By George Maxwell
Published on 01/10/2015
Behavioural activation – The activation!
So, now you will have hopefully completed all the steps on Get activated – Part 1. If you haven’t, then you may want to follow the link and give it a go. If you have followed the steps, you will now have a detailed record of your current levels of activity and ratings with regards to how much pleasure and achievement you get from each activity. Now we are going to put it to some use. Let’s start with some quick wins…
Taking a look at your completed diary, are there any activities which you have rated more highly in terms of pleasure than others? Even just a little? If there are, then we have got evidence to support the idea that doing more of this stuff will make you feel more pleasure. Take a blank activity diary and we are going to schedule some activities for the next week based upon this. Take the first activity that you have rated more highly than others and write it down on the activity diary at a time when you will be able to do it. For instance, if I rated the activity of “taking the baby to the park” with a pleasure score of 6, then if I schedule it for another time in the next week, or possibly even twice over the next week, then it is likely that I will experience a similar degree of uplift. Have a go…
When you have scheduled the one activity, I’d like you to repeat the process with another activity that you have rated highly for pleasure. Just write it down on the diary at a date and time when you feel you are going to be able to complete it.
Now we are going to take a look at the achievement based activities. Again, initially identify one or two activities which have scored more highly than others in terms of achievement. You may have completed a task in work or had a conversation with your partner which you may have been previously avoiding. Whatever it was, again schedule the same or a very similar activity into the diary for the next week.
As we are just getting started with behavioural activation, we’re not going to overload the diary with tasks for the next week. We just want to ensure that the tasks we have set ourselves are going to be manageable, and to set ourselves up for success. Regular, small successes are the key to challenging low mood.
Value based activities
Remember the values assessment? If you have completed it, I’d like you now to take just one of the values (e.g., Father, Partner, family, etc.) and consider just one activity which might support this value. For instance, if I choose the “father” value, an activity related to this might be “Play with the baby for one hour.” Once you have chosen an activity, again write this down into the diary. Other examples of activities associated with each of the Values assessment dimensions might be:
The idea here is to begin to include activities which fit in with our values, so we are starting to live our life as we want it to be, rather than how depression makes us feel it is.
Implementing the diary
Now you should have a diary which looks something like this:
You’ll notice that it’s not overloaded with activities. The idea here is that we are building up our activity levels gradually, and setting ourselves up for success. If we put too many items on the diary to start with, then it may seem too big a task for us, and we may give up and become frustrated with ourselves if we struggle to complete it. Too few, and we won’t experience the sense of pleasure, achievement and activation which we are after. There will be plenty of time to add to the diary as your recovery progresses so, for now, aim to be realistic and kind to yourself.
At the start of week three, now is the time to implement the diary. When the day and time arrives for when you have scheduled your activity, stick to the plan and act the activity out. Once you have acted the activity out, in the same way that you have done before, rate the activity in terms of achievement and pleasure. This gives us evidence relating to whether the activity works for us in lifting our mood. It’s really important to remember here to stick to the plan, not to how you feel. As we have talked about before, depression is typically characterised by a reduction or avoidance of activities and the urge on some days to not bother with implementing activities may be particularly strong. We need you to, as much as possible, to stick to the plan. This is another reason as to why we don’t overload the diary with activities to begin with – Small, realistic successes are the path to recovery.
In addition to carrying out the scheduled tasks, I’d like you to, just as before, record all of the other activities which you engage in on an hourly basis and rate them for achievement and pleasure. Again, we are interested in identifying further activities which elevate mood, and in any patterns of avoidance.
Reviewing your progress
Once you have implemented your activity diary, it’s time to spend a few minutes reviewing how it went. Were you able to complete all of the tasks that you had scheduled? What ratings did you give them? Was there anything that you would have done differently? What effect did the activities have upon your mood? What do we need to do for the next week?
It is important to approach this review stage with an as open, non-judgemental attitude as possible. If you haven’t quite managed to complete all of the activities which you scheduled, then maybe you need to break that particular activity down into smaller, more achievable chunks and schedule them first. Be kind to yourself. This is an ongoing process and can take time. By allowing yourself the space to move forward, without critical self-judgement for minor setbacks, you are going to be on your way to recovery.
Now that we have got the ball rolling with Behavioural Activation, we need to keep it rolling. Even though this site will cover other CBT techniques to reduce depression, Behavioural Activation has been shown in clinical studies to be an effective treatment for depression on its own. Some studies even suggest that it is the sole agent of change in CBT for depression. For this reason, we need to stick with it.
After week 3 of scheduling and recording activities, I would like to you to repeat the process on a weekly basis. As it becomes a habit, you will notice your mood start to lift. You will be finding and engaging in achievement and pleasure based activities and living your life in accordance with your own Values. Keep going with this as you explore the other CBT techniques covered in this site. Record your progress and use the phq-9 self report measure to assess your depression symptoms on a weekly basis. Next up, Cognitive restructuring.
Disclaimer: Depression in New Dads takes no liability for consequences of using materials on this site. In the event of crisis, a suitably trained mental health practitioner should be consulted.