How Does It Work for Depression?

Via Peters

A spiral into depression. A cycle of avoidance. A self-fulfilling prophecy.

Whatever you choose to call it, this pattern tends to play out in roughly the same way:

  1. You experience something painful.
  2. You begin to feel low, anxious, or overwhelmed.
  3. You stop doing certain things, like chores, work, or social outings, to help protect yourself from getting hurt again.
  4. The inaction leads to consequences, like loneliness, guilt, or self-punishment.
  5. You end up feeling worse than before.

If you’re searching for ways to break free from this pattern, behavioral activation therapy is one option to consider. You’ll often come across this technique in cognitive behavioral therapy (CBT).

You can also use it by itself to help replace a downward spiral with an upward spiral — one characterized by positive emotions and experiences that help promote lasting change, according to a 2010 review.

Read on to learn how behavioral activation works, plus get some guidance on using this technique to address mental health symptoms.

Peter Lewinsohn and his research team at the University of Oregon developed behavioral activation in the 1970s to help treat depression.

Lewinsohn was inspired by behaviorism, a theory that your behavior is determined largely by your environment. Basically, behaviorism involves two key principles:

  • You’re likely to repeat behavior when it’s rewarded. If you cook for loved ones and they compliment you, you’ll probably want to cook again, and perhaps even improve your skills.
  • You’re likely to stop behavior when it’s punished. If you cook for loved ones but they criticize you and your food, then you might, understandably, feel hesitant about trying again.

The famous behaviorist B.F. Skinner theorized that depression happens when a person gets too much punishment — and too few rewards — from their environment.

To put it another way, when everything seems difficult or painful, you’ll likely have trouble finding the motivation to do much of anything. And of course, physical symptoms of depression, like fatigue and changes in energy, can also factor in.

Depression can easily convince you that anything you try will end in failure. But if you do nothing, then nothing gets done — which only proves your conviction.

It’s hard to improve your mindset without some change in your situation. So, behavioral activation has you take action to feel better, instead of waiting until you feel better to take action.

Here’s why:

  • Doing fun activities can help remind you that life still has good things to offer.
  • Reaching small goals can help you recognize you’re capable of success.
  • Mastering skills can help boost self-esteem.

Choosing rewarding activities can also help improve your mood. A more hopeful and optimistic mood can, in turn, leave you feeling more encouraged and ready to try more challenging goals.

Lewinsohn’s team originally developed behavioral activation to treat depression, but 2020 research suggests it can also treat anxiety disorders, too.

Behavioral activation can ease depression symptoms by helping you:

  • rediscover what motivates and excites you, especially if depression has you feeling numb
  • build your life around what you find valuable, not what others expect from you
  • develop specific, realistic goals
  • identify and remove obstacles to your progress

When it comes to anxiety, behavioral activation can help you:

  • recognize when anxiety pushes you to avoid something
  • overcome emotional overwhelm and paralysis
  • address anxiety-related procrastination

Behavioral activation can help with symptoms that range from mild to severe.

According to a small 2015 study, this approach can also have benefits if you have subclinical symptoms of depression or anxiety. In other words, you might have a few mental health symptoms, but not enough to receive a clinical diagnosis of any one condition.

On the surface, behavioral activation can seem counterintuitive, if not flat-out insensitive to what depression actually feels like.

After all, if you had the ability to just get up and do things, you wouldn’t need help, right?

But behavioral activation isn’t about brute-forcing your way back to mental health. Rather, it offers a starting place to simply get your motor running, so to speak, and take small steps to build up your momentum.

This example of behavioral activation for depression can help illustrate how it works.

Activity monitoring

First, you’ll start by recording what you did each day.

Things to jot down:

  • what you did
  • how long you did it
  • who you did it with
  • how you felt — try a numbered scale ranging from 0 to 10, with 0 for a bad mood and 10 for a good mood

Over time, you’ll probably start to notice some patterns. Maybe:

  • Your mood tanks whenever you have to do laundry and other chores.
  • Your morning telephone chats with Grandma leave you feeling a little more hopeful.
  • You feel anxious before taking your dog for a walk, but you usually feel better when you return.
  • You dread meeting your co-workers at the bar every Friday evening.

You can use this information to help identify activities you want to spend more time on — the ones that make you feel good, in other words — and the activities you want to spend less time on.

Maybe you feel pressured to join your co-workers to fit in at work. But at the end of the day, forcing yourself to do something you don’t enjoy will likely only worsen your mood and overall well-being.

  • If it’s the location you want to avoid, try suggesting an alternate meeting place, like a quieter restaurant.
  • If it’s the socialization you need a break from, try politely declining every other week.

It goes without saying that you can’t cut tasks like laundry out of your life entirely. Instead, you might explore ways to make the task more enjoyable.

  • Maybe you create an energizing chore playlist.
  • Or, you might fold clothes while you watch a favorite show.

Value setting

The overarching goal of behavioral activation is prioritizing activities that help improve your mood and outlook.

That said, not all of these pursuits need to offer immediate rewards. Taking a short walk or jog might not exactly feel fun, but it can still benefit you, both in the moment and later on. A small 2018 study suggests even gentle exercise can help reduce stress.

Learn more about the benefits of exercise for depression and anxiety.

To determine your values, ask yourself what you find most meaningful:

  • Bonding with your family?
  • Growing your career?
  • Supporting your community?
  • Maintaining your health?
  • Honoring spiritual traditions?
  • Pursuing personal growth?

Take some time to think about your answers — jotting them down in a journal could help.

It’s fine if you consider all of these things important, but aim to choose two or three primary values to focus on.

Activity scheduling

Once you’ve narrowed down your most important values, you can begin exploring activities that embody those values.

  • If you ranked personal growth at the top of your list, you might schedule reading time into your week.
  • If you ranked supporting your community at the top of your list, you might plan to help with a neighborhood garden or volunteer at a local school.

Start with two or three simpler activities, and schedule them at a time you’re likely to actually do them. If you don’t enjoy getting up early, it’s probably best to avoid signing up for a sunrise bird watch.

Aim for SMART goals:

  • Specific. “I want to spend more quality time with my child” is more helpful than “I want to be a better parent.”
  • Measurable. “I want to run a 10-minute mile” is more helpful than “I want to be fitter.”
  • Attainable. “I want to get a higher paying job” is more helpful than “I want to be a billionaire.”
  • Relevant. “I want to improve my marriage by communicating better with my spouse” is more helpful than “I want to improve my marriage by buying a bigger house.”
  • Time-bound. “I want to clean the attic by the end of the month” is more helpful than “I want to clean up the attic.”

Troubleshooting

Depression can make it hard to imagine any pastime bringing pleasure or enjoyment. But even if you aren’t quite feeling it, challenge yourself to try the activity at least once or twice. You may find yourself having a better time than you expected.

Something comes up and keeps you from sticking to your plan?

Catch yourself skipping your activity multiple times?

  • Ask yourself if you’re taking on more than you can currently handle.
  • Consider scaling back your goals.
  • Check for any obstacles getting in the way of your progress.

This technique may not be ideal for everyone. You’ll generally want to work with a therapist if you experience:

  • Shifts in mood without an obvious trigger. A mental health professional can offer more support with identifying potential causes of sudden shifts in mood, like bipolar disorder.
  • Memory difficulties. When anxiety, depression, or other mental health conditions make it difficult to remember plans or how you felt at certain times, a therapist can offer more guidance with managing symptoms.
  • Panic attacks. Support from a therapist can help address possible causes of panic attacks and explore helpful coping techniques.
  • Trouble with basic functioning. If you find it difficult to move your limbs or take care of your essential needs, it’s best to get support from a healthcare professional as soon as possible.
  • Thoughts of death or suicide. If you’re thinking about suicide, it’s best to get support from a mental health professional or crisis counselor right away.

If you try behavioral activation by yourself and start feeling better, that’s a great sign.

But you might find behavioral activation a little overwhelming to try alone, and that’s just fine, too. A therapist can always offer more guidance with taking the first steps.

It’s especially important to work with a therapist when mental health symptoms:

  • last longer than 1 or 2 weeks
  • become severe enough to affect your everyday life, relationships, and performance at school or work

One good thing about behavioral activation? This approach has plenty of versatility.

In terms of therapy, behavioral activation is one of the many CBT techniques often used to treat depression and anxiety.

Other common techniques include:

Your therapist might use any of these techniques during your sessions to help you learn and practice new skills for navigating difficult emotions.

They might also recommend other talk therapy approaches, including:

Your therapist will work with you to help develop the right treatment plan for your unique needs.

Learn more about treatment options for depression and anxiety.

Living with depression can mean the things you used to enjoy no longer seem appealing. But behavioral activation can help restore meaning, joy, and motivation by encouraging you to fill your life with pursuits you find valuable and rewarding.

This approach is both effective and accessible — you can try it right now, on your own.

Just remember, it’s OK to start slow, with easy-to-achieve goals. Even smaller efforts can change your life in a lasting way.


Emily Swaim is a freelance health writer and editor who specializes in psychology. She has a BA in English from Kenyon College and an MFA in writing from California College of the Arts. In 2021, she received her Board of Editors in Life Sciences (BELS) certification. You can find more of her work on GoodTherapy, Verywell, Investopedia, Vox, and Insider. Find her on Twitter and LinkedIn.


https://www.healthline.com/health/behavioral-activation-therapy

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