How Does Behavioral Activation For Depression Work?

Depression is a serious mental health condition that impacts an estimated 5% of adults globally. Depressive disorders can affect an individual’s motivation, interest in their passions, and energy levels. This can lead to a common quandary: Symptoms of depression often make it hard to engage in the activities that may improve those very symptoms. 

One approach that can be used to address this frustrating cycle is behavioral activation, a technique that focuses on using healthy behaviors to promote positive feelings. It’s one of several potentially effective treatments for depression, often used in tandem with other therapy modalities and sometimes in combination with medication. Below, we’ll discuss what behavioral activation is, how it works, and how it may help improve symptoms of depression. 

What is behavioral activation therapy?

Behavioral activation is a therapeutic intervention centered around the use of certain behavioral changes to help alleviate symptoms of mental health challenges like depression, post-traumatic stress disorder (PTSD), and anxiety disorders. It’s one of a number of most effective treatments that may be recommended for those living with depression or other mental health concerns.

Again, symptoms of a depressive episode tend to make it difficult for individuals to engage in healthy activities, which can exacerbate unpleasant feelings of hopelessness, anhedonia (trouble experiencing pleasure), and sadness. For instance, exercising may help reduce depression symptoms, but fatigue and anhedonia could make it hard for a person to leave the house and go to an exercise class or to enjoy even activities they used to love, like riding their bike, dancing, swimming, etc. 

With behavioural activation strategies, a person with depressed mood or depressive symptoms may be able to find success in ways to incorporate these potentially helpful and meaningful activities into their lives in order to address their symptoms. Behavioral activation-based strategies are often used as a part of cognitive behavioral therapy (CBT), though they can also be a standalone approach. 

How do behavioral activation treatments work?

A therapist teaching behavioral activation techniques will usually begin by speaking with the participant about their current status in regards to mental health, the specific challenges depression is presenting in their life, and other factors of the disorder’s effects. Based on the information the client provides, the professional may identify certain behaviors that are connected to their specific depressive symptoms. 

From there, they can spend time helping the client come up with activities that may have the opposite effect: promoting positive feelings and helping improve symptoms. The therapist and client may then work together to develop strategies for implementing these behaviors regularly. This plan may include things like setting attainable goals, creating a detailed schedule, and monitoring progress over time. 

A look at an example

Let’s look at a behavioral activation example. Take, for instance, a situation in which an individual is experiencing depression due to losing their job. In response, they may engage in maladaptive behaviors like withdrawing from family and friends, which can exacerbate their sense of sadness and loneliness. Because their work provided them with a sense of purpose, they may also be experiencing a lack of motivation and a loss of interest in that passion. 

By utilizing behavioral activation principles, a therapist may help this person recognize the maladaptive behaviors (self-isolating) that lead to negative feelings and activate the healthy behaviors that make them feel better (socializing, having a purpose). They may then encourage the individual to do things like schedule consistent times to catch up with friends and family, which may help improve their mood and decrease loneliness. They might also be encouraged to find side gigs relevant to their line of work as they look for a new job, which can help provide them with a sense of purpose and increase their motivation. This could, in turn, help them engage in even more healthy behaviors, creating a cycle of positive reinforcement.  

Behavioral activation treatment strategies

An important factor of behavioral activation is generally the focus on determining which activities are personally meaningful, fulfilling, and helpful to a given individual, and then using various methods to incorporate them into their life. While you can utilize behavioral activation strategies yourself, a mental health professional may be able to provide you with guidance and insights that result in more comprehensive treatment. The following are several tips for using behavioral activation for depression. 

Identify beneficial activities

To start, it’s important to recognize which actions will be most likely to foster feelings of achievement, motivation, pleasure, etc. in you. Try to develop a list of activities that normally make you feel fulfilled, energized, and engaged. Examples could include connecting with friends and family to engage in their social life, exercising, drawing, or taking nature walks. 

To get a better idea of which behaviors lead to positive feelings, it can help to track your activities and mood daily. Consider keeping a log that details the activities you engage in and how you feel afterward so that you can start to identify patterns over time. As you compile examples of the connections between your actions and mood, you may notice that certain behaviors cause more positive or more negative feelings. For instance, you might discover that playing an instrument leads to joy or that journaling helps you feel more motivated. There may also be activities that you don’t necessarily enjoy but that you have noticed make you feel better, which are valuable too.

It can also be helpful to determine what values are important to you and then identify activities that align with those values. For example, if you feel strongly about the environment, volunteering with a non-profit organization that focuses on conservation or spending time in a community garden could produce positive feelings. Pinpointing activities that are meaningful, beneficial, and rewarding to you specifically is typically key to successful behavioral activation. 

Identify detrimental activities

Conversely, it can be important for you to determine which activities may exacerbate symptoms or make you feel bad as well. Becoming aware of those that lead to or worsen low mood, a lack of motivation, etc., can contribute to your understanding of your depression and help you identify which behaviors you’d like to replace, modify, or limit. For example, say you find that you start to feel sad when you struggle to get out of bed in the morning. In this case, one aspect of behavioral activation could be creating habits and routines aimed at helping you start your day when you wake up. 

Set achievable goals

Once you’ve determined which behaviors you’d like to practice regularly, it can help to create actionable, attainable objectives for each activity. A popular method is to use the SMART framework, which encourages people to set goals that are specific, measurable, achievable, relevant, and time-bound. Here’s what this might look like in the context of behavioral activation:

• Specific. Try to ensure the activities are well-defined. For example, instead of saying you’d like to read more, you might say you’d like to read 10 pages of a novel each night. 
• Measurable. You should be able to track your progress with each goal. For example, a goal of “texting one friend per day” or “calling one friend per week” is easier to measure than “reaching out to friends more” or “focusing on trying to feel connected to social relationships.” 
• Attainable. Setting small goals at the outset can help you stick with the activity. For example, you might start by going for a walk to the park and back once a week and then slowly increasing the distance and/or frequency. 
• Relevant. The activity should also be something that will produce the desired positive reinforcement. For example, eating more nutrient-dense meals may be helpful if you’re trying to experience increased energy and feelings of satisfaction.
• Time-bound. There should be a timeframe within which the goal will be achieved. For example, behavioral activation goals are typically set within one-week time periods. 

Monitor your progress

Keeping tabs on how your actions are affecting your feelings can be an important part of the process. One way of monitoring how behavioral activation therapy is progressing is to continue tracking your progress. While you don’t have to document every waking hour, writing down a few of the day's key activities and your feelings about them can help you assess your progress, recognize certain patterns, and make adjustments as needed. There are free worksheets and diary templates you can find online to help you keep an organized and easy-to-read log, or you could use a spreadsheet or a simple handwritten list on paper. 

Utilize social support

Another component of behavioral activation and other approaches that may improve its effectiveness is discussing your plan with friends and family who can help motivate you and keep you on track. You might tell your support network about your specific goals and ask them if they have suggestions for achieving them. They may have helpful insights to share given their knowledge of you. They can also engage in some of the positive activities with you, such as exercising together. Additionally, the simple act of strengthening bonds with loved ones to cultivate strong, positive relationships may help improve your emotional well-being.

You can also ask people in your support system to assist you in limiting behaviors that may exacerbate depression symptoms. For example, if you’ve noticed that drinking or recreational drug use is a behavior that makes you feel down afterward, you might ask your friends to help you avoid situations in which you might be tempted to consume alcohol or drugs. 

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Reward yourself

Behavioral activation is about creating a cycle of positive reinforcement through which an individual experiences feelings of happiness, well-being, etc., after being rewarded—motivating them to continue seeking more rewards. That means it can be important to reward yourself after achieving a goal to keep your momentum going. 

Simply pausing to mindfully recognize the mood-boosting benefits of a given activity could be a simple way to do this. Friends and family who see you carrying out your plans might also offer verbal encouragement and praise. 

Work with a professional

While you may be able to implement some behavioral activation techniques on your own, a therapist can help you develop a more comprehensive and effective approach. In addition to providing emotional support, a mental health professional can help you identify the sources of your symptoms and the behaviors that may be exacerbating them. 

Based on their unbiased perspective, they may also help you identify beneficial activities—and techniques for implementing them—that you hadn’t considered. They can be a source of motivation and accountability as well, helping you stay consistent as you work to incorporate more healthy behaviors into your life.  

Cultivating healthier behaviors in therapy

Someone living with depression might find it especially difficult to locate and then commute to and from the office of a therapist. If this is a barrier to seeking care that you’re experiencing, you might consider getting matched with a licensed therapist through an online therapy platform like BetterHelp instead. 

BetterHelp works with thousands of qualified mental health professionals who utilize a wide variety of strategies, so you’ll have a good chance of connecting with someone who can address your specific concerns regarding depression. Your therapist can also provide you with useful resources, such as at-home worksheets to help you stay consistent as you implement healthy behaviors. 

Research suggests that online therapy can be an effective way to learn behavioral activation techniques for depression with professional help. For example, a 2023 annual review on the topic indicates that online behavioral activation intervention can be “effective in reducing depressive symptoms.” These results are part of a growing body of research suggesting the effectiveness of online therapy in general for addressing a wide range of mental health concerns.