In Behavioral Activation, Depression, Fatigue, Mental Health, Mind-Body Medicine

Depression represents an extremely common mental illness that is noted for causing persistent feelings of hopelessness, sadness, fatigue, and loss of interest in activities, among other things. The National Institute of Mental Health states that depression represents an illness of the brain that can be caused by a combination of genetic, biological, environmental and psychological factors. Depression is very prevalent in the US. The Centers for Disease Control and Prevention estimate that 1 in 10 US adults report depression; keep in mind this does not include those who do not report or seek treatment for depression.

Given the prevalence of depression in the US, treatment of the illness has become a topic of interest. Some treatment models for depression include pharmacological treatment, psychotherapy, cognitive behavioral therapy, and behavioral activation. Research has indicated that behavioral activation treatment can be particularly successful in the treatment of depression. Let’s take a look.

What is Behavioral Activation?

Behavioral activation represents a treatment for depression that focuses on the changing of behaviors that either maintain a depressed mood or worsen the depression. This form of treatment is based on the concept that some elements of depression are environmental; as in the result of situations, life events, loss, trauma or genetic predisposition to depression. All of these elements can lead to individuals experiencing low levels of positive reinforcement; in non-psychological language, this means that much of depression might be related to behaviors such as staying in bed all day that don’t offer “joy” or other positive rewards.

With that being said, behavioral activation treatment focuses on changing behaviors to increase positive reinforcement. Behavioral activation is believed to be successful in treatment of depression because research indicates behavioral changes impact positive reinforcement and this can have a large impact on a patient’s depressive symptoms. This is because creating more positive events and positive consequences results in improved thoughts and feelings. Essentially behavioral activation treatment works to “identify individualized target behaviors, goals and rewards that serve to reinforce non-depressive or health behavior.”

What Does the Research Say?

Research supporting behavioral activation therapy for treatment of depression has become available in the last several years. One specific study compared behavioral activation treatment with cognitive therapy and medication treatment of depression. This study found all of these methods to be effective for mild depression but found that behavioral activation treatment and medication therapy to be more effective in the treatment of moderate to severe depression. Furthermore, behavioral activation therapy was found to have a lasting impact on the treatment of depression at the study’s two year follow up.

Another study found that behavioral activation treatment resulted in less client drop out than treatment of depression with cognitive behavioral therapy. This study also suggests behavioral activation does not carry the side effects or risks associated with pharmacologic treatment.

How is Behavioral Activation Used to Treat Depression?

The treatment of depression using behavioral activation exposes the patient to healthy behaviors and coping mechanisms and the positive consequences that result from these elements. The positive reinforcement that results from these healthy behaviors increases the likelihood that the client or patient will continue them and reduce their future risk of depression. The practitioner will encourage the patient to become more active, engaging and participating in more positive situations. Patients will work to identify situational factors that are contributing to the depressed behavior. Doing this will help them identify specific positive and negative reinforcements (or consequences) of the depressed behavior. The ultimate goal of this treatment is to improve depression by encouraging behavior changes that result in the patient feeling a sense of pleasure and accomplishment.

Exercise and Depression

A really great example of one positive behavior that may be encouraged during behavioral activation treatment is regular exercise. We are all aware of the numerous benefits of regular physical activity and our health; weight loss, more energy, lessens risk of heart disease, improves mood, and this list goes on and on. Our bodies were made to be active. Physical exercise is extremely beneficial. Given this, regular exercise serves as a behavior that may be encouraged as a part of behavioral activation treatment. A specific physical activity that an individual finds to be enjoyable may be a behavior goal as part of their treatment. Achieving this goal may result in a sense of accomplishment, improved mood and better health.

Research supports the notion that regular physical activity can be very useful in reducing symptoms of depression. Walking in particular appears to be a versatile activity that nearly everyone can participate in. One Portuguese study suggests that regular walking may even be better than antidepressants in treatment-resistant patients. Exercise is a very impactful, healthy behavior that encourages positive reinforcement and can reduce depressive symptoms.


Behavioral activation treatment represents an effective therapy for treatment of depression. This method of treatment encourages positive, life-long behaviors that encourage a patient’s sense of accomplishment and improved mood. In my practice, I look closely at a patient’s activity and may even have him or her complete a walking log as a mainstay of his or treatment. Behavioral activation can become an important part of integrative treatment of depression.

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