Behavioural Activation for Depressive Disorders
Behavioural Activation for Depressive Disorders
Authored by: Christiana Louisa Ticoalu, M.A., Psychology & Management
Language Editor: Alda Belinda, S. Psi.
Clinical Editor: Dr. phil. Edo S. Jaya, M.Psi., Psikolog
A Quick Refresher
What is a Depressive Disorder?
Though the symptoms of depressive disorders are heterogeneous, the conditions share several commonalities. Firstly, depressive disorders are characterized by a loss of pleasure or a depressed mood (including sadness, irritability and emptiness). Secondly, individuals who are experiencing depressive disorders typically experience a combination of cognitive, behavioural and neuro-vegetative symptoms, the latter of which may include a lack of appetite, weight fluctuations and insomnia. These symptoms are experienced for the larger part of almost every day, for a period of at least two weeks. These collective symptoms may greatly undermine an individual’s ability to function across important life domains.
Symptoms of Depressive Disorders
For a comprehensive list of depressive disorder symptomatology, we recommend you visit the ICD-11 webpage.
What is Behavioural Activation?
Theoretical background
According to the “inactivity trap”, a loss of interest in day-to-day activities and hobbies, once perceived as meaningful, may intensify a patient’s depressogenic symptoms. Proponents of behavioural theories posit that in the same way cognition and emotion are theorized to effect behaviour, behaviours influence both cognitions and emotional experience.
In some instances, individuals who experience debilitating or severe depressive disorders are unable to cope with simple day-to-day tasks, such as personal grooming, maintaining sensible eating patterns, partaking in social interactions and, in some cases, getting enough sunlight.
How it Works
Behavioural activation may be implemented on its own or incorporated as an additional component of Cognitive Behavioural Therapy, in conjunction with other treatments such as cognitive restructuring. The therapy involves incorporating or “activating” a positive repertoire of basic or pleasurable activities.
It is theorized that engagement in positive, fulfilling activities may decrease negative affect, and gradually and ultimately, lead to a self-enforcing cycle of positive contingencies. This can consequently improve cognitive, behavioural and depressive symptoms. The approach is considered an efficacious treatment for individuals with depression. When successful, the therapy has the capacity to break the cycle between depression and inertia.
This therapy may be used as a form of treatment amongst individuals with varying degrees of depression. Amongst those who are severely depressed, this approach serves to assist in the re-integration of basic goals, such as maintaining personal hygiene, the application of self-care routines, and encouraging social interactions. The therapy is implemented through a series of assignments provided to patients that address each personal goal.
Tailored Treatment plans
Dear Reader,
At IndoPsyCare, we formulate treatment plans on a case-by-case basis. Contingent upon your condition and situation, your therapeutic journey may or may not include a variation of the following components:
Assessments
Your therapist may administer assessments at various points throughout your therapeutic journey. This is done as a way of assessing your improvements and thus the effectiveness of the treatment plan. When treating depressive disorders, our clinicians typically administer several assessments including the Patient Health Questionnaire 9 (PHQ-9). Nevertheless, we ask that you please keep in mind that assessments may vary depending upon your specific condition and circumstances.
Psychoeducation
IndoPsyCare seeks to provide you with an understanding of your symptoms in the context in which they occur. Your therapist will provide you with a clear understanding of depression and explain its nature, symptoms and prevalence.
Your clinician will likely explain the relationship between your thoughts, emotions and behaviour, and provide you with an understanding of the positive implications of engaging in activities centring around self-care. You will likely receive an explanation regarding the potential benefits that participating in healthy behaviours will have on your overall well-being.
Furthermore, psychoeducation seeks to enhance your understanding of the rationale behind your therapy and its various components. Your therapist will help you feel more at ease by increasing your awareness of different treatment strategies, why they are undertaken, and how they are important aspects of your roadmap to recovery.
Formulation of an Activities List
Following an assessment of your condition, your therapist might construct a hierarchical list of tasks to integrate into your daily routine. Your therapist will typically encourage you to progress through this list in a graded manner, engaging in tasks that incrementally increase in difficulty.
For instance, if you struggle to integrate meals into your routine at all, often going a whole day without eating, your therapist may aim to first integrate one meal per day. Once this is achieved, a further additional meal will be incorporated, until the full re-integration of three meals per day is achieved.
If you are unable to get out of bed and have abandoned seemingly all personal hygiene, your clinician may ask you to have a shower once a day two days. This will gradually be increased to once a day.
If you are homebound, your therapist may ask you to go for a walk for five minutes a day in the sunlight. Further increments will be sought as your ability and confidence allow. Note that this hierarchical activities list will likely also involve the gradual implementation of several different adaptive and healthy behaviours.
Activity Scheduling and Monitoring
Many individuals with mental health conditions struggle to integrate these positive and adaptive behaviours into their schedules. Your therapist may aid you through your activity scheduling with the intention of mapping out clear timeframes and timelines for the implementation of specific goals. You and your clinician may revisit these activities whilst monitoring your feelings and progress.
Monitoring of Activities and Mood
If you are able to do so, you will be asked to self-monitor your success whilst engaging in different activities. Furthermore, you may be tasked with monitoring how the various situations make you feel. This reflective approach aids you in understanding the relationship between your behaviours, emotions, and cognition. These are subsequently discussed with your therapist during your sessions.
Relapse Prevention
During this phase, your therapist will likely reinforce your understanding of the strategies you have learned, including when and how they should be implemented. Furthermore, you will likely be taught to recognize your own personal warning signs. It is essential that you understand these warnings so you can seek timely assistance from your therapist who will re-address your recovery treatment plan.
Treatment Duration
How many sessions will I need?
The UK’s National Institute of Health and Care Excellence (NICE) recommends 12-16 sessions. Nevertheless, every patient is unique, thus it depends upon your personal situation.
The number of sessions you require is typically influenced by:
- The severity of your symptoms
- Existing comorbidities (co-existing conditions)
- The length of time you have been experiencing your condition
- Your personal motivation and progress
- Your social support network
Making the Most of Therapy
Asking for help is commendable
Asking for help is understandably difficult, thus reaching out is a testament to the strength of each individual who does so. A call for help should never be seen as a sign of weakness, as it is the first step in your journey to recovery. Although sometimes uncomfortable, sharing your vulnerabilities with the right people may provide an appropriate, timely, and forthright avenue through which your problems can be assessed and addressed.
Be open and honest
Think of therapy as a journey in which you are steering the ship; your therapist is your guide, navigating the journey based on your account of what you see and experience. Reaching your desired destination and goals will be acquired with more proficiency when you share your feelings and fears. As your therapist acquires a clearer understanding of the intricacies of your situation, he or she will be in a better position to guide you in the right direction.
Be consistent
You will not see change overnight. True, lasting, cognitive and behavioural change takes time. Therapy is not a “quick fix”, rather it requires patience, consistency and tenacity on your part. Allow yourself time, communicate with your therapist, and share your feelings if you feel you are losing sight of your destination.
Trust the process
More often than not, improving your condition requires you to go beyond your comfort zone, letting go of your maladaptive coping strategies. Trust that, whilst this process may inevitably become uncomfortable or difficult at times, temporary discomfort may bring long-term and lasting benefits.
A Gentle Reminder
Dear Reader,
We sincerely appreciate your dedication; you have made it through this page of our Psychlopedia. We trust that you have gleaned valuable information from this page. Before we part ways we would like to reiterate that each treatment plan will be uniquely tailored to you, your situation and your requirements. Your personal treatment plan may or may not include the elements on this page.
If you feel as though you require professional assistance, please refrain from self-diagnosis. IndoPsyCare has professionals who are here to help.
Resources and Recommended Readings
National Institute for Health and Care Excellence. (2022). Depression in adults: recognition and management. Retrieved 1 July 2022, from https://www.nice.org.uk/guidance/cg90
World Health Organization. (2019). ICD-11: International Classification of Diseases (11th revision). Retrieved from https://icd.who.int/
Code for Single Depressive Disorder: 6A70
- Fried, E., & Nesse, R. (2014). The Impact of Individual Depressive Symptoms on Impairment of Psychosocial Functioning. Plos ONE, 9(2), e90311. doi: 10.1371/journal.pone.0090311
- Monroe, S., & Harkness, K. (2022). Major Depression and Its Recurrences: Life Course Matters. Annual Review Of Clinical Psychology, 18(1), 329-357. doi: 10.1146/annurev-clinpsy-072220-021440
- Tindall, L., Mikocka-Walus, A., McMillan, D., Wright, B., Hewitt, C., & Gascoyne, S. (2017). Is behavioural activation effective in the treatment of depression in young people? A systematic review and meta-analysis. Psychology And Psychotherapy, 90(4), 770-796. doi: 10.1111/papt.12121
- Uphoff, E., Ekers, D., Dawson, S., Richards, D., & Churchill, R. (2019). Behavioural activation therapies for depression in adults. Cochrane Database Of Systematic Reviews. doi: 10.1002/14651858.cd013305