You Can Use Behavioral Activation Therapy to Treat Depression

Written by Paul Kelly, Ph.D., C.Psych.         October 9, 2023

Main Points:

1. Behavioral Activation is an effective treatment for depression.
2. It is easy to learn. You can use it as self-help for depression.
3. Sadness is normal, but it puts us at risk for depression.
4. When we withdraw and disengage, we can start to spiral into depression. Then, we can get stuck in a depression.
5. Behavioral Activation teaches you how to stop the downward spiral, and how to recover.
6. Check out the Free and Low Cost Self-Help Resouces near the end of this article. They will show you how use Behavioral Activation to have a happy and productive life.

 

Is This Article for You?

Do you see yourself on this list? If so, read on.

1. I have depression, and I want to overcome it.
2. I want to prevent sadness from becoming depression.
3. I care about someone who is depressed. I want to help them.
4. I am a lifelong learner, interested in wellness and mental health.

 

My Personal Depression Story:

About 10 years ago, I had a severe episode of depression. Yes, it can even happen to a psychologist. I had these symptoms:

• I felt like I was in a black, heavy, depression.
• I felt fatigued all the time.
• The future looked hopeless.
• I thought about how to kill myself.
• I had no appetite. I lost weight.
• I wanted to sleep all the time.
• It felt like my brain was full of molasses. I had trouble concentrating.
• It took tremendous effort to talk to people.
• I felt like I was barely hanging on.

Here is the good news: I recovered over several months.

How did I recover?

• I studied the Behavioral Activation method and used it. It worked for me.
• I recovered without medication.
• I have been depression free for over 10 years.
• When I got depressed, none of the positive things in my life helped me feel better.  –  until Behavioral Activation helped me get unstuck and reconnected.

I am a Clinical Psychologist. I have trained as a scientist and clinician, so I know how to review research studies. I used this training to pick Behavioural Activation. I picked it because it is a very effective treatment for depression. I also liked that it was simple and well-structured. Behavioral Activation could also be right for you. Would you prefer a self-help treatment for depression that is straightforward and effective.

 

What is Normal Sadness? How is it Adaptive?

Normal sadness is a natural and healthy response to loss, disappointment, or separation. It usually lasts for a few days or weeks and doesn’t interfere too much with our functioning after a few weeks.

How is it adaptive?

• It reminds us that something needs our attention.
• Sadness can motivate us to reflect on what happened so we can learn from our mistakes.
• It can encourage us to adjust our plans or expectations.
• Sadness can help us disengage, so we don’t waste effort on something that didn’t work out.
• It can also motivate us to change our situation.
• Sadness is helpful socially. It can inspire us to reach out to others. And, when our friends see that we are sad, they will reach out to us with help or empathy.

 

How does Normal Sadness Develop into Depression?

Normal Sadness includes some withdrawal and disengagement:

• It can be healthy to slow down and disengage after we have experience a loss, or a disappointment.
• Withdrawal gives us a chance to reflect on things. It helps us recharge our batteries, and refocus our activities.
• If a relationship ends, we need time to understand what happened. Then we can make realistic plans for our social life.
• If we fail an exam or lose a job, withdrawing can give us a chance to learn from our mistakes. After that we can decide what we need to do to get our life back on track.

Sadness develops into Depression in this way:

• When we withdraw and disengage, we stop doing activities that could make us feel better. For example we stop exercising or being with people.
• This leads to further isolation, boredom, and dissatisfaction. And a spiral of strong negative feelings and thoughts gets started.
• We try to stop feeling bad. We use things like avoidance, rumination, overeating, or substance use.
• These efforts to find relief may work in the short term but worsen things in the long term.
• All this creates a Depression Loop.  Atd we get trapped in a downward spiral of depression that is hard to break out of.

 

How To Break Out of Depression Loops and Recover from Depression?

Behavioral Activation is an effective method to break out of depression loops. There are three main components:

1. Engage in Alternate Behaviors based on your values and goals.
2. Replace Avoidance Coping with Adaptive Coping.
3. Neutralize or Stop Ruminations.

How to Set Up a Self-Help Plan: Behavioral Activation for Depression:

1. Identify your Values and Goals. Values are what you care about. What values matter most to you:  family, health, career, or spirituality? Goals are activities that support your values. What goals are necessary because of your values? And, what subgoals, small steps, would support your big goals? For example, if you value health, your goal might be to get fit. And, your sub-goal would be to exercise three times a week for 20 minutes. Your depression will lift when your activities align with your values and goals.
2. Track your Current Activity. Start by tracking your activities. What did you do and how long did you do it? Which activities give you a sense of pleasure or accomplishment? Which activities make you feel more hopeless and depressed? How often do you engage in positive and meaningful activities. And, how often in neutral or negative ones?
3. Build an Upward Spiral of Motivation and Energy. Pick some activities that give you a feeling of pleasure or accomplishment. Then, schedule times to do them. As you do them, you will see that your behavior can improve and restore your mood.
4. Identify Potential Barriers and Solutions. What prevents you from spending more time on positive and meaningful activities? Do some brainstorming to find solutions. It is okay to ask friends and family for advice and support.
5. Neutralize Rumination. Ruminating about the past or the future keeps us stuck in depression. Practice mindfulness so you can notice thoughts without getting caught up in them.
6. Take Things Slow. When you are depressed, motivation and energy are low. Respect that and be kind to yourself. Start with small, manageable changes. These small successes are the way to get unstuck from depression.
7. Most Important Step: Use the Self-Help Resources in the next section of this article.

 

Free and Low-Cost Self-Help Resources:

Are you inspired to learn more about Behavioral Activation? Would you like guidance so you can start to use it? These resources are an excellent place to start. I have checked them out, so you can trust they are credible and useful.

A Free Self-Help Manual.

Behavioral Activation for Depression. This manual is free from the University of Michigan.  It explains how behavioral activation can help you. It tells you the steps to use it, and provides many helpful checklists and recording forms.

YouTube Videos about Behavioral Activation:

1. Dr. Cara Genbauffe has produced two excellent videos about “Behavioral Activation. She calls it The Gold-Standard Treatment for Depression. This is a good summary for you. Watch Part 1 and Part 2 (about 6 minutes total time).
2. Two Excellent videos, with a free workbook. The first video explains how you can get stuck in the vicious cycle of depression (about 10 minutes). The second video describes how to break out of the vicious cycle of depression (about 8 minutes). Check out the free print resources.  The Center for Clinical Interventions in Australia produced the workbook and other handouts.

Self-Help Books about Behavioral Activation for Depression:

I have found 2 books for you. They are both accessible and helpful.

1. Activating Happiness: A Jump-Start Guide to Overcoming Low Motivation, Depression, or Just Feeling Stuck, by Rachel Hershenberg, Ph.D., is an excellent place to start. It is very conversational and easy to read. It has more explanations and examples than the free manuals mentioned above.
2. Overcoming Depression One Step at a Time: The New Behavioral Activation Approach to Getting Your Life Back, by Michael E. Addis, Ph.D. and Christopher R. Martell, Ph.D., ABPP. The Association for Behavioral and Cognitive Therapists awarded this book the Self-Help Seal of Merit. It is an excellent self-help book. It is well organized. It will take you through all the steps you need to recover from depression. It discusses the kinds of obstacles you can expect – and offers solutions.

Final Thoughts:

1. The Behavioral Activation method is an effective self-help treatment for depression. Self-help does not mean – don’t get help from anybody else! At the very least talk with a trusted friend or family member. Let them know how you feel and what you are doing to help yourself. Ask if  they could be a ‘study buddy’ – read through the material with you and discuss it. Another option would be to get support from a cognitive behavior therapist. A CBT therapist would be worth considering if you are having a lot of trouble using the method.
2. Medical problems like heart disease, cancer, or hormone problems can cause depression symptoms. Have a checkup with your doctor to rule these out.
3. Lifestyle changes can support your recovery from depression in a big way. Here is a summary.

 

Sources:

I selected and reviewed all the sources for this article. I also used my judgement based on decades of clinical experience treating depression.  I wish you well. Dr. Kelly

1. Addis, M.E. & Martell, C.R. Overcoming Depression One Step at a Time: The New Behavioral Activation Approach to Getting Your Life Back. New Harbinger Publications. 2004
2. Martell, C. R., Dimidjian, S, & Herman-Dunn, R. Behavioral Activation for Depression: A Clinician’s Guide, The Guilford Press,2nd Edition, 2022.
3. Behavioral Activation for Depression, University of Michigan, Behavioral-Activation-for-Depression.pdf (umich.edu)
4. Hershenberg, R. Activating Happiness: A jump-start guide to overcoming little motivation, depression, or feeling stuck. New Harbinger Publications, 2017.
5. Lambert, K. Lifting Depression: A neuroscientist’s hands-on approach to activating your brain’s healing power. Basic Books, 2008
6. Behavioural Activation for Depression; An Update of Meta-Analysis of Effectiveness and Sub-Group Analysis
7. Ekers D, Webster L, Van Straten A, Cuijpers P, Richards D, et al. (2014) Behavioural Activation for Depression; An Update of Meta-Analysis of Effectiveness and Sub Group Analysis. PLOS ONE 9(6): e100100. https://doi.org/10.1371/journal.pone.0100100
8. Stein, A. T., Carl, E., Cuijpers, P., Karyotaki, E., & Smits, J. A. J. (2021). Looking beyond depression: A meta-analysis of the effect of behavioral activation on depression, anxiety, and activation. Psychological Medicine, 51(9), 1491–1504. https://doi.org/10.1017/S0033291720000239
9. Malik, K., Ibrahim, M., Bernstein, A. et al. Behavioral Activation as an ‘active ingredient’ of interventions addressing depression and anxiety among young people: a systematic review and evidence synthesis. BMC Psychol 9, 150 (2021). https://doi.org/10.1186/s40359-021-00655-x