Behavioral Therapy for Depression

Behavioral therapy improves depression symptoms by promoting changes in behavior. While it may seem surprising that behaviors could influence one’s emotional state enough to relieve clinical depression, behavioral therapy can have a significant impact in a short period of time. It is customizable for individuals in all types of therapeutic environments, making it suitable for individuals with a variety of needs.

When addressing clinical depression, cognitive-behavioral therapy (or CBT) is considered a primary treatment option. But ever since the behavioral component of CBT was shown to be as effective as a standalone treatment, interest in this earlier iteration of therapy renewed, as behavioral therapy for depression was reconfigured into a therapeutic approach called behavioral activation (BA). With its roots in classic behaviorism, BA provides a more modern approach, by acknowledging some cognitive aspects of depression. While cognitive-behavioral therapy is more commonly used to treat clinical depression, behavioral therapy has become known as an effective and efficient treatment option.

Read on to learn what behavioral therapy for depression is and the theoretical foundation behind the treatment. Then look more deeply into treating depression with behavioral therapy, specifically with the strategy of behavioral activation.

clinical depression cognitive behavioral therapy

Behavioral Therapy for Depression – An Introduction

Behaviorism has evolved beyond the strict viewpoints of classical conditioning (Ivan Pavlov) and operant conditioning (B.F. Skinner) to include a more modern perspective, with certain cognitive elements. Its emphasis on behavioral aspects of therapy has been shown to offer significant benefits, as gleaned in a pivotal study from 1996, which determined that the behavioral component of cognitive-behavioral therapy (CBT) alone was as effective as the more diverse CBT treatment option.

What is Behavioral Therapy for Depression?

Behavioral Activation for depression helps individuals change how they interact with their environment, to alleviate symptoms of their condition. A brief present-focused psychological intervention treatment, BA employs self-monitoring skills to connect individuals with their mood and environment through the following ways:

  • Increasing engagement in activities that result in pleasure or mastery.
  • Decreasing their investment in activities that maintain or elevate depression risk, or limit opportunities for positive engagement.
  • Understanding and addressing barriers that contribute to behavioral adjustments.

Unlike cognitive-behavioral therapy for depression, in BA, distorted or negative thoughts are not directly addressed. Such is the case with rumination, which is a common behavioral symptom of depression, described as a persistent focus on negative thoughts resulting in distress. Under BA, ruminative thought content is not challenged and is instead acknowledged as a barrier to positive engagement, or as a repetitive action that can bring about a depressive state.

The Behavioral Foundation of Depression

The behavioral model of depression states that the disorder results from a lack of positive reinforcement of behaviors that maintain a positive mood, or a sense of purpose. When an individual’s environment presents them with obstacles, they may choose unhelpful responses that promote and maintain depressive symptoms. Under BA, conceptualizing an individual’s depression would rely on understanding the context and the variables impacting their behavior and mood.

For example, an individual diagnosed with a life-changing health condition may feel overwhelmed by the prospect of significant life changes. Due to their history of social discomfort, this event triggers them to withdraw socially to cope with the overwhelm, causing them to avoid opportunities to connect with others who would support them through their period of adjustment. Their lack of positive social contact maintains their discomfort and reinforces their avoidance, thus perpetuating their isolation and depressed mood.

Behavioral therapy for depression addresses the individual’s symptoms within the context of the life-changing event, and their unhelpful response of avoiding social interaction. Positive reinforcement from socially supportive relationships is pivotal in changing the individual’s behaviors and improving symptoms.

Treating Depression with Behavioral Activation

Behavioral activation is a structured form of depression therapy lasting approximately 12-24 sessions with homework assignments that move individuals toward their goals. Individuals are encouraged to take an active part in defining them and setting timeframes, promoting higher engagement and follow-through. Collaboration gets individuals into a proactive state of problem solving and away from a passive role where they are more reactive to their environment.

Addressing Cognitions

Cognitive-behavioral therapy for depression addresses both negative thought content and behavioral depression symptoms. Since BA is essentially the behavioral component of CBT, the attention given to cognition during BA therapy is relatively small by comparison. Individuals are advised to acknowledge their depression-related cognitions as part of their experience, such as traffic flow on a busy road. They are taught to see their thoughts for what they are and keep some distance, putting their energy into changing behaviors instead.

Activity Scheduling: A Key Strategy in Behavioral Activation

BA centers around activity scheduling, a strategy designed to increase the opportunities for positive reinforcement of healthy behaviors and social interaction. Because behaviors can directly influence emotion, behavioral activation involves intentional engagement in positive activities to activate positive emotions. Individuals benefit most when these actions align with their beliefs and values.

But activity scheduling is more than merely planning to meet friends and finding things to do. Individuals take a step back to consider the role their thoughts and ruminations play in their avoidance of enjoyable and positive activities. Activities and social encounters are scheduled with these insights in mind, helping individuals move past cognitive obstacles that reinforce their depression and approach enjoyable activities more frequently. As sessions progress, individuals reflect on the homework activities they completed and the impact on their depression symptoms.

Consider, for example, the individual adjusting to a health condition. Behavioral activation would teach them to evaluate how their avoidance behaviors prevent them from socializing. Rather than use social encounters to feel more emotionally supported, their choice to turn down social invitations could reinforce their loneliness and isolation, perpetuating their depression.

By analyzing their behaviors, as part of BA therapy, they could identify (and later address) their most common avoidance behaviors: not answering texts and phone calls, creating reasons to stay home, or ruminating about being an inconvenience to others. With these in mind, the individual can strategically schedule and engage in activities to break the avoidance pattern and reduce depression symptoms.

cognitive behavioral therapy for depression

Behavioral Therapy for Depression

Because of its history of efficacy in treating clinical depression, cognitive-behavioral therapy is often a top treatment choice. But research has shown that behavioral therapy for depression can reduce symptoms through a more straightforward, action-focused approach than CBT. For those who find it appealing, behavioral therapy for depression may provide relief in a matter of months. Taking action requires effort and commitment, but it can move individuals from a state of depression to improved well-being.