Behavioral Activation: Changing the Treatment of Depression and Anxiety

One in four people experience at least one episode of depression in their lifetime, but even though depression is common, it is still not completely understood. Often depression is described and treated as an illness. We call this an internal explanation for depression-that is dsomething that exists inside a person. It is most common to believe that depression is biological, like a chemical imbalance or psychological, like a pattern of negative thoughts.  The biological component to depression can be treated with medication prescribed by a doctor. The psychological component to depression can be treated by talking with a therapist or other professional and dealing with the feelings and thoughts around depression.

There is another component to depression-the behavioral component- that is often ignored and is considered the external explanation for depression. The behavioral component of depression suggests that depression is not only a problem inside a person, but a problem with how a person interacts in their world.

Depression is not only a problem inside of you, but a mismatch between you and how you interact in the world.

For someone who is depressed and who may be seeing only the bad in themselves, a behavioral approach to depression can be freeing. If you believe that the problem is inside of you, it may make you feel worse about yourself and could feel impossible to change. But, if you also understand that the problem could be outside of you in your environment, you can begin to see that there is hope to change the things around you to decrease your depression.

Depression is recognized as an illness by the American Psychiatric Association and by healthcare professionals and insurance companies. This can make it easier to understand depression and feel less self-blame about your depression diagnosis, but there are also some limitations involved in understanding depression as a disease.

First of all, thinking of depression as a disease means that you have a list of symptoms, but you don’t know how those symptoms started or what to do to get them to stop. Secondly, thinking of depression as a disease defines it as a strictly a physical problem, but research shows that depression involves biology, psychology, and environmental factors.  Third, using a medical model of depression means that the focus is on only medical solutions, and while medical advice and solutions should always be a part of treating depression, there are many other options to consider, including behavioral activation.

Depression is often described as a vicious cycle. If you are experiencing depression, you probably understand this cycle. The symptoms of depression often include low energy, lack of motivation and a feeling of not getting pleasure from things you used to enjoy. A lack of enjoyment and energy leads you to withdraw, isolate yourself, and stop doing things, which leads to even lower energy and lack of motivation.

Depression often begins with a specific event that triggers the symptoms and feelings of depression. This could be a new event, like losing a job or the memory of a previous event, like losing a loved-one. The experience of that event causes feelings of sadness, anxiety, or despair. Those emotions lead to behaviors of inactivity and isolation, like staying inside, avoiding friend phone calls, and cancelling plans to do things that are enjoyable. Avoidance and isolation create another series of events, like friends stop calling and texting because you never want to go out anymore or your work piles up because you are avoiding it or you don’t have interesting things to do anymore. This leads to greater isolation as you feel guilty that you aren’t meeting your responsibilities or lonely because friends aren’t calling or boring because you aren’t doing things that are fun and satisfying. This loop can continue indefinitely if you don’t take steps to interrupt the loop.

Behavioral Activation (BA) is a therapeutic treatment that can be used to disrupt the depression cycle. With the help of a trained therapist, you will be guided to understand your triggers for depression and the behaviors that you choose when you are depressed and then coached to create a plan that will help you create new behaviors that are more effective. This process is called activation and will help you to systematically stop the depression cycle, as you learn new ways of setting up your environment for success.

Learn about the step by step process of activation