Behavioral Activation Treatment of Depression

 

Behavioral Activation (BA) is a core component of Cognitive Behavioral Therapy and is one of the most powerful and lasting treatments for depression. Whereas some treatments characterize depression as a medical illness, Behavioral Activation was born out of a psychological tradition that views depression as a set of learned behaviors – such as avoidance, withdrawal, and rumination – which can be “un-learned.” It offers hope that clients can learn new ways of living more rewarding lives.

The basic premise of Behavioral Activation is that increased engagement in meaningful activity will decrease depression. In contrast, the avoidance of unpleasant feelings and thoughts can backfire and lead to greater suffering. For example, a person may avoid the stress of the upcoming day by sleeping in late, but this strategy may leave the person with fewer chances for rewarding experiences; having fewer positive experiences can cause more unpleasant thoughts and feelings, leading to more avoidance, and ultimately more suffering. The solution to this depression feedback-loop is to learn how to become more active and engaged with meaningful activities (hence the name Behavioral Activation), even while feeling unhappy, anxious, unmotivated, or irritated.

Behavioral Activation is an evidence-based therapy, meaning research shows that it can help people. In one study (Dimidian et al., 2006), BA was shown to be as beneficial as anti-depressant medication in treating major depression – without the harmful physical side-effects. Further still, Behavioral Activation has been shown to be more effective than anti-depressant medications at preventing relapse of depression after treatment has ended (Dobson et al, 2008). In fact, research shows that it is primarily the behavioral component of Cognitive Behavioral Therapy that has accounted for its success (Jacobson et al, 1996). This point makes sense because, instead of directly trying to change the ways people think and feel, Behavioral Activation works “from the outside in” – the focus on changing behavior can lead to a better quality of life that then improves people’s inner experience – their thinking and emotions.

In conjunction with mindfulness practices and ACT, the Depression Treatment Program at Portland Psychotherapy utilizes Behavioral Activation in individual and group therapy. Clients who participate in our program can learn how to stop the cycle of depression and prevent future depressive episodes. Our therapists help clients to work with rumination, to overcome avoidance and passivity, and to gain more flexible problem-solving skills. As a part of this work, we help clients achieve insight into the difficulties they experience by fostering greater self-awareness through mindfulness. We look closely at triggers of avoidance and help clients become less reactive and more deliberate in making effective choices. Most importantly, our therapists help coach clients to pursue activities they value. Our expertise in Behavioral Activation offers clients an opportunity to live more rewarding and meaningful lives.