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Behavioral Activation: The Depression Intervention You Probably Don’t Want to Hear About

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Author John Green was grumpy when he posted a TikTok on the “stupid daily walk” he takes every day for his mental health – even though he never wants to.

“Then when I’m actually taking it I’m always like, ‘Ughhhh fine, it’s enjoyable and good for me,’” he said, encouraging other TikTok users to stitch his video while going on their own “stupid walks.”

@literallyjohngreen Take a walk with me. #walktoks ♬ original sound – John Green

I hate to break this to you, but he’s onto something, and this practice is actually a legit therapy technique.

Behavioral activation – or, in layman’s terms, doing something before you want to do it because it (annoyingly) might help your mental health – is a concept that comes from cognitive behavioral therapy (CBT), a therapeutic treatment model that’s all about how your feelings, thoughts, and behaviors relate to each other.

Huge disclaimer before we get into it: Behavioral activation doesn’t mean going for a walk will “cure” your depression, and it should never be applied in a shameful or degrading way. Depression is a real and valid barrier to doing the activities we love, and practicing behavioral activation should never remind you of your Aunt Karen saying at a holiday party, “Have you tried yoga?” We’re working in a nuanced area here: Yes, research shows behavioral activation is found to be effective, and doing positive and productive activities can help break the cycle of depression, but that doesn’t mean it’s easy, a magic cure, or should be applied flippantly. Below, we’ll get into what behavioral activation is, why it works, how to apply it – and why it should be practiced with a spoonful of grace and patience.

What Is Behavioral Activation?

Behavioral activation is a fancy phrase for a pretty straightforward concept: for some people, reducing “negative” behaviors and increasing “positive” ones can help them break out of periods of depression. I put negative and positive in quotes intentionally, because what counts as a “negative” or “positive” behavior is really up to you.

For example, some days sleeping in is a joy. It’s fun to spend extra time in bed under the covers, scrolling on our phones, giving ourselves some much-needed TLC, and letting ourselves indulge in the comfort of our bed for a few extra hours. This could be considered a positive behavior, and there’s nothing inherently wrong with enjoying sleeping late.

Other times, this same action of sleeping in feels more negative. Instead of staying in bed because we’re enjoying ourselves, we’re oversleeping because we don’t want to face the day. Because there’s no point in doing anything else. Because we’re actively avoiding life and responsibilities, and the bed is just a safer place as we grapple with the thoughts and feelings that accompany our depression. This type of behavior – the type of behavior that’s avoidant makes us feel shitty about ourselves, and is done out of self-loathing rather than self-love – is what behavioral activation attempts to reduce.

Why Does Behavioral Activation Work?

You might be familiar with this sequence of events: depression rocks you, zaps your motivation, and makes everything, even small things, feel so much harder. So to survive, you lean into comfort behaviors. Watching TV, sleeping more, scrolling on your phone… anything to distract you and make engaging in life not so hard. At first, these behaviors might not be considered negative! As we mentioned before, there’s nothing inherently wrong with sleeping more or watching TV – and some days, it’s nice to “give in” to distraction. It might be the only way you get through the day.

These behaviors become negative, though, when they start taking away from our quality of life. One day of watching TV and ignoring our lives becomes two and then three. Soon, we’re missing calls and skipping social events because we just can’t move away from these safe behaviors. Little do we know, these behaviors we initially started for temporary comfort have actually reinforced our depression, taking us deeper into a depressive state. Depression loves it when we do this because it makes the depressive pattern in our brain that much stronger.

 Depression makes us engage in negative behaviors → negative behaviors make us feel like shit → feeling like shit reinforces our depression → depression makes us engage in negative behaviors… and the cycle continues.

Behavioral activation works because it gets us out of this cycle, tricking our brain with activities that stop this depressive pattern in its tracks. It takes away some of depression’s power and puts it back into our hands. When depression is yelling at us not to engage in positive behaviors, there’s no better “F you” than doing it anyway. Even if we lack motivation in the beginning, we might finish feeling even a little better than we started. Avoidance only breeds more avoidance, and sometimes the bravest thing we can do is go on that “stupid” walk when everything in us wants to stay in bed.

How Do I Use Behavioral Activation?

Step one: Identify your personal “negative” and “positive” behaviors.

The first thing we have to do is name which “negative” behaviors we want to reduce and which “positive” behaviors we want to increase. This could look like literally listing out, maybe hour by hour, what you do on a typical day with depression. For example, wake up at noon, scroll on your phone for 1-2 hours, watch a TV show, scroll on your phone again, have a few drinks, etc.

Then ask yourself: what positive behaviors do you wish you were doing? If you’re stuck, start by thinking about your values. For example, if you value being social, some positive behaviors might include texting your friends, doing one social activity a week, or scheduling a phone call with someone you love. If you value spending time outside, positive behaviors could include going for a walk, visiting a garden, or even lying in the grass at a nearby park. Unfortunately, positive behaviors can include not-so-fun adulting stuff like cleaning our kitchen or putting a load of laundry in – activities that may not be inherently enjoyable but offer rewards in the long run.

Step two: Rank the positive behaviors you want to start from lowest effort to highest effort.

This part is important. Behavioral activation is not about forcing yourself to start running every day or keeping your home perfectly clean. We’re talking about starting small, and figuring out which positive activities will be the lowest effort with the highest reward. Some “low effort” activities could include: walking around your apartment for the length of one song, splashing water on your face, or texting one friend.

Then, of course, you can work your way up, eventually challenging yourself with “higher effort” behaviors, like walking around your block, attending a social event, or cleaning your room. But we always want to start small, trusting that those “little wins” will snowball into bigger ones.

Step three: Make a specific plan.

Once you have your positive behaviors ranked from low-to-high effort, now it’s time to try them out! This could start by trying to do one low-effort positive behavior a day, or if that’s too much, one a week. Here are some ways to set yourself up for success.

  • Choose a specific time and date
  • Set a reminder on your phone
  • Pick an accountability partner (could be a friend or a therapist!), and have them check in on you to make sure you actually did the thing
  • Have a “plan B” to eliminate any barriers (for example, if you want to take a walk outside, tell yourself if it rains you’ll dance for a minute instead)
  • Adjust our expectations: If you didn’t complete the task you set out to, maybe you have to think a bit smaller, or maybe there’s another barrier you need support with
  • Be patient with yourself – this stuff isn’t easy!

A Gentle Reminder

Replacing negative behaviors with positive ones is no easy feat, and the whole point of behavioral activation is that we need help getting these positive behaviors back in our lives. Choosing to do behaviors when you don’t feel like doing them is a hard choice, and there’s nothing wrong with using other support – like medication or other forms of therapy – as you attempt to get your life back from depression.

Because, really, this it’s all about. Living the life you deserve to live, and not letting depression dictate every second of our wonderful, messy time on Earth. So go for that walk. Do a jumping jack. Do one thing today to show depression who’s boss… even if it’s small, it’s a start.

Photo by Ashley Byrd on Unsplash

Originally published: April 4, 2022
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