Behavioral Activation

Behavioral activation can be provided by any mental health professional. Although training in evidence-based treatment may be useful, it may not be necessary. If you wish to learn more about behavioral activation (and other cognitive behavioral therapy-based interventions), there are many training programs and courses you can take to become competent with this approach.

Using Principles of Cognitive Behavioral Therapy

Behavioral activation is based on a principle that by changing our behavior, we can produce change in our thoughts and feelings. When using behavioral activation, we start by altering behavior. As shown below, changes in behavior can lead to changes in the thoughts and feelings that may be contributing to depression.

Activity Monitoring

Activity monitoring can be a useful first step in behavioral activation. Activity monitoring is often used for individuals with depression but can be useful for anyone who can benefit from finding ways to organize and engage in enjoyable activities in their day. This is a tool that can be used for gathering data to gain an understanding of the times or activities that are pleasurable or reinforcing to the student. Once you begin to identify these patterns, you can help the student increase the amount of time they spend on activities that provide them a sense of accomplishment or pleasure. You may also see patterns in their mood at various times of the day. This step may not be necessary for some students who already have ideas of what pleasurable activities they may want to try or do not need the baseline data.

1. Make a weekly calendar with the student with hourly blocks. You can do this on paper or on a computer or phone.
2. Have the student fill out the activities that they completed that day
3. Encourage your student to note how much pleasure they experienced from that activity (i.e., the amount of enjoyment they feel from that activity on a scale from 1-10).
4. Ask your student to start filling out the form in session with you so they have an understanding of what to do when they leave your office.
5. Remind your student to fill out as many aspects of their day that they can, no matter how mundane or routine the activity is.
6. Use the data you gather from these activity schedules to notice specific activities or patterns in activities that provide the most pleasure to your student.
7. Help your student to increase the amount of time they spend on pleasurable activities.

These can be completed directly on a calendar or as a list as shown. You may have the student track their calendar for a week or longer depending on the student and their needs.

Example Activity Monitoring

Monday:

• 7:00 AM – Wake up and get dressed: rating 1
• 8:00 AM-3:00 PM – School: rating 3
• 4:00 PM – Walk dog: rating 5
• 6:00 PM – Dinner with parents: rating 4
• 7:00 PM – Homework: rating 2
• 8:00 PM – Watch Netflix: rating 5
• 9:00 PM – Shower: rating 5

Tuesday:

• 7:00 AM – Wake up and get dressed: rating 1
• 8:00 AM-3:00 PM – School: rating 4
• 4:00 PM – Walk dog: rating 3
• 7:00 PM – Dinner with parents: rating 3
• 9:00 PM – Watch Netflix: rating 5

Behavioral Action Plan

A behavioral activation plan helps the student re-engage in positively reinforcing activities. You may use data that you gathered from your activity monitoring to brainstorm ideas of activities.

1. Brainstorm a list of activities that the student enjoys. These may be activities they used to do before they were experiencing depressive symptoms, or something that can help them achieve a sense of well-being, mastery, or pleasure. For example, they may enjoy going on a walk, listening to a favorite song, reading a poem, biking, sports, spending time with friends, going to an after-school club, or reading a book. They may feel a sense of mastery when they return a text in a timely manner or complete a chore (e.g., bathing a pet).
2. Encourage your student to think of brief activities. It is important to start with small goals, so that your student is able to complete the plan and experience success. For example, making a plan with a friend may be a big first step, so your student may want to first plan a few text conversations, then a phone call, and then make a plan in person to build up their activity plan.
3. Brainstorm various barriers or obstacles to completing their plan. Think about ways to overcome those barriers.
4. Help your student plan a specific day and time that they want to complete the activity.
5. You may want to stick to only one or two activities at a time to make this plan more doable.
6. Write the plan down on a piece of paper or notecard so that your student has a physical reminder of their plan. Also, consider adding reminders on their phone or scheduling the pleasant activities in their calendar.
7. Have the student make a rating before each task (How much fun to do expect to have, on a scale from 1 (none/no fun) to 10 (extreme fun) and after each task (How much fun did you have, on a scale from 1 (none/no fun) to 10 (extreme fun).
8. Gradually increase the amount of time planned for activities until there is at least one fun activity planned each day (maybe even multiple activities on days without school).

Discuss the ratings together so you can learn about patterns. For example, if they had fun (e.g., 5 or higher) or had more fun than expected (pre-rating of 2 and post-rating of 4), you can use this to motivate them to continue to engage in the activity, and to question the utility of their expectations/thoughts. Remind them that changing our behavior can lead to changes/improvements in our thoughts and feelings. You will want to make a new plan each week with increasingly larger activity goals.

Example Behavioral Action Plan

1. Play with my dog on Wednesday at 4:00 after school
   1. Rating before the task: 3

   1. Rating after the task: 4

2. Paint my nails on Saturday at 1:00
   1. Rating before the t

   1. Rating after the task: 5

Once you have implemented behavioral activation, it may be useful to move into other CBT techniques. You can learn more about CBT here.