What is Behavioural Activation Therapy?

This article briefly introduces behavioural activation therapy, an effective applied behaviour analysis intervention used to treat clients with depression. Prefer video? Watch this video version via the MHA YouTube channel.

Introduction

Behavioural activation is a type of applied behaviour analysis, a field of research based on the work of behaviourist B.F. Skinner, and particularly, on Skinner’s findings that, “in a given environmental context, behaviours that produce favourable outcomes will continue to occur through the process of reinforcement and those behaviours that do not produce favourable consequences will decrease over time, or extinguish” (Roane et al, 2016).

Definitions

BAT has been defined as:

“a structured, brief psychotherapeutic approach that aims to (a) increase engagement in adaptive activities (which are often those associated with the experience of pleasure or mastery), (b) decrease engagement in activities that maintain depression or increase risk for depression, and (c) solve problems that limit access to reward or that maintain or increase aversive control” (Dimidjian et al, 2011). 

How Behavioural Activation works

As a therapeutic intervention most often used to treat depression, it allows clients with depressive symptoms to “learn to cope with their negativity” and to “increase positive awareness through the re-development of personal goals in the form of short, medium and long-term life goals” (Chan et al., 2017). Thus, BAT helps clients to plan more activities they enjoy (or once enjoyed) doing, develop their social skills (to make the social environment more rewarding), and also helps them to track their emotions, particularly as those relate to various activities.

One of behavioural activation’s strengths is that it is highly customisable, each plan being set up particularly according to a client’s values and preferred activities. It can also be customised for specific types of depression, and for those who have depression co-morbid with other mental health conditions, such as personality disorders (Selva, 2018). Accordingly, nearly all cases of depression can be ameliorated with BAT.

Behaviour or thoughts?

Unless you are a very new therapist, you are likely to have encountered the various debates which have raged in the field of mental health over the years, with some behaviourists in the past proclaiming the superiority of behaviourism over cognitive therapy, and other therapists touting the advantages of cognitive behaviourism, meaning that the added component of cognition is a more valuable target. Most modern CBT-style models include both components. Ironically for proponents of the latter, at least one study has shown that a primary reason for the efficacy of CBT is the behavioural activation part of it. In this study, the study participants who completed a behavioural activation intervention alone saw as many benefits as other participants who completed both BAT and some cognitive components of CBT (Jacobson et al, 1996). Thus, BAT may be a big reason why CBT, deemed the “gold standard treatment” for many conditions, is so effective.

The advantages of Behavioural Activation Therapy

At least, we can confidently advocate for behavioural interventions, given that behaviour – being observable – is much easier to target than thoughts! Beyond that, however, BAT is valued for its simplicity, the quickness and ease of learning how to apply its interventions, and the consequent cost-effectiveness of it. Unlike with anti-depressant medications, there are no side effects, and because it is so simple, you as a therapist are likely to be able to deliver it with greater fidelity than you would more complex treatments. In terms of our collective societal mental health, it makes sense to treat as many people as possible with a simple, relatively brief, cost-effective therapy which “ordinary” therapists can deliver, reserving more long-term, specialist treatments for those who really need them (McEvoy, 2016).

When your client shouldn’t do BAT on their own

Some BAT manuals can often be used by clients on their own. There are a few situations, however, in which your client is better off working with you than dispatched (albeit with a manual) to their own devices. These include when they are manifesting:

• Shifts in mood without an obvious trigger. Here, you could offer additional support to identify potential causes for mood shifts, which could include conditions such as bipolar disorder.

• Memory difficulties. Anxiety or other mental health concerns could be at play, and should be explored for possible treatment.

• Panic attacks. Deeper looking into these, along with coping techniques, may be necessary for clients with panic issues (related article: Assessing and Treating Anxiety).

• Trouble with basic functioning. If your client cannot take care of their essential needs, just scheduling in a few fun activities will not be sufficient intervention.

• Thoughts of death or suicide. You must – to be ethical and practice safely – be certain that your client is not in danger of harming themselves (with or without intention to die) (Healthline, n.d.).

Key takeaways

• Behavioural Activation Therapy (BAT) is an applied behaviour analysis used to treat depression.
• BAT helps clients to plan more activities they enjoy, develop their social skills, and track their emotions.
• Studies have shown behavioural activation as a primary reason for the efficacy of Cognitive Behavioural Therapy (CBT).
• Behavioural Activation is valued for its simplicity, the quickness and ease of learning, and cost-effectiveness.
• Clients should not pursue BAT alone if they experience mood shifts without trigger, memory difficulties, panic attacks, trouble with basic functioning, or thoughts of death or suicide.

References

• Chan, A.T.Y., Sun, G.Y.Y., Tam, W.W.S., Tsoi, K.K.F., & Wong, S.Y.S. (2017). The effectiveness of group-based behavioral activation in the treatment of depression: An updated meta-analysis of randomized controlled trial. Journal of Affective Disorders, 208(1), 345-354.
• Dimidjian, S., Barrera, M., Martell, C., Munoz, R.F., & Lewinsohn, P.M. (2011). The origins and current status of behavioral activation treatments for depression. Annual Review of Clinical Psychology, 7(1), 1-38.
• Healthline. (n.d.). Behavioral activation therapy: Does it always help? Healthline.com. Retrieved on 5 January, 2023, from: https://www.healthline.com/health/behavioral-activation-therapy#does-it-always-help
• Jacobson, N.S., Dobson, K.S., Truax, P.A., Addis, M.E., Koerner, K., Gollan, J.K., Gortner, E., & Prince, S.E. (1996). A component analysis of cognitive-behavioral treatment for depression. Journal of Consulting and Clinical Psychology, 64(2), 295-304.
• McEvoy, P. (2016). Explainer: What is behavioral activation for depression? The Conversation. Retrieved on 4 January, 2023, from: https://theconversation.com/explainer-what-is-behavioural-activation-for-depression-62910
• Roane, H.S., Fisher, W.W., Carr, J.E. (2016). Applied Behavior Analysis as treatment for autism spectrum disorder. Journal of Pediatrics, 175(1), 27-32.
• Selva, J. (2018). Behavioural activation therapy: 14+ techniques and worksheets. PositivePsychology.com. Retrieved on 5 January, 2023, from: https://positivepsychology.com/behavioral-activation-therapy-treating-depression/