Cognitive Behavioral Therapy (CBT) for depression often involves a component of behavioral activation, whether it is the core of the treatment, or if it is used alongside other skills. Behavioral activation aims to intervene in the cycle of depression that keeps people from engaging with the activities that bring enjoyment and meaning to their lives.
In treatment that uses behavioral activation, the therapist will aim to help the client understand their cycles of depression that lead to disengagement with enjoyable activities. This often includes noticing how you react to different life events or thoughts, and how that makes you feel. For example, the therapist will work with the client to help them understand triggers for thoughts that lead to emotions connected to feelings of depression (sadness, stress, irritability, etc,) and then what they do, or don’t do, in response to those feelings. The goal is to set the groundwork for the client to understand how their thoughts, feelings, and actions all interplay to contribute to the cycle of their depression.
Activity monitoring builds on this concept, further helping the client become aware of the ways in which mood, emotions, and behaviors influence each other. By being aware of daily cycles of events, mood, and activities, we can begin to understand which activities help the individual feel better, and which contribute to making them feel worse. Activity monitoring often involves using a chart to track the time of the day, basic activities that the client is engaging with, and mood on a scale from 0 (worst) to 10 (best), before making any changes. Based on these mood ratings which are connected to activities in the daily life of the client, the client works with the therapist to identify which activities help them feel more positive, and which activities make them feel more down. This monitoring and categorizing helps the client and therapist work collaboratively to increase the number of activities that lead to positive feelings and decrease the number of activities that lead to negative feelings.
Another important component of behavioral activation is collaboratively building an understanding with the client of what makes life worth living for them. Exploring what makes life worth living includes discussing values they resonate with, identifying pleasurable activities that they enjoy for the sake of doing them, the concept of mastery, which involves the satisfying development of skills and accomplishments, and goals, which can help drive how a client aims to experience their lives
By considering their values, what brings them pleasure, how they can work towards mastery in the development of skills, and goals they’d like to set for living their lives to the fullest, clients begin the work of infusing meaning into their life. This structure sets up a long-term oriented strategy for addressing motivation, and it is fueled by behavioral activation along the way. In therapy, this may look like engaging with a variety of activities that are designed to help the client understand what their values are, how they can build off current strengths, and what that means for creating a life worth living for them. Through these activities, the therapist gets an understanding of the client and works with them to identify activities that bring them pleasure, actions that align with their values and goals, and small steps they can begin engaging in to create more meaning in their life.
With these building blocks, the client and therapist will work together to plan proactively for the client to engage with pleasurable activities, value-based activities, or goal-oriented activities. Planning to integrate these activities into their lives, and tracking how it goes, and the impact they have on the individual’s mood, can help overcome the initial difficulty of motivating to engage with these newly identified plans. The role of the therapist is to help schedule these activities in a realistic and achievable way and help stategize for how they might react if barriers to engagement pop up at the time of the scheduled activity. Often, this includes planning ahead to break down tasks into small, manageable chunks, to increase the likelihood of success!
Want to learn more?
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- Read The Science and Theory of Behavioral Activation for Depression