When your child is struggling with depression, it can feel challenging to identify ways to help them manage their emotions and improve distressing symptoms. Many decades of research on interventions for depression has told us that a combination of therapy and medication is often most effective. The best approach for each child or teen may look different, and getting an assessment and specific recommendation from a mental health professional is the ideal way to search for and select treatment. An approach for treating depression, that has a large evidence base, is Cognitive Behavioral Therapy (CBT). Within CBT for depression, treatment often involves an intervention called behavioral activation.
Behavioral activation aims to improve mental health by increasing engagement in pleasurable and rewarding activities and decreasing engagement in activities that maintain depression. The approach is based on both neuroscience, which has identified areas and systems of the brain that function differently when an individual is experiencing depression, and a basic cognitive-behavioral theory that our thoughts, feelings, and actions all influence each other.
A key characteristic of a depressive episode is anhedonia, which is the inability, or reduced ability, to experience pleasure or joy in activities that typically are enjoyable for the individual. This includes feeling a loss of interest, motivation, or excitement, a diminished capacity to experience positive emotions, and difficulty processing any feelings of reward for having engaged with a previously rewarding experience. For a person experiencing a depressive episode, research has shown that there is altered functional connectivity within the reward-processing network in the brian that explains anhedonia. Anhedonia in individuals with depression has been linked to differences in brain activity in the areas of the brain linked to reward processing, and behavioral activation treatments are designed to activate areas of the brain that are underactive. Behavioral activation strategies aim to strengthen the reward pathways by increasing engagement in goal-directed activities and values-driven behaviors, as well as increasing the focus on rewarding activities.
The behavioral activation approach for depression is based on Aaron Beck’s cognitive theory, which drives all Cognitive Behavioral Therapy (CBT) approaches. The theory suggests that thoughts, feelings, and behaviors all influence each other and collaboratively drive how a person responds to the situation they are in. For example, if your child loses a soccer game, they may have the thought, “I am a loser”, which would lead to them feeling bad about themselves, and to them retreating to their room or becoming irritable with parents. Or, if they instead have the thoughts, “It’s just one game and I tried my best,” they may be able to feel motivated to practice, and move on with their day in a more adaptive way. Or, even if the child still has the thought, “I am a loser”, they may still feel bad and down, but if they’re able to engage with an activity that they like and which brings them pleasure, like playing a board game with the family, they might have the capacity to move on from the upsetting thoughts and feelings about the soccer game and enjoy the rest of their afternoon. The idea behind this is that we have the power to intervene at different times during this connected cycle of thoughts, feelings, and behaviors to change the outcome. We can either work to change our thoughts, or we can work to change our behaviors, and both have the capacity to influence our feelings.
Behavioral activation is focused on intervening at the point where we engage with behaviors. For example, if you listen to a sad song when you’re not sad, you may begin to feel sad. Alternatively, if you listen to a happy song while feeling down, it may play a part in lifting your mood a little bit. Of course, managing depression symptoms and anhedonia is more complicated than just listening to music that you like, but the theory behind behavioral activation is based on this basic idea.