’t just work overnight. It takes time and determination. Often, clients will need to push through with activities to see the benefits. Work with your clients to agree on markers for progress. This is essential for helping your client move towards positive reinforcement. You might have them recruit the help of a friend or relative to keep them on track. Enlisting the support of their social circle will help keep them accountable. It will also mean there’s more encouragement available to your client outside of your one on one time. The combined impact of your sessions, support of a social network, and increased capacity for joy and meaning can help your client to climb back out of depression.
