What is Behavioral Activation
In short, Behavioral Activation is a treatment for depression that holds that context rather than internal factors such as cognitions is a more efficient explanation for depression and a more efficacious realm in which to intervene. In other words, BA seeks to help people understand environmental sources of their depression and seeks to target behaviors that might maintain or worsen the depression. C. B. Ferster (1973) proposed a behavioral analytic theory of depression providing an alternative to psychoanalytic theory that was prominent at that time. Peter Lewinsohn and colleagues at the University of Oregon were the first to develop Behavioral Activation as a treatment for depression and developed the treatment to increase pleasant activities for depressed individuals (Lewinsohn, 1994; Lewinsohn, Biglan, & Zeiss, 1976; Lewinsohn & Graf, 1973).
The BA model proposes that life events, which can include specific trauma or loss, biological predispositions to depression, or the daily hassles of life, lead to individuals experiencing low levels of positive reinforcement in their lives. Furthermore, many behaviors used to cope with negative feelings that make the individual feel better in the short run but are detrimental in the long-run increase through a process of negative reinforcement. It is natural for a person that feels sad and is no longer finding pleasure in activities that were previously enjoyed to attempt to cope by withdrawing socially, ceasing to engage in activities and “shutting down”. The problem is that such coping strategies do not help alleviate depression, they make it worse.
BA targets inertia. When depression zaps motivation, the BA approach is to work from the “outside-in”, scheduling activities and using graded task assignments to allow the client to slowly begin to increase their chance of having activity positively reinforced.
BA targets avoidance. Behavioral analytic theory recognizes that the outcome or function of a behavior is more important than the form of the behavior. Formally, for example, sitting on the front stoop of one’s house resting your head in your hands is always just that – sitting. However, you may be sitting there waiting for a friend to pick you up to go to a show or you may be sitting there to escape from a nasty argument with a partner. In those two instances “just sitting” serves very different functions. In the first it functions as an approach behavior, engaging in life. In the second it is an escape or avoidance behavior. Avoidance behavior has not been a primary target of most treatments for depression, in BA it is the primary target.
