Behavioral Activation Therapy (BA) is a structured, evidence-based approach primarily used to treat depression, but it can also help with other mood-related issues. It focuses on identifying and increasing engagement in positive, meaningful activities that align with your values and interests. Behavioral activation treatment helps you reconnect with sources of joy and achievement while reducing avoidance. In this post, I review this method, some of the techniques we’ll use (most notably the behavioral activation worksheet), and a case example. I’ll also show how this approach often pairs with cognitive restructuring. It also works well with ACT psychotherapy and narrative therapy.

If you have any questions about how behavioral activation therapy might work for you or a loved one or general questions about this approach, please feel free to contact me or schedule a consultation anytime.

Behavioral Activation Overview

Behavioral Activation Therapy

The following is an overview of behavioral activation treatment. Of course, as with any cognitive-behavioral approach, your treatment plan will be uniquely tailored to your needs and goals.

Core Principles of Behavioral Activation Therapy

  1. Behavior-Emotion Connection
    • Behavioral activation therapy recognizes that behaviors influence mood. A lack of activity or engagement can worsen feelings of depression and vice versa.
  2. Breaking the Avoidance Cycle
    • Depression often leads to withdrawal from activities, relationships, and responsibilities, which further reinforces low mood. Behavioral activation helps break this cycle by encouraging small, manageable steps to re-engage with life.
  3. Focus on Observable Change
    • Behavioral activation treatment emphasizes observable and measurable behaviors (e.g., “Go for a 10-minute walk,” rather than “Feel happy”).

How Behavioral Activation Works

  1. Activity Monitoring
    • You track their daily activities and rate your moods on a behavioral activation worksheet to identify patterns (e.g., “When do I feel better or worse?”).
  2. Activity Scheduling
    • Plan specific, achievable activities that bring pleasure (e.g., hobbies) or mastery (e.g., completing a small chore).
  3. Identifying Values and Goals
    • Activities align with your broader values to promote purpose and satisfaction.
      Example: If health is a core value, scheduling time for exercise or cooking healthy meals becomes a priority.
  4. Problem-Solving Barriers
    • In individual therapy sessions, you address challenges like procrastination, fatigue, or negative thoughts that hinder activity engagement.
  5. Graded Exposure
    • For people who struggle with overwhelming tasks, a well-designed behavioral activation worksheet uses a step-by-step approach to gradually reintroduce activities.

Who Can Benefit from Behavioral Activation Therapy?

I use behavioral activation therapy with a wide variety of people, including:

  • Individuals with depression, including major depressive disorder, seasonal affective disorder, or challenging life transitions
  • People experiencing low energy, loss of motivation, or anhedonia (loss of interest)
  • Those with anxiety that stops them from doing things they would otherwise enjoy
  • Young adults in therapy who are struggling with school or social challenges and anyone who has low self-esteem

Benefits of Behavioral Activation Treatment

  • Improves mood and energy levels
  • Promotes a sense of achievement and purpose
  • Breaks negative cycles of avoidance and inactivity
  • Encourages healthier coping strategies

Behavioral Activation therapy is often used as part of Cognitive Behavioral Therapy (CBT) but can also be delivered as a standalone treatment. Its simplicity and practicality make it accessible and effective.

CBT BA Techniques

Here are key techniques used in Behavioral Activation Therapy to help you engage in meaningful activities and improve your mood:


1. Activity Monitoring

  • Purpose: To identify current patterns of behavior and their impact on mood.
  • How: Use a behavioral activation worksheet to track daily activities, thoughts, and feelings.
    • Example: “I noticed I feel worse when I stay in bed all morning, but slightly better after walking my dog.”

2. Activity Scheduling

  • Purpose: Plan specific activities ahead of time to break cycles of avoidance and inactivity.
  • How:
    • Start with small, specific tasks (e.g., “Go for a 10-minute walk at 4 PM”).
    • Schedule activities in a calendar or planner.
  • Tip: Treat the activities like appointments that cannot be skipped.

3. Graded Task Assignment

  • Purpose: Overcome overwhelm by breaking tasks into smaller, achievable steps.
  • How: Gradually increase the difficulty of activities.
    • Example:
      • Step 1: Spend 5 minutes cleaning the desk.
      • Step 2: Add another 5 minutes tomorrow.
      • Step 3: Tidy the entire desk area over the week.

4. Pleasant and Mastery Activities

  • Purpose: Balance activities that bring pleasure with those that bring a sense of accomplishment (mastery).
  • How: Make two lists on your behavioral activation worksheet:
    • Pleasant Activities (e.g., watching a movie, drawing, listening to music).
    • Mastery Activities (e.g., completing an assignment, doing laundry, cooking).
  • Schedule a mix of both to boost mood and motivation.

5. Values-Based Activities

  • Purpose: Ensure activities align with personal values to create meaning and purpose (which we’ll discuss in our behavioral activation therapy sessions).
  • How: Identify key values (e.g., health, relationships, education) and set goals accordingly.
    • Example: If “family” is a value → Schedule a phone call with a loved one.

6. Overcoming Barriers

  • Purpose: Identify and address obstacles that interfere with activity completion.
  • How: Use problem-solving techniques:
    • Barrier: “I feel too tired to go outside.”
    • Solution: “I’ll start with just sitting outside for 2 minutes.”
    • Barrier: “I don’t feel motivated.”
    • Solution: “I’ll focus on how I might feel better after completing the activity.”

7. Behavioral Activation Experiments

  • Purpose: In behavioral activation therapy, we’ll test assumptions about how an activity will make you feel.
  • How:
    • Prediction: “If I go for a walk, I’ll still feel tired, and nothing will change.”
    • Action: Go for the walk.
    • Outcome: “After walking, I actually felt a little more awake and refreshed.”
  • Tip: Track and challenge negative predictions.

8. Use of Rewards

  • Purpose: Reinforce positive behavior by rewarding yourself after completing activities.
  • How: Pair activities with small, enjoyable rewards.
    • Example: “After I finish studying for 30 minutes, I’ll watch an episode of my favorite show.”

9. Behavioral Substitution

  • Purpose: Replace unhelpful activities with more constructive ones.
  • How: Identify avoidance and swap it for positive activities.
    • Example: Instead of scrolling on social media, go outside for 5 minutes.

10. Behavioral Activation Worksheets

  • Purpose: Measure progress and identify what works.
  • How: After completing an activity, rate your mood on a scale of 1-10.
    • Example: “Before the walk: 3/10. After the walk: 5/10.”
  • Use this feedback to prioritize effective activities.

These behavioral activation treatment techniques can be tailored to specific needs, such as students struggling with procrastination, individuals with ADHD, or anyone experiencing depressive moods.

Behavioral Activation Worksheet Example


Step 1: Activity Monitoring

Track your current activities and mood to identify patterns.

Time of Day Activity Mood (Rate 1-10) Thoughts or Feelings
8:00 AM Woke up, stayed in bed 3/10 Tired, “I can’t do this.”
10:00 AM Scrolled on phone 2/10 Felt stuck and unmotivated

Instructions:

  • For 1-2 days, write down what you’re doing and rate your mood during or after each activity (1 = very low, 10 = very high).
  • Look for activities that make you feel better, worse, or neutral.

Step 2: Identifying Values and Goals

What’s important to you? Write down your values and a small goal for each.

Value (What matters?) Activity Goal (Specific and Small)
Health Go for a 10-minute walk today.
Social Connection Text one friend to say hello.
Education Spend 15 minutes working on one assignment.

Step 3: Activity Scheduling

Plan activities for the next few days based on your values and goals.

Time of Day Activity (Specific) How Likely Will I Do This? (1-10) Completed? (Y/N) Mood After
9:00 AM Get out of bed and stretch 7/10
2:00 PM Spend 10 minutes reading or studying 6/10
4:00 PM Go outside for a short walk 5/10

Tips:

  1. Start small. Even 5 minutes counts.
  2. Make the activities specific and realistic.
  3. Schedule activities at a specific time of day.

Step 4: Identify and Overcome Barriers

What might stop you from doing these activities? Write down solutions:

Activity Potential Barrier Solution
Go for a 10-minute walk “I feel too tired.” Remind myself it’s just 10 minutes; put on sneakers now.
Text a friend “I don’t know what to say.” Keep it simple: “Hey, how are you doing?”

Step 5: Reflect and Adjust the Behavioral Activation Worksheet

After completing activities, look at the behavioral activation worksheet and reflect on how you felt:

  1. Which activities improved your mood?
    • Example: “Going for a walk made me feel clearer and more energized.”
  2. What was challenging? How can you adjust next time?
    • Example: “It was hard to start studying, so I’ll set a 5-minute timer tomorrow.”

Bonus Tip: Use a reward system!

  • After completing a scheduled activity, reward yourself with something small you enjoy (e.g., watch a short video, have a favorite snack).

Weekly Reflection

Each week look at your behavioral activation worksheet and think about:

  • What progress have I made this week?
  • What will I focus on next week?

Behavioral Activation Treatment Case Example

Here’s a fictitious case example illustrating how Behavioral Activation Therapy (BA) can be applied:


Behavioral Activation Therapy Example: Sarah, a College Student with Depression

Background:

  • Sarah is a 20-year-old college sophomore who has felt overwhelmed, sad, and unmotivated for the past two months.
  • She used to enjoy attending classes, spending time with friends, and going to the gym. Recently, she has been isolating herself, skipping classes, and spending hours in bed scrolling on her phone.
  • Her grades have dropped, and she reports feeling “lazy” and “hopeless” about improving her situation.

Step 1: Activity Monitoring

  • Sarah starts her behavioral activation worksheet by tracking her daily activities and mood for a week.
  • Findings:
    • She spends most of her time in bed (up to 12 hours), avoiding assignments and not responding to texts from friends.
    • Her mood is lowest when she isolates herself and skips responsibilities.
    • On a rare day she forced herself to attend a class, her mood improved slightly.

Step 2: Identifying Values and Goals

  • In one of her first behavioral activation therapy sessions, Sarah identified the values that are important to her:
    • Education
    • Health and Fitness
    • Friendships and connection
  • Sarah sets small, achievable goals that align with these values.

Step 3: Creating the Behavioral Activation Worksheet

Sarah and I talk about her scheduling specific activities to break the cycle of inactivity and avoidance gradually.

  • Goals for Week 1 (small, manageable steps):
    • Education: Attend 1 class this week (even if just for 30 minutes).
    • Health: Go for a 10-minute walk twice this week.
    • Social Connection: Reply to 1 friend’s text message.

These behavioral activation treatment goals are realistic, specific, and time-limited to avoid overwhelm.


Step 4: Graded Exposure and Problem-Solving

  • Barriers: Sarah initially struggles with low energy and negative thoughts like, “What’s the point?”
    • To problem-solve, I encourage her to focus on how she might feel after completing the activity, rather than before.
    • Sarah agrees to set alarms and remind herself, “I’ll feel better if I just try for 5 minutes.”
  • Graded Exposure:
    • Once she successfully completes smaller goals, they increase the intensity:
      • Week 2 Goals: Attend two classes, increase her walk to 20 minutes, and invite a friend to coffee.

Step 5: Monitoring Progress

Over time, Sarah notices that:

  • After walking, her mood improves slightly, and she feels less “stuck.”
  • Attending class and completing even small assignments give her a sense of accomplishment.
  • Texting a friend reduces feelings of isolation, and she plans to see people.

Her behavioral activation worksheet reflects increased engagement in positive, meaningful tasks and reduced time spent in bed.


Behavioral Activation Therapy Outcome After 8 Weeks

  • Sarah is attending most of her classes and feeling more engaged in schoolwork.
  • She’s back to going to the gym twice a week and spending time with friends.
  • Her mood has improved, and she reports feeling “more like myself again.”

Key Takeaways

  • In behavioral activation treatment, reintroducing small activities aligned with Sarah’s values helped her break the cycle of avoidance and low mood.
  • Behavioral activation treatment showed her to take action first (behavior change), improving her mood.

Pairing Behavioral Activation with Cognitive Restructuring

Behavioral Activation (BA) and Cognitive Restructuring complement each other well, particularly in Cognitive Behavioral Therapy (CBT). While behavioral activation treatment focuses on changing behaviors to improve mood, cognitive restructuring addresses the negative thoughts and beliefs that often lead to low mood and avoidance.

Together, they create a powerful combination:

  • Behavioral Activation Treatment helps clients act their way into feeling better by engaging in meaningful activities.
  • Cognitive Restructuring helps them think their way into feeling better by challenging and reframing unhelpful thoughts.

How They Pair Together

  1. Identifying the Behavior-Thought Cycle

    • Low mood often leads to avoidance, which reinforce negative thoughts, creating a cycle.
    • Example:
      • Thought: “I’ll fail, so there’s no point in starting.”
      • Behavior: Avoiding studying → Feeling worse.
    • Combining techniques:
      • BA: Schedule 10 minutes of studying to break the avoidance.
      • Cognitive Restructuring: Challenge the thought with “I don’t need to be perfect, I just need to start small.”

  1. Behavior as a Tool to Test Thoughts

    • Behavioral Activation can serve as a “behavioral experiment” to test the accuracy of negative beliefs.
    • Example:
      • Thought: “If I go to the gym, I’ll embarrass myself because I’m out of shape.”
      • BA: Commit to going to the gym for 5 minutes.
      • Reflection: “No one paid attention to me, and I felt better after exercising.”
    • Outcome: The action disproves the negative thought, and cognitive restructuring can reinforce a new belief: “It’s okay to start slow; people aren’t judging me.”

  1. Addressing Barriers to Behavioral Activation

    • Negative thoughts often serve as barriers to engaging in activities. Cognitive restructuring can challenge these thoughts and clear the path for action.
    • Example:
      • Barrier Thought: “I won’t enjoy it, so why bother?”
      • Restructuring: “Even if I don’t love it, doing something is better than doing nothing.”
      • BA Action: Schedule a small, manageable activity like taking a 5-minute walk.

  1. Reinforcing Positive Outcomes

    • After completing activities planned through BA, Cognitive Restructuring can help the client reflect on the experience and reinforce positive changes.
    • Example:
      • Activity: Went to a class after weeks of skipping.
      • Thought: “I can’t do this; it’s too overwhelming.”
      • Reflection: “It wasn’t perfect, but I showed up, and that’s a win.”
    • Cognitive Restructuring helps shift the focus from perceived “failure” to recognizing progress.

  1. Creating Momentum

    • Behavioral Activation provides immediate behavioral momentum, which makes cognitive work easier.
    • As mood improves with action, negative thoughts can lose their grip.
    • Example:
      • Small win from BA: Completing one task → Improved mood.
      • Cognitive Restructuring: “If I managed that, maybe I can handle something else, too.”

Example: Anna’s Case

Scenario: Anna, a college student, avoids writing a paper because of the thought, “I’m a terrible writer; I’ll fail anyway.”

  • Cognitive Restructuring:
    • Challenge the thought: “I don’t need to be perfect; I just need to get started.”
  • Behavioral Activation:
    • Schedule 10 minutes of writing.
  • Outcome: Sarah realizes writing for 10 minutes isn’t as overwhelming as she thought, and she feels a sense of accomplishment.
  • New Thought: “I’m not perfect, but I can make progress when I try.”

Why the Pairing Works

  • Behavioral Activation focuses on what you do to create immediate mood improvement.
  • Cognitive Restructuring helps address why you think you can’t act, breaking mental barriers.

Together, they build a reinforcing cycle of better behavior → better thoughts → improved mood.

Summary and My Work

I provide behavioral activation treatment, often but not always paired with cognitive restructuring. This therapy is effective virtually, which works well since much of the approach involves homework you do outside of sessions. Behavioral activation treatment is often time-limited, and while it is most commonly associated with individual therapy, it is something that couples in therapy and whole families in treatment can benefit from as well. It pairs well, for example, with solution-focused therapy for families and individuals.

If you have any questions about behavioral activation therapy, please feel free to contact me or schedule a consultation anytime.

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Dr. Alan Jacobson Founder and President
Dr. Jacobson is a licensed clinical psychologist providing individual, couples, and family therapy for over 20 years. He uses an integrative approach. choosing from a variety of proven and powerful therapeutic methods.