Behavioral activation involves a lot more than simply encouraging your clients to “put themselves out there.” Below are techniques that can ground your behavioral activation practice.
1. Activity monitoring
When implementing behavioral activation, therapists often start by asking their client to keep a log of their daily activities, along with notes about how they felt during each one. This exercise helps establish a baseline, can start to unveil patterns of avoidance and the types of activities missing from a person’s daily life, and begin to identify activities that could be targeted for pleasure or mastery reasons.
Tip: Walk through the activity log with your client, helping them determine which activities made them feel best or worst.
2. Value and activity identification
Ideally, behavioral activation is about more than just getting clients out of the house (although that’s important, too). It’s about helping them tap into behaviors that positively impact their mood.To get there, it can help to have clients think about their values — not just what they want to do or achieve, but what’s actually important to them as a person.
Tip: Asking open-ended questions about how your client wants to show up in the world, not just what they want to do, may help clarify values.
3. Create an “activity menu”
Once your client has a better understanding of their values and what brings them fulfillment, help them brainstorm a list of activities that will serve them. These don’t have to be ambitious — in fact, it’s wise to start small so your client doesn’t get discouraged. You may even want to help your client rank activities from those that feel easiest to hardest to achieve, and encourage them to start with the easy things. It is important to have clients rate these activities on their sense of accomplishment and enjoyment they get from them. Revisit these ratings as clients engage in the activities, as our preconceived notion of how something will feel often differs from reality.
Tip: If your client is struggling to think of activities that would feel good, ask them about previously fulfilling practices they might want to restart.
4. Schedule activities
Next, help your client craft plans for engaging in the activities they’ve identified. These plans should be as specific as possible to make it simpler to follow through. “I will go for a 15-minute walk with my husband as soon as I finish work at 5 p.m.,” is better than “I will take a walk each day.” It is best to make these as realistic as possible to implement and repeat in daily life. Consider introducing the SMART Goal framework for these behavior changes.
Tip: Write out plans on a calendar or worksheet to encourage accountability.
5. Develop commitment strategies
Motivation can be a major hurdle for clients struggling with depression. The key to successful behavioral activation is knowing that motivation is not a prerequisite for action – you don’t have to want to do something before starting, you have to commit to doing it no matter how you feel. It can be helpful to discuss strategies to build commitment and accountability. Would it help to get loved ones involved in activities? Would small rewards reinforce positive behavior? Talk it through in advance, so they leave therapy set up for success.
Tip: If your client has struggled with unproductive habits in the past, proactively discuss them and come up with plans for overcoming them.