Behavioral activation is an approach to mental health that involves someone using behaviors to influence their emotional state. It is often a part of cognitive behavioral therapy (CBT), but it can also be a standalone treatment.
Most research into behavioral activation has focused on its effect on depression. This is because people with depression often lose interest in activities they used to enjoy or no longer find pleasure in their hobbies.
A loss of interest in one’s hobbies can intensify the symptoms of depression, particularly if the person stops activities that were meaningful, that helped them maintain social connections, or that bolstered their self-esteem. Behavioral activation encourages people to engage in “antidepressant behaviors” to counter this.
This article looks at what behavioral activation is, how it works, how effective it is, and how people can practice it.
Behavioral activation is based on behaviorism. This is a branch of psychology that focuses on how someone’s environment shapes their actions and, therefore, their mental health.
The idea behind behavioral activation is that by deliberately practicing certain behaviors, people can “activate” a positive emotional state. For example, engaging in fulfilling or healthy activities can make someone feel good, which then makes them more likely to keep participating in those activities.
However, according to this concept, the reverse is also true. Engaging in behavior that makes someone feel bad can activate unpleasant feelings, which then creates a vicious cycle. The worse a person feels, the less likely they are to engage in behaviors that benefit them.
Some therapists recommend behavioral activation for depression because the symptoms of this condition make it hard to engage in pleasurable or meaningful activities. Some also recommend it for substance misuse as a way of replacing the addiction with a healthier behavior.
Activities that make people feel good vary from person to person, but here are some examples of how people can use behavioral activation.
Increasing pleasure and meaning
One of the main ways people use behavioral activation is to increase pleasurable feelings and create a sense of meaning.
For example, a person who usually loves gardening may struggle with motivation when they have a depressive episode. This may mean that they stop gardening entirely. Doing this may reinforce the feeling that things are hopeless or deprive them of an activity that makes them feel good about themselves.
However, if they try to do a small amount of gardening each day, it proves that they can do it. This may improve their mood, keep them physically active, and remind them of things they value.
Replacing unhelpful behaviors
Another way to use behavioral activation is to replace an unhelpful behavior with a beneficial one.
For example, if someone notices that they often drink alcohol when stressed but that this ultimately makes them feel worse, they might wish to replace it with another pleasurable and stress-relieving habit, such as a creative hobby.
Doing this creates positive feelings, making it easier to avoid alcohol the next time the person feels stressed. It also helps them manage the stress more effectively, without the side effects of alcohol.
Experiencing painful emotions can make it harder to reach out to loved ones or participate in social activities. This, in turn, may cause someone to become withdrawn or isolated. This can intensify depression, cause loneliness, or mean that a person has less social support.
A person who is finding it difficult to socialize may wish to try to commit to a weekly movie night, a regular catchup with a friend, or quality time with their child in order to prevent this. Even if the person does not really feel like socializing, engaging in these activities may ultimately provide them with a sense of connection, comfort, or fun.
Several studies have yielded promising results associated with behavioral activation. The following sections look at these in more detail.
One 2019 study followed older adults with depression who participated in a treatment model called “Engage,” which included behavioral activation. The participants either did solitary activities, activities with one other person, or group social activities.
These rewarding activities improved symptoms of depression. However, the group that engaged in one-on-one activities showed the most improvements, which may suggest that social connection is an important factor.
Both groups had some success with quitting smoking. However, at 12 months, the group practicing behavioral activation was more successful, with 30% of participants quitting (compared with 18% in the group practicing CBT alone).
The researchers carried this trial out at a residential facility with 263 participants, many of whom were in court-mandated treatment.
To practice behavioral activation:
- Notice how behavior affects emotions: People may wish to keep a log to compare the behaviors that made them feel good with the behaviors that made them feel bad.
- Identify behaviors to increase: Choose one or two behaviors and set a specific, achievable goal for practicing it or them more often. For example, a person who has difficulty getting out of bed may wish to commit to putting on an outfit that makes them feel good every morning, even if they do not go out anywhere.
- Minimize or replace unhelpful behaviors: People can also use this approach to reduce behaviors that make them feel bad. For example, this may involve setting a limit on the amount of time they spend on social media or replacing it with phone calls to friends.
- Monitor progress: Throughout this process, keep track of how the behavioral changes affect feelings. The person may notice that they find it easier to do other activities that are beneficial over time. If not, they may want to adjust their approach.
The University of Michigan provides free worksheets that can help someone get started.
If someone is not sure what behaviors to focus on, they might find it helpful to consider their values, what they enjoy, and what makes them feel a sense of mastery.
Values are the things that matter most to a person. They can guide how the person lives or how they would like to live.
Discovering what these values are can take time and reflection. People may want to ask themselves:
- What matters most to me in life?
- How would I like to live if nothing was stopping me?
- Who do I look up to? What qualities do they have?
When someone understands their values, they can identify behaviors that help enact them. The table below lists some examples.
|spending time with family
maintaining healthy communication
taking an active role in parenting
|ending harmful relationships
maintaining healthy boundaries
meeting new people
|community and causes
|attending community events
helping people in need
Pleasure is also important. Pleasurable behaviors include anything a person enjoys for its own sake, such as hobbies, interests, and play. They can also include socializing or sensory experiences. Some ideas include:
- relaxing activities, such as baths, massages, or nature walks
- mindful cooking and tasting
- sports and games
- creative projects, such as painting, crafting, or music
A sense of mastery comes from activities that provide a feeling of accomplishment. Some examples of these activities include:
- starting an interesting book
- learning or practicing a skill
- taking part in workplace training
Behavioral activation can be a very useful tool, but it does have some limitations. This does not mean that it will not help, but it does mean that some people may find that it works best in combination with other approaches.
Focus on external behavior
Behavioral activation alone only focuses on behavior and mood, not on how someone thinks. It can disrupt negative thinking patterns as they are happening, but it does not attempt to help someone unlearn them.
For people with mental health conditions that are influenced by their thoughts, this may not be enough to create long-term change. It is for this reason that behavioral activation is often a part of CBT, which focuses on how thoughts, feelings, and behaviors are all connected.
Gaps in research
Another drawback is that most research into behavioral activation has only assessed if it works rather than compared it with other treatments. For this reason, it is unclear whether it is more or less effective than other treatment approaches.
One 2021 systematic review of past research found that many previous studies had not been able to establish a causal relationship between behavioral activation and symptom improvements.
No consideration of other factors
Many factors can contribute to depression. Although some people may respond well to behavioral changes alone, others may need a mixture of therapies to help.
For example, if someone develops depression following a traumatic event, they may benefit from a combination of behavioral activation to reduce their day-to-day symptoms and trauma therapy to help them process what happened.
A person’s relationships, physical health, environment, and medications can all influence mood disorders. If behavioral activation alone does not help with a person’s symptoms, it is important to remember that it is not the only approach.
A mental health professional may be able to treat the condition more holistically in partnership with someone’s medical team.
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
Behavioral activation is an approach to mental health that focuses on using behaviors to “activate” pleasant emotions. The idea is that by putting action first, a person does not need to wait to feel motivated, but they can still gain the benefits that the action has on their well-being.
Some research suggests that behavioral activation can help people with depression and those with addiction. It is an accessible way for people to practice self-care, as they can use behavioral activation in daily life. However, it is important to be mindful that some individuals may need multiple types of mental health support.