Behavioral Activation and Depression in CBT

Behavioral activation is one of the most effective things we can do when we’re feeling depressed and unmotivated. It’s often the first step in treating depression with CBT. With behavioral activation, we gradually increase our levels of activity. And as we do this, our moods start to lift, we have more energy and motivation, and we start to resume doing the things we used to be able to do before becoming depressed.

Behavioral Activation For Depression

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

When we’re feeling sad and depressed and just don’t feel like doing anything, acting based on how we feel and cutting back on our level of activity, and spending too much time in bed, or wasting time on the Internet, or not wanting to socialize or make plans with friends, just feeds back into how we’re feeling making those feelings even stronger. But when we’re sad or depressed one of the best things we can do for ourselves is to increase our level of activity. We call this behavioral activation and it’s often the first step in lifting our mood or pulling ourselves out of a period of depression.

Behavioral activation involves starting small and gradually increasing our level of activity. And we focus on three types of activities: activities that give a sense of pleasure or enjoyment; activities to give a sense of accomplishment or achievement; activities that involve some social interaction, which is going to be a lot harder now with everyone practicing social distancing.

As difficult as it can be to imagine something being pleasurable when you’re depressed, just doing anything is usually more enjoyable than isolating yourself, or sitting around just doing nothing. And you might find that activities aren’t as enjoyable as they used to be, or as you’d like them to be, but even things as small as getting out of bed having a shower, eating breakfast, or going for a walk can all make a difference in how you’re feeling. And so it’s important to do at least some small things like this every day to give yourself a chance to feel a little better, or at least help prevent yourself from sinking even deeper.

And when you’re depressed it’s hard to imagine you could do anything that could give you a sense of achievement or accomplishment. But there’s no need to be ambitious. These can be simple things—answering an email, doing the dishes, paying some bills—no matter how small these things may seem they can still give you some sense of accomplishment, which in turn usually helps improve your mood even if just a little bit.

And when you’re depressed sometimes you just want to isolate yourself from people. Socializing can seem impossible, and you can feel like nobody would want to be around you the way you are and you’d just be a burden. But a sense of isolation can be a big contributing factor to feeling depressed, so it is important to find some way to have contact with other people.

Things like going to a party or being with a big group of people can seem overwhelming, so focus on things that are more manageable, whether it’s talking to someone on the phone, or texting with them, going for a coffee, or even just going out by yourself and being around other people. Though obviously these last couple are not good ideas right now which makes staying connected to others during the coronavirus crisis that much more difficult as we need to find ways to socialize that don’t involve physically being around other people. But the more you isolate yourself the more depressed you’re likely to feel, and just having any sort of social interaction can help lift your mood and make you feel a little better.

Now if your mood is really low and you go for a little walk everything’s not going to be sunshine and rainbows all of the sudden, but you’ll probably feel at least a little bit better. And being aware of even small shifts in your mood is important, because when you’re feeling this way it can be so difficult to notice anything positive or have any hope. And so even the smallest improvement in how you’re feeling is worth recognizing because it is a big step compared to not being able to get out of bed or up off the couch and just feeling worse and worse as the day goes on.

And another reason why being more active is so important is because when we’re feeling sad or depressed we tend to ruminate a lot. And research has found that the amount of rumination associated with an emotion is the determining factor in how long that emotion lasts. And because we ruminate so much when we’re feeling sad, sadness is by far our longest lasting emotion, and so anything we can do to cut down on how much we’re ruminating when we’re feeling sad or depressed helps limit how long those feelings last. And even something as simple as going for a walk can help us get out of our heads start ruminating less and as a result our mood starts to improve.

Behavioral activation can often be hard to put into practice because when we’re feeling depressed we tend to be very pessimistic and have lots of negative thoughts, and these thoughts can sometimes get in the way of increasing our level of activity. To help counteract this type of negative thinking and these negative expectations one thing that we encourage with these activities is that you use a behavioral activation diary, which you’ll find a link to below in the description, to help you predict beforehand how much pleasure or enjoyment, sense of achievement or accomplishment, or sense of social connection you’ll get from doing the activity.

And then after you’ve done it record the actual amount of pleasure you got, the actual sense of accomplishment that you felt, and the actual sense of social connection you experienced, as often these will be higher than predicted. And this can help counteract that negative thinking you have that tells you there’s no point in doing anything, why bother, it’s not gonna help, or it’s gonna make you feel worse.

And then this is a way of giving yourself some evidence that even though you don’t want to do anything, can’t see the point in doing anything, when you actually do do something you tend to get more out of it than you think you will. And then this can help motivate you to do more in the future even if your depression and negative thoughts are telling you not to bother.

You can download a Behavioral Activation Diary in PDF or Word format. If you have any questions or comments, please leave them on the YouTube video page.