10 principles of behavioral activation for depression and other treatments

Behavioral Activation Therapy is listed on the APA website as one of the most effective treatments for depression and is also being studied as a possible treatment for other disorders. We can think of behavioral activation as a treatment in its own right or as part of a treatment within cognitive behavioral therapy.

According to Christopher Martell:

“The strategies used in cognitive behavioral therapy are multifaceted into three main categories: behavioral strategies designed to change how people act in situations, cognitive strategies designed to change how people think about specific situations, cognitive strategies designed to change enduring core beliefs that people have about themselves, their future and the world”.

In this text, I will describe 10 principles of behavioral activation that correspond to the first of the categories mentioned above.

Principle 1: The key to changing how people feel is helping them change what they do

Charles B. Ferster, one of the authors who helped create behavioral activation, argued that depression could be characterized as a decrease in certain types of activity and an increase in other types of activity. That is, looking through the prism of behavior, depression as a disorder defined in this way, could bring the focus of treatment to changing behavior as the central key to improvement.

Principle 2: Life changes can lead to depression, and short-term ways and strategies of coping can keep the person stuck

Due to the non-reinforcement of activities in the client’s life history, strategies to deal with the consequences of their behaviors, such as increasing the amount of avoidant behaviors, can keep the person stagnant in a behavioral pattern that prevents them from overcoming the symptoms. .

Principle 3: The keys to figuring out what will be antidepressant for a particular client lie in what precedes and follows the client’s important behaviors.

This principle refers to the use of behavioral psychology concepts that can be grouped into the idea of ​​operant behavior. A specific behavior is performed in view of what came before and what came after (in the sense of whether or not similar behaviors were reinforced in the person’s life history). Evaluating what will be antidepressant in the behavioral sense consists of increasing reinforcing behaviors, also understanding the context and the before.

Principle 4: Structured and scheduled activities must follow the plan, not the mood

In behavioral activation therapy, structured and planned activities are proposed for the client. When a person is in a depressive state or is experiencing a symptom of some other disorder such as anxiety, the plan agreed upon in the session is often not carried out because the patient responds the way he is feeling and not what was planned. The idea here is to take action, change behavior, even if the mood, the emotion of the moment, is influencing the will not to do it.

Principle 5: Changes will be easier if they are small at the beginning

Structured and planned activities must be thought of from the simplest to the most complex. The first changes are small steps that can be implemented without much difficulty. An example would be getting back to doing an interesting activity that doesn’t require a lot of effort.

Principle 6: Activities that are naturally reinforcing should be emphasized

An activity that is naturally reinforcing is one in which the consequence of the behavior already follows the behavior itself. What is naturally reinforcing may differ from person to person, of course. As an example, we can think of a light physical activity like a walk, which will produce hormones that can bring pleasure already with the behavior itself.

Principle 7: The therapist should act as a coach

Acting as a coach here means that the therapist is in a position to encourage new behaviors to be performed week by week. The word in English can be translated as coach, that is, one of the therapist’s roles in behavioral activation is to assist in training new behaviors and skills. (Not to be confused with Coaching)

Principle 8: empirical approach to problem solving is emphasized, and all results are recognized as useful

Problem solving is an important skill that the customer begins to learn. The idea here is that any different, more reinforcing behavior that the client begins to perform should be encouraged, as new activities point to the onset of symptom reduction and recovery from depression.

Principle 9: The focus should not just be on talking, but also on doing.

Obviously talking is important in therapy. However, the focus of treatment in behavioral activation is changing behavior. Therefore, doing, carrying out, behaving, acting are synonyms of what represents the essence of this approach.

Principle 10: Potential activation barriers and problems must be anticipated and resolved

In the proposed activities for the next week, the therapist also helps the client to think about what could be a barrier to carrying out the activities and helps to solve possible problems that could be obstacles for the new behaviors to be introduced and maintained.

Conclusion

Behavioral activation therapy has a long history of research going back to the 1980s. Today it is recognized as one of the leading treatments for depression. As we said at the beginning, it can be used as an adjunct treatment to other approaches such as cognitive behavioral therapy, or as a treatment in itself.

Behavioral activation therapy is also being studied for the treatment of other mental and emotional disorders. Making an analogy with acceptance and commitment therapy, we can conclude this text with the title of Steven Hayes’ book: get out of your mind, into your life. In Portuguese we could translate the idea of ​​the title as: get out of your mind and enter your life, that is, abandon the emphasis on changing the thoughts that appear in your mind and start acting to change your life.

References

Martell, Christopher, Sona Dimidjian, Ruth Herman-Dunn. Behavioral activation for depression: a clinician’s guide. Guilford Press, 2010.

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