Behavioural Activation and Activity Scheduling!

Behavioural Activation is designed to increase someone’s contact with positive and rewarding activities that they may have been avoiding due to a low mood. Depression can keep us from doing the things that bring enjoyment and meaning to our lives, any withdrawal from activities and social interaction can lead into deeper depression, ruminating and missing out on fun experiences.

Behavioural Activation looks at identifying specific goals along with valued directions that someone may have. Value directions are what we find meaningful and important in life, for example we may value family and therefore choose to spend time with them.

When therapists teach the behavioural activation skill, patients are taught how to analyse the consequences of their responses from inactivity and rumination. For example, a person may be trying to find reasons for their past, be attempting to solve insoluble problems or constantly seek­ reasons for the depression. Individuals are then helped to turn ‘Why’ or ‘If only’ into ‘How’ questions that relate to their goals and valued directions. For example ‘Why do I feel so sad?’ into ‘How can I make myself feel better?’ or ‘If only I had done some exercise today I would have felt happier!’ to ‘How can I make sure to incorporate exercise into my schedule today?’.

Patients are taught to become more aware of their surroundings and to see events for what they are, rather than what their mind is telling them.

For example… someone who suffers with depression, anxiety and has a hard time figuring out why their mood dips, could use behavioural activation to discover specific mood triggers. This would change their approach and allow their mood to improve!

Another example is… if stress, seasonal change and never feeling in the mood for ‘fun’ activities, contributed to their depression, behavioural activation would help to find strategies to help with motivation. The use of practicing awareness of different avoidance patterns and developing alternative and adaptive behaviours will increase the patient’s mood.

A lovely coping visualisation example says…engaging with thoughts is similar to standing in the road and trying to avoid cars. Even if you manage to divert from a car, there are always more to deal with. The goal is to acknowledge the thoughts but not to attempt to stop or control or answer back at them. Try to accept your thoughts and ‘walk along the side of the road’, engaging with life despite the traffic.

During these sessions the therapist helps to determine what factors are involved in the way the patient is thinking, feeling and how they respond to the factors that depress their mood. After discussions on reasons for avoidance and escape, planning alternative behaviours, and Activity Scheduling comes into action!

Activity scheduling involves scheduling “pleasant” activities which elevate the clients mood. Having set timetables encourage the client to aim towards their short­-term goals and to treat their timetables as a series of appointments with themselves.

The aim is to introduce small changes, building up the level of activity gradually towards long­ term goals.

The activities chosen and added into the schedule, must relate to what the individual has been avoiding and move them towards their values in life. This also includes activities that are soothing and pleasurable, as rewards. For example, exercise can produce endorphins in the brain that lift mood, and Pilates/relaxation encourages the parasympathetic nervous system, which conserves energy and slows down the heart rate.

The Activity schedule looks very much like a diary with block times... I would suggest that once you have completed the activity, put a face (happy/medium/sad) next to the time/day, so you can refer back and make any necessary changes.

Some people make changes when they are “ready” as if there is a day that they will wake up and suddenly feel different and able to face whatever they are avoiding. We put off exercise routines, diets, getting homework done, calling back important people, etc.. because we feel unmotivated most of the time. The solution is that they should always act according to the activity schedule, not according to how they feel at the time. People are told that the longer they wait, the greater the likelihood that they will become even less motivated.

Activating these techniques changes our brain state and can make us feel better right away and the more we practice activating, the more situations we find ourselves in positive experiences!

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