Fall 2021 Newsletter

Using behavioral activation therapy as a treatment for depression

couples walk and run over a city bridge

A diagnosis of depression can make those who suffer from the disorder feel lethargic, reluctant to participate in activities that once brought them pleasure, or feel unable to take action to better their situation. Behavioral activation (BA) is a method of psychotherapy that helps people get re-engaged in their life by reducing depression, enabling individuals to live more in the present moment, and increasing their overall enjoyment of life.

Christopher Martell
Christopher Martell

Christopher Martell, Director of the UMass Amherst Psychological Services Center and Lecturer in the Department of Psychological and Brain Sciences, is one of the original developers of the protocol for BA. Earlier in his career, Martell worked as a BA research therapist alongside Neil Jacobson, professor of psychology at the University of Washington. Jacobson had published an important study in 1996 on the effectiveness of various components of cognitive behavioral therapy (CBT) on treating depression, which found that the BA component can be successful all on its own. This work led to other influential studies. Jacobson, Martell and a small team of psychologists and graduate students in Seattle worked together to develop a resurgence of BA, which was formerly called “activity scheduling”.

A psychotherapist trained in BA will work with a client to individualize their treatment plan. Martell explains, ”we use a metaphor of working from the outside in…it's easy for us all to live our lives from the inside out; if we feel happy, we do something fun, if we feel sad, we weep.

“When people are depressed, they often feel is unmotivated. Things aren't giving them pleasure and the desire is to not be depressed. The conundrum is that when you're not motivated and you don't take pleasure in anything, the things that you need to do to be less depressed will just keep escaping you.

“The idea from BA of working from the outside in is that you identify what's important to you, the kinds of activities that are meaningful or were meaningful to you, or those activities that would help you pursue goals.”

The psychotherapist will then assist their client with identifying barriers to taking action. A common barrier to initiating a new activity is that it seems too overwhelming. One technique is to break down an activity into smaller more manageable steps. For instance, if you would like to run two miles but maybe you’re a little out of shape, start by walking a half mile to keep things achievable. Creating a schedule for your new pursuits will also help you commit to doing them. Tracking your progress is another crucial part of working towards a larger goal like running five miles.

The idea of “implementation intentions” also comes in to play during this process. In addition to setting a goal, you perform tasks that will enable you to begin your new activity with ease. For example, you want to start a regular running routine, but you don’t have good running shoes. An implementation intention would be to buy new running shoes, which will start you off on the right track.

A therapist can act like a coach helping to plan a client’s next action, the success of which will foster positive and reinforcing outcomes. Often creating multiple plans of action is in order to help an individual accommodate new situations or feelings as they arise. For instance, if you want to start spending more time with a friend, plan A could be to meet for coffee. If that plan doesn’t work out, plan B might be to talk with them on the phone instead. Achieving small successes with our actions is an important part of reaching larger goals.

Another challenging behavior that many depressed individuals struggle with is avoidance. Someone may be avoiding a pursuit because of the negative feelings they get from it, or evading tasks that make them feel overwhelmed. Additionally, people may get caught in repeating negative thought patterns which  can cause them to be unable to make decisions or move forward.

Regarding thinking patterns, Martell explains, “In behavioral activation we ask, ‘when do you start thinking that way?’ and ‘how much does ruminating and brooding over this thought pull you in and  keep you stuck in your own mind and disengaged?’”

When we brood, we may be dwelling on an unhappy subject, thinking deeply about how bad we feel, or concentrating on our failures rather than our successes. Brooding is a type of rumination, or thinking over and over about something, which can make us feel caught in cycles of thought.

However, not all rumination is necessarily a bad thing. When we are reflecting, or thinking back on something, it's often what we do when we need to solve a big problem. Martell advises working to transform negative or brooding rumination into a reflective type and make it problem oriented.

“If someone is depressed and brooding about past failures, unhappiness, etc. this is likely to contribute to feelings of hopelessness and helplessness (we can’t undo the past). A BA therapist would work with the client to recognize when rumination is brooding over something unchangeable or that they can’t imagine how to change. The therapist would then teach them some problem-solving skills of identifying a small solvable problem, hopefully related to what they brood about, and to identify and evaluate possible solutions that they can try,” Martell relates. 

Once a person comes up with a solution to a problem, they can feel better and start to get unstuck from ruminating thoughts.

BA is highly customizable to the needs of an individual. This therapy may also include tracking emotions and mood, developing social skills, and targeting specific behaviors that contribute to depression. Through participating in rewarding activities and sharing positive experiences with others, BA therapy can help guide a person to greater fulfillment in life.

More information on behavioral activation with a video demonstration can be found through this link.