Evidenced-based Treatment for Depression

Behavioral Activation

Behavioral Activation (BA) is an essential component of Cognitive Behavioral Therapy (CBT) and is one of the most effective treatments for depression. In fact, in this study Behavioral Activation was shown to be more effective than anti-depressant medications at preventing relapse of depression after treatment has ended.

BA views depression as a set of learned behaviors – such as avoidance, withdrawal, and rumination – that can be changed. Depression is framed less as a disorder of mood or feelings, but as a collection of counter-productive behaviors. Behavioral activation seeks to halt this vicious cycle through active engagement, even when the patient is unmotivated, sad or anxious.

The basic premise of Behavioral Activation is that increased engagement in meaningful activities will reduce depression. In contrast, the avoidance of unpleasant feelings and thoughts can ultimately 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 even while feeling unhappy or unmotivated.

In Behavioral Activation, therapists try to understand the environmental sources behind patients’ depression, and focuses on behaviors that maintain or exacerbate the depression.

Avoidant Behaviors in Depression

  • Social Withdrawal: Not answering the telephone. Avoiding friends.
  • Non-social Avoidance: Not taking on challenging tasks. Sitting around the house. Spending excessive time in bed.
  • Cognitive Avoidance: Ruminating on trying to explain the past or solve insoluble problems. Not thinking about relationship problems. Not making decisions about the future. Not taking opportunities. Not being serious about work or education.
  • Avoidance by Distraction: Watching Netflix. Playing video games. Gambling. Comfort-eating. Excessive exercise.
  • Emotional Avoidance: Use of alcohol and other substances.

Behavioral Activation Books