Staff Perspective: The Importance of Behavioral Activation

Staff Perspective: The Importance of Behavioral Activation

Winter has many associations that stir a range of emotional responses. Some may look forward to the holiday season, colder weather, and burrowing indoors with the comforts they have come to seek over the years. Others may find themselves longing for sunshine, wishing they could fast-forward to warmer months. In Hawaii, winter usually consists of cooler temperatures, rain, a shifting swell (from the south shore to the north shore), and relatively shorter days. The changes that accompany the seasons, whether drastic or nuanced, can serve as reminders that we, too, are changing.

Such reminders are paradoxical in that to change means to be alive and to be alive means to be moving closer to death. During the winter months, existential inquiries begin to move from the depths of the unconscious or subconscious to the subconscious or conscious respectively. The unanswerable questions humans have asked for centuries can surface and the accompanying anxiety or sadness is as natural as the sun rising in the east. To experience such emotions, especially in the context of meaning and change, is to be human.

For those with depression, winter can be particularly dark. Low energy, decreased interest in activities, and difficulty completing tasks are commonplace. Reduced engagement in activity is typically followed by low mood, which in turn furthers disengagement in activity and worsens depression. Through the lens of depression, this cycle can often appear reinforced by the harshness of winter weather.

Whether you have been diagnosed with depression or not, maintaining engagement in pleasurable and rewarding activities will improve your mood and increase your sense of accomplishment. Although this assertion may seem obvious, depression has a way of distorting perception and making even the most familiar or simplest of tasks feel burdensome. Cognitive-behavior therapy (CBT) for depression uses behavioral techniques and cognitive techniques in tandem to decrease depressive symptoms and achieve treatment objectives. CBT often starts with behavioral activation before diving into more complex cognitive interventions. Behavioral activation describes any method designed to make positive changes and to re-energize (Wright, Brown, Thase, and Basco, 2017) and is one of the most effective strategies for disrupting the downward spiral of depression. Behavioral interventions can reverse patterns of anhedonia, diminished activity levels, and energy depletion. Engaging in realistic and feasible behavioral activation plans can improve mood, instill a sense of hope, and increase feelings of mastery.

When developing a behavioral action plan, it is important for the methods to match the energy levels and the unique needs of the individual. Therefore, the individual is often best equipped to generate and decide which pleasurable and/or purposeful activities are to be added to a behavioral action plan. For those providers interested in learning more about behavioral methods, action plans, activity scheduling, and troubleshooting (which are beyond the scope of this blog), I recommend Learning Cognitive-Behavior Therapy, Second Edition, by Wright, Brown, Thase, and Basco (2017). For anyone interested in learning more about cognitive-behavioral strategies to overcome depression and anxiety, the following self-help books are recommended:

Burns, D. D. (2008). Feeling Good: The New Mood Therapy, Revised. New
York, Harper-Collins.
Clark, D. A, & Beck, A. T. (2012). The Anxiety and Worry Workbook: The
Cognitive Behavioral Solution. New York, Guilford, 2012.
Greenberger, D., & Padesky, C. A. (2015). Mind Over Mood: Change How You
Feel by Changing the Way You Think, 2nd Edition. New York, Guilford.
Kabat-Zinn, J. (2005). Wherever You Go, There You Are: Mindfulness
Meditation in Everyday Life. New York, Hyperion.
Williams, M., Teasdale, J. D., Segal, Z. V., & Kabat-Zinn, J. (2002). The Mindful
Way Through Depression. New York, Touchstone.
Wright, J. H., & McGray, L. W. (2012). Breaking Free From Depression:
Pathways to Wellness. New York, Guilford.

Whether you are experiencing existential anxiety and sadness innate to the human condition or have been struggling with depressive symptomatology for quite some time, everyone can benefit from maintaining engagement in pleasurable and/or meaningful activities. For some, this might mean rediscovering old interests that have long been forgotten. For others, this might include introducing new hobbies/activities. For many struggling with depression, this might mean keeping a log of daily activities, to include showering, cooking, reading, going for a walk, etc. Regardless of where you are currently, take solace in the inevitability of change and remember that behavioral activation can be the catalyst to restoring energy and hope in even the darkest of times.

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.

Kaleigh E. DeSimone, Psy.D., is the Center for Deployment Psychology's Military Internship Behavioral Health Psychologist at Tripler Army Medical Center, Honolulu, HI.

Wright, Brown, Thase, & Basco (2017). Learning Cognitive-Behavior Therapy,
Second Edition. Arilington, Virginia, American Psyciatric Association.