ckm_a’s Reviews > Behavioral Activation for Depression: A Clinician's Guide > Status Update

"In order to alleviate depression, BA assumes clients must be assisted in engaging in behavior that they will ultimately find pleasurable or productive or that will improve their life situations in such a way as to provide greater rewards."

"BA is based on the premise that problems in vulnerable individuals’ lives reduce their ability to experience positive reward from their environments, leading to the symptoms and behaviors that we classify as depression."

"BA is a brief focused treatment for depression that aims to activate clients in specific ways that will increase rewarding experiences in their lives."

"Mei pointed out to her how unrewarding her life had become...Mei also explained that the feelings of sadness, fatigue, & hopelessness were natural and often experienced when life is unrewarding. She explained that these feelings often followed periods of anxiety and worry, and that they certainly were understandable after losing a good job. Mei also said that staying in bed actually made sense when one felt these.."

"She had expected the woman to sit back quietly and nod as she poured out her life story. The therapist, Mei, instead asked about her sleep and eating habits, her mood, level of enjoyment of activities, use of alcohol or drugs, and social interactions. Mei also focused on how life was prior to Addilyn’s job crisis. What were Addilyn’s plans for her life? What had she expected things to be like at this time?"

Close Cousin Behavior Therapies
- DBT "opposite action" (act in ways opposite to the action urges of emotions that they want to change) v.s. BA (opposite action for depression)
- ACT v.s. BA: similar tx targets, attending to values to identify targets for activation in BA, acting in the presence of negative thoughts and emotions
- UP (modifying action tendencies): possibility of BA as a transdiagnostic tool?

BATD (Lejuez & colleagues, 2011):
- brief BA
- consists exclusively of activity monitoring and scheduling
- integrates focus on value-driven activities
- develop a list of activity goals for the week and then note on each day whether they attempted the activity and whether they achieved their goal for that activity
- Hopko et al., 2011: BATD v.s. problem solving - roughly 3/4 of both groups improved in depressive sx

BA (as a straightforward approach) was relatively easy to train
- Moradveisi et al., 2013: 16-session BA (91.1% remittance) v.s. sertraline (68.6.1% remittance); by psychologists not trained by a known BA expert) x 20 hours
- Healthy Activity Program study (2016, 2017): brief 6-8 session BA superior to usual care; by lay counsellors
- Richards & colleagues (2017): BA comparable to CT; by junior mental health workers

The Seattle study (2006)
- 241 depressed adults
- Placebo-controlled trial
- (1) BA, (2) CT, or (3) Paroxetine
- Acute: BA comparable to antidepressant + BA superior to CT (even among more severely depressed); No differences among tx for less severely depressed
- Longer-term: Benefits of BA as enduring as CT (relapse prevention); Greater relapse rates after withdrawal from antidepressants (than prior BA or CT)

Component Analysis Study (Jacobson et al., 1996):
- 150 depressed adults
- Randomly assigned to (1) BA, (2) BA + CR of AT or (3) BA + CR of AT and core beliefs OR full CT package
- Same therapists provided all tx
- No significant differences among the three treatments, either in the acute treatment of depression or in the prevention of relapse across a 2-year follow-up