Behavioral activation (BA) is a form of cognitive behavioral therapy, designed to treat depression. It is a targeted, uncomplicated behavioral treatment that targets patterns of avoidance and sets us up for opportunities for positive reinforcement (or “pleasant experiences”). BA is a program that is brief and teen-led. Your therapist is available to provide you with education about depression and how to overcome it but you will be the one putting BA strategies to the test, in your real life.
The first step of behavioral activation is to identify relationships between situations, activities, and moods. To do this, we have to take a detailed account of our actual daily activities. In treatment, we do this by writing out a schedule for the day (e.g. Monday 8:00am-10:00pm) and fill in each hour with the activities you engaged in (e.g. virtual school, homework, video games). It is also typical for your therapist or counselor to provide your caregiver(s) with education about what depression is, and how it impacts adolescents’ behaviors at the onset of treatment.
Next we have to learn — and be able to recognize — the difference between behavior that is directed by our current mood (“mood-directed behavior”) and behavior that is pre-planned and “goal-directed.” Often times, our behavior seems to depend upon our mood (for example, if you feel drained you may stay in bed much of the day). In behavioral activation, it is important to identify these patterns (e.g. feeling tired → staying in bed) and plan ahead to change the cycle. At this point in treatment, we are ready to monitor both our daily and hourly activities and our moods throughout the day. Much of the time, teens will notice patterns in their activities and moods (e.g. FaceTimed a friend → felt content; played video games for two hours → felt happy). This helps us to see which kinds of activities may be more likely to result in a positive mood shift versus a negative one. At this point, it is often useful for teens to rethink their daily schedules and begin to plan for activities that will most likely boost their mood.
Another helpful component of many cognitive-behavioral therapies, BA included, is problem solving. It is essential for us to learn to problem solve in stressful circumstances and to communicate with a caregiver or trusted adult regarding what to do when stressed. Another aspect of BA is setting clear and attainable goals. This usually involves writing in a notebook or on a worksheet to put your ideas into visual form. With your therapist, you will work to identify anything that has previously gotten in the way of achieving your goals. For many teens, avoidance is a key barrier to achieving goals and to feeling better. This is because when we avoid something that is distressing (e.g. procrastinate on an assignment, isolate from our friends, stay home from school, etc.) we only feel relief in the short term. But in the long run, avoiding can make our problems even worse. BA teaches you how to identify your own personal patterns of avoiding and you will work to come up with an alternative response to feeling stressed, that will really benefit you in the long term.
Before the brief course of treatment ends, you’ll meet with your therapist one or two more times to discuss how you can take BA skills into your life and “graduate” from therapy. BA is not intended to go on forever and, once you have learned the program, you will be capable of maintaining the work outside of therapy meetings. These final sessions are called “relapse prevention” and are used to identify your personal triggers, stressful situations, and warning signs that depression may be coming back. Depression is episodic and although it is treatable, it is possible that symptoms will return in the future. The final sessions of BA are all about preventing a return to old patterns of behavior.
If you are interested in engaging in Behavioral Activation to boost your mood, there are self-help smart phone apps such as “Moodivate” and “What’s Up” that offer some guidance. If you have been diagnosed with depression (e.g. Major Depressive Disorder) or suspect that you may meet criteria for a mental health diagnosis, please contact us at 512-246-7225 to schedule an appointment or consider contacting your Local Mental Health Authority (for Travis County, the LMHA is Integral Care).
Source: McCauley, E., Schloredt, K. A., Gudmundsen, G. R., Martell, C. R., & Dimidjian, S. (2016). Behavioral activation with adolescents: A clinician’s guide. Guilford Publications.
By Jordan Levine, PsyD, supervised by Misti Nicholson, PsyD