Below, mental health professionals break down the meaning and effects of behavioral activation, as well as the best ways to apply this technique in your everyday life.
What is behavioral activation?
“Behavioral activation is a concept and intervention frequently used in cognitive behavioral therapy that utilizes behaviors to influence emotions, thoughts and mood,” said Rachel Thomasian, a licensed therapist and owner of
Playa Vista Counseling in Los Angeles. “In other words, a therapist will often prescribe behaviors for their client to take part in, with the expectation that it will modify or ease some painful emotion they might be experiencing, such as anxiety or depression.”
AN ESSENTIAL DAILY GUIDE TO ACHIEVING THE GOOD LIFE
A common symptom of depression is the inability to engage in behaviors that used to bring a person joy ― even though those behaviors would likely help alleviate their depression. Examples include socializing, exercising, cooking nice meals, self-pampering with showers and skin care routines, trying new activities and more.
“Instead, people who are feeling sad or lonely may seek out situations or fall into patterns that confirm their feelings of isolation and sadness,” said Meg Gitlin, a New York-based psychotherapist who runs the Instagram account
@citytherapist. “This can be seen as somewhat of a self-fulfilling prophecy or a downward spiral. Behavioral activation requires you to consider the alternate ― that is, that by planning out activities and rewards that once brought you pleasure, it’s likely that you will experience those same good feelings once completed.”
How does it work?
“Our mental health and emotional state is so tied to the behaviors we engage in,” Thomasian said. “Deciding to stay in bed and going on a morning walk release very different chemicals in our brain, create starkly varying thoughts in our mind that then reinforce or break our emotional state.”
Engaging in behaviors that foster a healthy mental state can create a positive ripple effect that in turn encourages you to continue participating in those activities. This concept is at the root of the popularization of self-care.
“Behavioral activation therapies help reduce depression and anxiety symptoms by activating a reward system, and have been shown to be very effective,” said
Bisma Anwar, a licensed therapist with Talkspace. “For example, replacing avoidant behaviors, like staying at home, with more rewarding behaviors, such as meeting up with friends for a walk, can increase a person’s motivation to continue this positive behavior.”
Initially, these actions might feel daunting and require a lot of effort. But if you commit to just giving it a try, you activate the positive reinforcement system.
“When you put one foot in front of the other, voila! You start walking,” said
Sue Varma, a clinical assistant professor of psychiatry at NYU Langone Health. “Just like exercising, you may not initially be in the mood, but you end up feeling good afterwards and are glad you did it.”
Another way that behavioral activation can improve mental health is by helping people become more aware of which activities give rise to positive emotions, and which have the opposite effect. A person using this approach might also be reminded that they have the ability to experience joy, and remember how it feels.
“Through intentional tracking, the client improves their ability to recognize positive experiences throughout their day and increases their awareness of cause and effect,” said
Marianela Dornhecker, a licensed psychologist practicing in Missouri and Texas. “With this increased awareness, clients typically feel more motivated to engage in those activities, and mindful of avoiding activities that aren’t helpful to them.”
[/URL]
DELMAINE DONSON VIA GETTY IMAGES
Behavioral activation, which is similar in some ways to the "fake it till you make it" approach, is often used as a mental health coping strategy.
Is it the same as “fake it till you make it”?
“This technique is often accompanied by the idea of ‘fake it till you make it’ because at the time, you may not feel like doing the things that are part of the behavioral activation, such as going for a walk or planning a nice meal with a friend,” Gitlin said. “The technique asks that you not think too hard about whether or not you genuinely feel like doing something ― i.e. fake it ― and instead focus on completing the task itself.”
In a sense, behavioral activation is like pretending that you feel better. But in doing this positive behavior, you’ll likely develop some positive feelings that can lead to “an upward spiral of motivation,” Gitlin said.
Still, some experts say there are crucial differences.
“There is an aspect of ‘fake it till you make it’ because you’re activating behaviors that don’t necessarily align with your current emotional state or idea of your sense of self,” Thomasian said. “However, I think the difference comes from the intent of the behavior.”
She offered running as an example. Following a pure “fake it till you make it approach,” you would fake being a runner even though you’re a beginner, until you eventually get good at running.
“In behavioral activation, there is a different end to the means,” Thomasian said ― it’s more like “I’m going to start running even though it’s the last thing I want to do, because doing so will help my emotional state.”
Besides, if you think of behavioral activation as “faking” your motivation to do an activity, it could affect your intentions and make the technique less likely to work.
“‘Faking it’ implies forced action, a lack of authenticity, connection and a cynicism around an experience,” said Monica Vermani, a Toronto-based clinical psychologist and author of
“A Deeper Wellness: Conquering Stress, Mood, Anxiety, and Traumas.” “Framing it as a route or path to betterment, self-improvement, healing, overcoming anxiety and fears, and self-actualization creates a more positive and enjoyable process and experience ― which can help conquer maladaptive patterns.”
Dornhecker believes a better way to think about the mechanism of behavioral activation is the idea that “energy begets energy.”
“When someone is experiencing depression, their brain can feel like it is in a fog, or everything feels ‘underwater’ or dulled out, which can lead to low activity,” she explained. “This low activity actually has the effect of creating even lower energy and decreasing motivation. However, when someone makes the decision to do an activity that requires energy (even if they don’t feel like it), this actually has the effect of creating more energy in the body and thus increasing motivation and mood.”
How can you implement it?
Behavioral activation can take many forms, but here are some general steps for using this technique.
1. Monitor your actions and feelings.
“The first step of behavioral activation is actively monitoring,” said
Shagoon Maurya, a psychotherapist based in Australia. “It is critical to be fully aware of our daily activities and how they affect our mood.”
You can keep a journal or download an app to take notes about what you’re doing and how you’re feeling. As you track your actions and the emotions they evoke, make a list of the behaviors that make you feel good and commit to implementing them in your everyday life.
“If you’re unsure what behaviors to focus on, it can be helpful to consider one’s values,” said
Sanam Hafeez, a neuropsychologist in New York. “Your values are what matter most to you, and can guide how you live or how you’d like to live. You can ask yourself: ‘What would my life be like if I had no obstacles?’ ‘What matters most to me?’ ‘Who do I look up to? What qualities do they encompass?’”
Once you’ve determined which activities improve your mood and give you a sense of purpose, challenge yourself to do them more, even if you can’t always find the motivation.
“Repetition is key,” Vermani said. “You want to become bored by what makes you anxious, apprehensive and uncomfortable. The more you do something, the less intimidating and threatening that activity feels. The less threatening an activity becomes, the less power cognitive distortions and maladaptive thoughts [have].”
2. Set achievable goals for positive behaviors.
Vermani recommends setting achievable goals by focusing on one or two behaviors at a time and practicing them on a regular basis.
“For example, a person who has difficulty getting out of bed could commit to putting on an outfit that makes them feel good every morning, even if they do not go out anywhere, or commit to setting their alarm to play their favorite music to motivate them to get out of bed,” she said. “The goal here is to create something that elevates and improves your mood, lowers your sense of dread and sadness, and limits potential stressors.”
Eventually, you can build up to bigger activities like organizing a social gathering or pursuing a major project at work.
3. Minimize the negative behaviors.
As you identify and implement the behaviors that positively impact your mood, you should also take note of which ones don’t bring you joy or fulfillment.
“Reduce behaviors that make you feel bad,” Vermani said. “For example, someone may choose to limit the amount of time they spend on social media, and replace this with connecting one-on-one with friends. By getting rid of unneeded and unhelpful behaviors, you can increase self-esteem and self-confidence.”
4. Don’t confuse behavioral activation with busyness.
“Behavioral activation can sometimes be misunderstood to mean that being busy is the way to combat depression,” Dornhecker said. “Busyness for busyness’ sake is not what helps someone feel motivated ― in fact, this can lead to burnout.”
She noted that some of the activities that are valuable in combating mental health symptoms involve being busy ― for instance, learning a new skill. But other helpful activities can be slow and relaxing, like spending time outside or sipping coffee as you listen to music.
5. Use the technique in combination with other coping strategies.
Remember that behavioral activation is just one of many tools involved in cognitive behavioral therapy. It doesn’t necessarily work for everyone, and that’s OK.
“Although some people may respond well to behavioral changes alone, others may need a mixture of therapies to help,” Vermani said. “When behavioral activation alone does not help with a person’s symptoms, a mental health professional may be able to treat the condition more holistically in partnership with their medical team.”
