Behavioral Activation: Are You Using it Correctly?

Behavioural activation is a therapeutic intervention that aims to help individuals overcome depression by encouraging them to engage in activities that promote pleasure and mastery. The approach is based on the premise that depression and other mental health issues often reduce enjoyable and fulfilling activities, which in turn can exacerbate symptoms and lead to a cycle of worsening mood.

Understandably, clients with low mood, motivation, and energy, difficulty feeling pleasure, and sleep disturbances will not feel like doing much. However, the less someone does, the less opportunity they have to feel a sense of joy or achievement, which only leads to symptoms of depression worsening.

Behavioural activation aims to help individuals break this cycle by identifying and engaging in activities that promote pleasure and mastery. Pleasure refers to activities that are enjoyable and provide a sense of satisfaction. In contrast, mastery refers to activities that challenge the individual and help them develop skills and a sense of accomplishment.

In my experience supervising and training early-career psychologists, I found that behavioural activation is often misunderstood or incorrectly used. Behavioural activation is not simply activity scheduling.

Instead, we purposefully assist our clients in increasing meaningful activities that will allow them to feel pleasure and mastery and improve their mood. But first, we need to identify their current levels of pleasure and mastery to understand where we can go next. It is helpful to start by capturing a baseline of your client's mood, pleasure, and mastery levels over a week and then use that information to create change.

The following are some fundamental principles of behavioural activation:

1. Choose the right activities: Identify and promote activities that will allow the client to have some increase (not a complete and instant return to joy) in their levels of pleasure and mastery. The goal is to increase the time spent on these activities gradually. The most effective way of doing this is by getting the client to identify the activities themselves and not to be too directive (unless necessary). I would typically start by generating two lists—one for pleasure and the other for mastery. I would assist the client by identifying realistic, accessible, and achievable activities based on their interests and level of functioning.
2. Monitor progress: Clients should monitor their experience of pleasure and mastery in their chosen activities by completing a daily log and using a rating scale. This assists in determining whether the intervention is working and what (if anything) we need to modify for maximum effectiveness.
3. Address maladaptive thoughts and behaviours: Maladaptive thoughts and behaviours can often interfere with the ability to engage in activities that promote pleasure and mastery. While we wouldn't usually address cognitions before behavioural activation, we can assist our clients by providing them with psychoeducation on motivation. Helping our clients understand how motivation works, and addressing limiting beliefs about motivation, can assist them in getting going.
4. Behavioural experiments: When the client struggles to identify activities that may promote pleasure and mastery, the therapist and client work together to test out different activities to see what works best. This can involve trying new hobbies or engaging in activities that challenge the client in new ways. It can also assist in identifying activities that used to create pleasure or mastery for your client when they were "well" or earlier in their life.
5. Graded task assignments: The therapist and client work together to identify activities the client has been avoiding or finding difficult, then break them down into smaller, more manageable steps. The client is then encouraged to gradually work up to engaging in the entire activity, with the support and encouragement of the therapist.

Overall, the evidence suggests that behavioural activation is effective in treating depression. Behavioural activation is so much more than simply scheduling activities for clients. The main principle of behavioural activation is its focus on increasing pleasure and mastery, which is one of the quickest ways of improving mood in depressed clients. To be used to its maximum effect, pleasure and mastery activities should be prioritised daily for the client.

This post also appears on Amanda Moses Psychology.