Promising Benefits of Behavioral Activation for Mood Disorders
With self-care being all the rage these days, patients and practitioners alike are looking for ways to make positive, lasting changes. That is where behavioral activation comes in: It is touted as a building block for recovering from depression and other mood disorders, and it could be the addition you are looking for.
To bridge the gap on behavioral activation for patients, Clinical Manager Kate Bowker fills us in on what behavioral activation is, who it’s for, and how to put it into practice.
What is behavioral activation?
Behavioral activation is focused on breaking the cycle that keeps a person with depression down. For example, when someone is feeling low, they avoid seeing friends or engaging in their environment. Then, due to this isolation, they feel lonelier and further depressed. The goal of behavioral activation is to decrease a patient’s avoidance of activities and increase engagement in mood-boosting activities.
Kate puts it this way: “When patients experience depression, they may feel like they are stuck on the outside of our window of tolerance — or stuck on ‘off.’ Behavioral activation helps people widen and live within that window of tolerance through intentional engagement in things they may otherwise avoid when symptomatic — like unloading the dishwasher, going for a walk or taking a shower.
No matter how big or small a task may seem, active participation in that valued activity will increase feelings of joy and achievement, decrease feelings of depression and help an individual feel more motivated to continue this positive forward movement. It’s an important step to becoming ‘unstuck.’”
Who benefits most from behavioral activation?
Everyone can reap the benefits of trying behavioral activation, but those with anxiety, depression, or another mood disorder are likely to see the biggest improvements in symptoms. The magic of behavioral activation rests in taking time to notice how an individual is behaving, how that behavior makes them feel, and addressing those feelings head-on.
To maximize this practice, activity journals are recommended: Using a phone app or a piece of paper, you or your patient write down how they spend each hour of the day. This tracking helps find patterns of what lifts them up versus what brings them down.
How can patients start behavioral activation?
Between sessions with a professional, or on their own, patients should keep a list like the one we mentioned above. Next, consider values. This might include family, career goals, spiritual growth, or physical health. Consider activities that would engage these values, such as trying a new workout or scheduling a family outing. These do not have to be big undertakings, just actions that are in line with your patient’s value set and bring them closer to the life they want to live.
To make behavioral activation a habit, Kate recommends that patients work with their therapists to create these lists. They can then choose in advance which behavioral activations they will carry out, planning in as much detail as necessary. Hopefully, the more an individual practices behavioral activation, the easier it becomes and the more motivated they are to continue.
How do we use behavioral activation to help patients?
At Eating Recovery Center (ERC) and Pathlight Mood & Anxiety Center (Pathlight), Kate says, “We create opportunities for patients to engage in behavioral activations inside and outside of the group setting. Patients work with their therapists to identify tasks they may be avoiding due to their symptoms of depression that serve as a barrier to recovery.
Patients are then able to carry out this task in our Optimal Engagement group with the support of staff and peers — they assess their feelings of depression, joy, and achievement before and after completion of the identified task and process how to increase effectiveness going forward.”
Are there limitations to behavioral activation?
As we know, depression can be debilitating. Behavioral activation is helpful in moving a patient from a state of hypoarousal (feeling disconnected, shut down, numb), but someone experiencing severe depression will need the added support and assistance of therapy, coping skills, and medication to get there.
In most cases, behavioral activation is practiced in conjunction with regular therapy and medication management. Kate says, “It is difficult to make our way back inside that window of tolerance and stay there comfortably, and behavioral activation, therapy, and medication are all important and useful tools.”
When working with patients, be sure to recognize the wins with your patients — big and small. Behavioral activation creates many opportunities to see tangible progress and that should be celebrated.
How does behavioral activation tie into self-care?
With many worksheets and tips on the internet, it is possible to create a behavioral activation routine as part of a self-care routine. Engaging in self-care can be easier said than done for someone with or without depression, so framing these important tasks as behavioral activation and being intentional about rewarding oneself with a valued activity is a useful practice for all.
Similar to self-care, completing a behavioral activation can often provide immediate relief. While doing behavioral activations at Pathlight, a majority of patients experience an increase in feelings of joy and achievement and a decrease in depressive symptoms directly following completion of the exercise and valued activity.
Behavioral activation kickstarts individuals into action, even when they do not feel like it, and rewards them with positive emotions. For depression especially, it can be a vital practice to help lift the sadness that can veil life. Consider using it for your patients or in your own life and reap the benefits.