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Behavioral activation is one of the most important CBT skills used in
treating depression. It has to do with the way that behaviors and
feelings influence each other.
In this chapter we’ll learn how your behavior can directly affect your
mood, for better or worse, and how to use skills to put ourselves in
situations that will make it most likely to improve our mood.
Have you ever noticed that certain things that you do influence your
mood or anxiety? For example: When you listen to sad music do you
ever notice feeling sad for longer periods of time? Do you ever feel
less motivated to apply for a job or school when you are actively
worrying?
Will Behavioral Activation be helpful for me? Behavioral activation is helpful for many people. If you answer “yes” to any of the following questions, BA could be a good fit for you.
- Do I have a sense of what is triggering my mood or anxiety?
- Do I generally find myself doing very little, with little pleasure or meaning in my life?
- Are there times that I feel better or worse and I’m not sure why?
- Do I have a difficult time working with my negative thoughts, but seem to feel better when I can get myself moving and doing something?
- Do I have a hard time even knowing what I enjoy or find meaning in?
Behavioral Activation (BA) is a specific CBT skill. It can
be a treatment all by itself, or can be used alongside
other CBT skills such as cognitive restructuring.
Behavioral activation helps us understand how
behaviors influence emotions, just like cognitive work
helps us understand the connection between thoughts
and emotions.
Here are some examples of how BA may be used:
Jim deals with depression and anxiety. He has a hard time figuring out why his
mood drastically dips and also finds it difficult to understand why he feels better
for short periods of time. While working with his schedule in therapy, he began
to discover specific mood triggers (how he spent his time or random events) that
he had never noticed before. He was able to become more aware of these
triggers and change his approach, ultimately allowing him to change his mood.
Debbie knew that her family history, stress with taking care of her special needs
son, and seasonal change contribute to her depression. Though she knows the
triggers, she struggles with managing her mood as she often does not feel like
doing activities that will help her depression. She often tells herself that she will
wait until it warms up outside to exercise and does not feel up to calling her
friends who usually cheer her up. With her therapist she began to find strategies
to help her motivation by practicing awareness of different avoidance patterns
and developing alternative, adaptive behaviors.
On the next few pages we illustrate the “vicious cycles” of depression, according to the research on depression and Behavioral Activation. Note: Behavioral Activation has been shown in research studies to be effective on its own for some people to overcome depression. However, it is often used alongside other therapeutic skills, as it may not address your specific situation all by itself. Consider it just one of many options in your effort to manage depression. Action precedes emotion!?
We often wait to feel better or more motivated before
doing something.
Remember that anxiety and depression come from
parts of our brain that are really trying to protect us by
getting us to avoid or isolate. This means that as long
as we are following the lead of the anxiety and
depression, we will continue to feel less motivated and
want to avoid and isolate.
So, when we are feeling anxious and depressed,
we cannot wait on the brain to give us the
motivation to get out there and do things.
Research has shown that our decision to activate (in
other words, to do the opposite of what the
depression wants us to do, and do something in
line with our values and goals) is necessary for
emotions to change.
So why activate first? Firstly, activating changes our brain state and can make us
feel better, right away. For example, exercise can produce “good chemicals” in
the brain that lift mood while they are in the bloodstream. Secondly, the more
that we activate, the more situations we find ourselves in that can give us positive
experiences. The technical term for this is “reinforcing positive context
contingencies.” Technicalities aside, we need to “get out there” and give
ourselves the best chance of feeling better, even if we don’t feel like it at the
time.
What happened
(stressful life events, triggers from past, etc.)
“I lost my job” “We had our first child” How you feel (emotions) Sad Anxious Stressed Shut down Embarrassed What you do (or don’t do) Stay in bed Don’t engage with family Don’t return calls or texts Avoid people FIRST VICIOUS CYCLE Events often get the depression “ball rolling.” This could be something new or a reminder from a past stressful event. The stress of events leads to negative emotions that are distressing and make us want to draw back. Emotions lead to behaviors: we avoid or isolate, which makes us feel worse.
What happened (life events, triggers, etc.) How you feel (symptoms) What you do (or don’t do) Try to determine your own “vicious cycles,” identifying specific events, emotions, and responses.
With BA, we rate mood on a scale of 0-10, 10 being the best, 0 being the worst. We ask people to rate mood in each hour to the best of their ability in order to understand mood changes. For example: Monday:! 8am: Woke up (5)! 9am: Went to go eat breakfast (6)! 10am: Got to work, talked to Bob (5)! 11am:Sitting at my desk reading e-mails (3)! 12pm:Eating lunch at my desk, worrying about meeting (3)! 1pm:Meeting, thinking about issue with reports that I missed, tired (3)! 2pm: Sitting at my desk working (4)! 3pm: Working (4)! 4pm: Working (4)! 5pm: Driving home (6)!
Being aware of our mood,
emotions, and behaviors is an
important part of CBT. In order to
know what to do to fix a problem,
we first need to understand what is
going on!
Activity Monitoring is the first step
of Behavioral Activation. It is
important to know exactly what we
are doing throughout the day, and
how this corresponds to our mood.
While we can’t fix the depression
just by noticing this, we can take a
step toward feeling better by
understanding which behaviors
help us feel better, which continue
to maintain the depression as it is,
and which make us feel worse.
Use the Activity Monitoring Chart
on the next page to start tracking
your activities and mood.
Get out that pen and paper!
Research shows that people who
write things down as part of CBT
practice do better than those that try
to do it all in their heads. While it
does involve more work (and may
seem like going back to school), we
hope you will give it a try at first, until
the skills become more natural.
Antidepressant/UP Activities Depressant/DOWN Activities Based on the mood ratings you recorded on the Activity Monitoring Worksheet, determine which activities helped you to feel more positive (“UP” activities) and which led to feeling down (“DOWN” activities). In Behavioral Activation, one of our aims is to increase “UP” activities and decrease “DOWN” activities. Over the next section we will learn more about the types of activities that will lead to better mood, to add to the list above. Over time, we can replace the “DOWN” activities with more “UP” ones.
A Life Worth Living: Values, Pleasure, Mastery, and Goals
The next step in Behavioral Activation is determining the behaviors on which to
focus to improve our mood. While some behaviors, like exercise and meditation,
can be used right away to improve mood directly, many of the behaviors that are
likely to help us are those that align with the things that we enjoy or are
important to us.
An exploration of “values,” “pleasure,” and “mastery” describe much of the
“stuff” that makes life worth living. This process can help us come up with
tangible goals to move us toward the things that are most important to us.
Goals and objectives outline the steps we take to experience our lives more
fully. They give us targets to help us experience more pleasure, mastery, and
value-driven behavior.
“Values” are what we find meaningful in life. They
are the most important things to us. Everyone has
different values, and for each of us they can
change over time. They are like a compass,
pointing us in the direction we want to go.
“Pleasure” involves activities, or “play” that we enjoy for the sake
of the activity itself. Hobbies, games, spending time in nature, or
spending time with a good friend.
“Mastery” involves activities, such as work or sports, that
involve the development of skills; we are able to
accomplish things and feel a sense of mastery over our
environment. When enjoyed in moderation and
diversified well with other activities, they can increase
positive emotions and improve how we feel about
ourselves. Also, we may feel more creative as we learn to
master certain skills, adding to the possibilities of
enjoyment.
To feel more consistently engaged and happy in the world, it is usually best to
find a balance of goals centered on values, pleasure, and mastery. How that
balance looks for you will be unique. On the following pages, we will help you
understand how this balance might look for your own life.
Family relations
- Work on current relationships
- Spend time with family
- Take an active role in raising my children
- Maintain consistent healthy communication Marriage/couples/intimate relationships
- Establish a sense of safety and trust
- Give and receive affection
- Spend quality time with my partner
- Show my partner how much I appreciate them Friendships/Social Relationships
- End destructive relationships
- Reach out for new relationships
- Feel a sense of belonging
- Have and keep close friends
- Spend time with friends
- Have people to do things with Mental/Emotional health
- Seek fun and things that give me pleasure
- Have free time
- Be independent and take care of myself
- Challenge my negative thinking
- Make my own decisions
- Engage in therapy
- Take my medications
- Stay active Physical well-being
- Live in secure and safe surroundings
- Engage in regular exercise
- Have a steady income to meet physical needs
- Eat foods that are nourishing to my body
- Maintain a balance between rest and activity
- Get enough sleep Citizenship/Community
- Contribute to the larger community
- Help people in need
- Improve society
- Be committed to a cause or group that has a larger purpose
- Make sacrifices for others Spirituality
- Follow traditions and customs
- Live according to spiritual principles
- Practice my religion or faith
- Grow in understanding myself, my personal calling, and life’s purpose
- Discern the will of God
- Find meaning in life
- Develop a personal philosophy of life
- Spend time in nature
- Focus on the greater good Education/Training/Personal Growth
- Be involved in undertakings I believe personally are significant
- Try new and different things in life
- Learn new things
- Be daring and seek adventure
- Have an exciting life
- Learn to do challenging things that help me grow as a person Employment
- Be powerful and able to influence others, have authority
- Make important decisions that affect the organization
- Be a leader
- Make a great deal of money
- Be respected by others
- Be seen by others as successful, be ambitious
- Become well-known, obtain recognition and status
- Be productive, work hard
- Achieve significant goals
- Enjoy the work I do
- Do what I’m told and follow the rules Below is a list of general value categories, and some specific values that are common in each. See if any of them fit you, and use this page to fill out the values rating sheet on the next page. Values, con.
Here are some other experiments to explore your own values:
1. Imagine that an important newscaster were doing a biographical story on your life.
Think about how you’d want them to describe you. How would they describe the way
you spent your time? How you related to others? What was most important to you?
What are your strengths as a person? Write down a narrative of what they would say.
2. Imagine you could read the mind of a person that’s important to you and with whom
you’ve had a good relationship. They are thinking all kinds of thoughts about your
qualities: what you stand for, what your strengths are, what you mean to him or her, and
the role you play in his or her life.
3. Think about your heroes. They can be people directly in your life, or other people that
you look up to, even fictional characters. What are their qualities? What do you admire
about them?
4. Imagine you are writing your own autobiography. Imagine how you would like to live
your life, barring all barriers, in the “best case scenario.” What are the things that are
most important to you in this scenario? What would you stand for? How would you
spend your time?
5. Imagine that someone is performing the eulogy at your funeral. Looking back on your
life, they would be commenting on your strengths, values, and achievements. How
would you want them to describe your life?
6. If you are struggling to find a valued direction, commit to experimenting with some of
the values on the previous pages for just one week. After choosing a value, plan to
notice your reactions to making the effort to hold to this value. Make a list of behaviors
that might fit with the value and choose one behavior to try. Notice your judgments
that come up about choosing this behavior. Then make a plan to fulfill on the value-
driven behavior. Just do the behavior without telling anyone about it and see what
happens. Commit to following through on this behavior once per day for one week.
Keep a diary of your reactions to behaving this way and others’ reactions to you. At the
end of the week, reflect on your experiment with someone else, like a therapist or
group leader.
Values, con.
The next step is to translate our values into activities that help us fulfill on those goals. Take a moment to think about the values that you identified on the previous page. What are some short term goals in each area? What are some long term goals? Use this page and the next to start to brainstorm. Write down your results on the upcoming page: “Values, Pleasure, and Mastery Master List.” Parenting I want to be involved in my children’s interests and learning. I’d like to build special memories with my kids and spend quality time with them.
I’m going to attend the
next PTO meeting and
maybe contact the
teacher to be a
classroom volunteer. I
can plan a small vacation
to take with the kids
next summer.
VALUE ACTIVITIES
Example:
VALUE ACTIVITIES
Mastery
Mastery involves activities, such as work or sports, that involve the development of
skills; we are able to accomplish things and feel a sense of mastery over our
environment. When enjoyed in moderation and diversified well with other activities,
they can increase positive emotions and improve how we feel about ourselves.
Here are some examples of how people experience mastery to experience fulfillment
in their lives. Circle the ones that apply to you, and add others that aren’t included
below.
Job or Meaningful Daytime Activity
Look for or attempt to develop some of these
qualities in your occupation volunteer work, or
other meaningful daytime activity:
- Enjoyment
- Creativity
- Feelings of competence (able to
accomplish tasks satisfactorily)
- Potential for development of skills
- Ability to “move up” in the organization or
take on more responsibility, if this is
desired
- Social contact with coworkers, colleagues,
others in the field
Other skill-based activities
- Sports
- Music practice and performance
- Home improvement/building
- Woodworking
- Visual art (painting, drawing,
pottery, sewing, knitting
(history, politics, food,
language, culture, etc.)
- Crafting, pottery, and other
creative skills
Other?
- Soaking in the bathtub
- Planning my career
- Collecting things (coins, shells, etc.)
- Going for a vacation
- Recycling old items
- Relaxing
- Going on a date
- Going to a movie
- Jogging, walking
- Listening to music
- Thinking I have done a full day’s work
- Recalling past parties
- Buying household gadgets
- Lying in the sun
- Planning a career change
- Laughing
- Thinking about my past trips
- Listening to others
- Reading magazines or newspapers
- Hobbies (stamp collecting, model building, etc.)
- Spending an evening with good friends
- Planning a day’s activities
- Meeting new people
- Remembering beautiful scenery
- Saving money
- Gambling
- Going to the gym, doing aerobics
- Eating
- Thinking how it will be when I finish school
- Getting out of debt/paying debts
- Practicing karate, judo, yoga
- Thinking about retirement
- Repairing things around the house
- Working on my car (bicycle)
- Remembering the words and deeds of loving people
- Wearing sexy clothes
- Having quiet evenings
- Taking care of my plants
- Buying, selling stocks and shares
- Going swimming
- Doodling
- Exercising
- Collecting old things
- Going to a party
- Thinking about buying things
- Playing golf
- Playing soccer
- Flying kites
- Having discussions with friends
- Having family get-togethers
- Riding a motorbike
- Sex
- Playing squash
- Going camping
- Singing around the house
- Arranging flowers
- Going to church, praying (practicing religion)
- Losing weight
- Going to the beach
- Thinking I’m an OK person
- A day with nothing to do
- Having class reunions
- Going ice skating, roller skating/blading
- Going sailing 65.Travelling abroad, interstate or within the state
- Sketching, painting
- Blowing bubbles
- Doing embroidery, cross stitching
- Sleeping 70.Driving 71.Entertaining
- Going to clubs (garden, sewing, etc.)
- Thinking about getting married
- Going bird watching
- Singing with groups
- Flirting
- Playing musical instruments
- Doing arts and crafts
- Making a gift for someone
- Buying CDs, tapes, records
- Watching boxing, wrestling
- Planning parties
- Cooking, baking
- Going hiking, bush walking
- Writing books (poems, articles)
- Sewing
- Buying clothes
- Working
- Going out to dinner
- Discussing books
- Sightseeing
- Gardening
- Going to the beauty salon
- Early morning coffee and newspaper
- Playing tennis
- Kissing
- Watching my children (play)
- Thinking I have a lot going for me
- Going to plays and concerts
- Daydreaming
- Planning to go to college or university Here are some examples of activities that tend to increase pleasure and mastery. You might think of more that are not listed. Circle the ones that you think could lead to enjoyment or mastery for yourself.
