Topic 5: The Practice of CBT – Behavioral Activation {by 10/5}

There are two readings due this week (Beck – 1 Chapter; Wright et al. – 1).  For this discussion, share at least one main thought: (1) There is much research that supports the effectiveness of behavioral activation as a specific factor for CBT.  Share your thoughts on possible reasons why behavioral activation is effective at reducing client distress.  Your original post should be posted by the beginning of class 10/5.  Have your two replies posted no later than 10/7.  *Please remember to click the “reply” button when posting a reply.  This makes it easier for the reader to follow the blog postings.

Advertisements

33 Comments (+add yours?)

  1. Venessa Wiafe
    Oct 02, 2017 @ 23:01:14

    Behavioral activation is a procedure that is normally utilized during the early or first sessions within CBT, as well as a source for the conservation of treatment for a client. Behavioral activation is used for individuals battling mental disorders, such as depression, in aims of assisting them with letting go and ceasing behavior patterns that aren’t having a positive impact on their life. These patterns can include instances in which an individual feels hopeless due to an unfortunate event that has occurred, causing him to be idle and not put effort into anything that was once daily routines for him. The negative life event that transpired in a client’s life is perceived by him as being so terrible to the point that life can’t be the same, and that they have failed, so nothing is enjoyable or worth engaging in anymore. In order to refute these negative thoughts and behaviors, the therapist instills hope in the client that they can move into a good space and progress is still possible to achieve. The therapist works in collaboration with the client to alter the way he is doing things by picking a couple activities that could help the client change the way he currently feels and also help the client find ways to execute the activities so that they are possible to achieve. Behavioral activation is indeed an effective procedure to reduce client distress because it can assist a client with recovering and going back to operating in a manner that is positive and healthy for him. Behavioral activation helps clients acknowledge their inactivity and help themselves, along with help from their therapist, to be able to remove behaviors that aren’t improving them and instead engage in activities that will get them back into functioning with a purpose. These activities can also increase improvements in the mood of the client and decrease the act of the client withdrawing from activities that are satisfying. Avoidance and isolation can make the client fell worse rather than make them get back to doing things they normally do to keep them content. When avoidance and isolation is removed from the client’s life in an appropriate pace for him, positive and rewarding behaviors can be activated and refute these obstacles from his life. Support from the therapist is one of the essential keys to helping the client get back to prospering in life and the activities should be achievable and easy at first for the client. When the therapist asks the client about how he is doing with his plan, the therapist should reward the client with praise whenever he is successful with each activity, and motivation when he has a hard time at first. This will help the client to continue moving towards getting back to his normal self again and not letting situations prevent him from being full of life. This technique suppresses one’s distress and instead uplifts one’s road back to recovery and finding pleasure in life again.

    Reply

    • Alana Kearney
      Oct 07, 2017 @ 08:27:03

      Hey Venessa,
      I appreciated that you mentioned the therapist’s participation in this process. It is just as important for the therapist to be active in this part of therapy by reinforcing and encouraging the behaviors. The clients will most likely find it difficult to initiate this behavioral change, which is why the therapist must be present to ensure that the client is, in fact, prepared and can execute these behaviors on his/her own.

      Reply

  2. Julie Crantz
    Oct 03, 2017 @ 12:37:41

    Behavior activation has been found to be an effective element of CBT. It is an intervention that is especially helpful for clients who are experiencing distress from depression, anxiety, eating disorders, and other mental disorders (Wright, Basco, & Thase, 2006). Behavior activation refers to the process of involving clients in making changes that will foster hope and encouragement for taking action. Clients who suffer from depression are often plagued by a vicious cycle of self-defeating behaviors, lack of pleasure, inactivity, feelings of worthlessness, and inability to take action. With behavior activation, a therapist assists the client with choosing a few action items to take that have the potential to help the client feel better. The therapist and client will work together to formulate a basic plan for carrying out the action items. Behavior activation is frequently used during the first few therapy sessions with a client, and can also be used later in therapy to help with other targeted behaviors. Behavior activation is extremely beneficial for clients who are distressed because it is a method for quickly engaging clients in activities early in the process of therapy and creating positive movement for them. This can increase self-efficacy for clients, as well as increase self-esteem, and provide them with a more adaptive viewpoint (Beck, 2011). Behavior activation can lead to feelings of pleasure and a sense of accomplishment. This valuable intervention can help break clients away from maladaptive behavior patterns such as inactivity and social isolation, and help them to feel a sense of well-being and enjoyment. Clients will then be encouraged to continue taking action and positive steps toward healing (Wright, Basco, & Thase, 2006).

    Reply

    • Olivia Grella
      Oct 05, 2017 @ 21:53:41

      Hi Julie, I like how you mentioned how behavioral activation can help increase the client’s self-efficacy. Because self-efficacy regards how the client personally perceives their own ability in a certain area, behavioral activation can be extremely beneficial. By seeing that they are capable of accomplishing these tasks that they value will improve how they perceive their ability to handle those tasks, thus increasing their self-efficacy.

      Reply

  3. Noella Teylan-Cashman
    Oct 04, 2017 @ 00:47:18

    Behavioral activation is a CBT technique implemented mostly in the early stages of therapy (though still effective over the course of treatment) that entails the therapist instructing the client to list 1-2 actions they feel would improve their emotional state. Together, the therapist and client formulate a feasible plan to carry out the proposed activity. Behavioral activation is a tool that produces concrete change in the beginning of therapy, which instills hope and encourages clients to continue with the therapeutic process.

    Often times, clients enter therapy feeling defeated and helpless. Successful behavioral activation shows clients that they can regain some control over their life, and can make a difference in the their symptom severity and presentation. Behavioral activation also serves as a foundational structure for supplemental behavioral interventions; once clients have integrated these simple positive actions into their schedule, it gives them a sense of accomplishment and helps them feel competent enough to complete other therapeutic tasks. Additionally, behavioral activation helps to establish immediate rapport between the client and the therapist, which will ultimately lead to better treatment outcomes.

    Reply

    • Julie Crantz
      Oct 06, 2017 @ 13:42:05

      Hi Noella,
      I appreciate your comment on how behavioral activation can help clients regain some control over their lives. When clients are overwhelmed by depression, they can certainly feel a loss of control and feel very overwhelmed by even the smallest of tasks. Working with a therapist to engage in a basic activity that may make them feel better is a great first step in making a positive difference with their symptoms. I also agree that behavioral activation is a valuable tool to establish immediate rapport between the therapist and the client. It lays a solid foundation for the therapeutic relationship.

      Reply

  4. Matthew Collin
    Oct 04, 2017 @ 11:40:24

    There are a few ways in which I think behavioral activation is affective at alleviating client distress. One would be that having a client perform particular behaviors – that make him/her uncomfortable – can be used in collaborative empiricism – it can be used as evidence to confirm or deny particular beliefs someone has about himself/herself or about something. For instance, if a client is very depressed, thinks he/she is no good, and no one will ever want to go out on a date with him/her, assigning a homework assignment to ask five women or men out on a date can be used to confirm or deny that belief. The same goes with anxiety. If someone thinks the world will end if A happens, then you get him/her to confront that fear (behavioral activation) to confirm or deny his/her thought that the world will end if he/she encounters A.
    Another way behavioral activation is helpful is that it can break the cycle of particular patterns of thought, emotions, and behavior. In the CBT paradigm, there are bi-directional transactions between all of these components. If one is hard to tackle – let’s say thoughts – a therapist may want to begin with simple behavioral techniques to break the pattern. You see this a lot with people suffering from depression. For instance, a depressed patient may lay in bed all day, not perform chores, or daily hygiene rituals. It’s known that if most depressed patients follow some sort of behavioral schedule (i.e. take a walk at 8am, eat breakfast at 9am, etc.) that simply targeting the patterns of behaviors that maintain a depressed state can significantly alleviate depressed mood. A lot of behavioral techniques look to tackle the somatic symptoms of mental illness, which typically cause a never ending cycle of reinforcing particular thoughts, and those thoughts continue to feed into the somatic symptoms. Behavioral activation attempts to disconnect or reroute that cyclical and maladaptive pattern.
    Behavioral activation can also be used to expose clients to things that make them uncomfortable. In classic behaviorism theory, the end goal of this process is to have someone become habituated with the experience that makes him/her feel distress. You can see this in phobias. If someone is afraid of driving, then the best way to alleviate that fear is to make him/her drive. Eventually, this habituation causes him/her to create new thoughts about the experience. If his/her beginning thought was “I’ll die” or “I’ll get lost”, then he/she drives and neither of those two thoughts come true, then behavioral activation has successfully produced the evidence that neither of those two thoughts are logical. The hope would be to create thoughts that align with the evidence produced by the behavioral activities.

    Reply

    • Stephanie Welch
      Oct 07, 2017 @ 20:29:14

      Matthew,
      I really liked the examples that you provided for behavioral activation. I especially liked how you pointed out the use of behavioral activation for depression. I think that it is interesting how a client can begin to feel a less depressed mood by doing simple tasks. I also agree that behavioral activation is good for targeting the thoughts of “if I do this, then I will die” or the beliefs that the client has about feeling a certain way after doing an activity.

      Reply

  5. Stephanie Welch
    Oct 04, 2017 @ 16:13:03

    My thoughts on the possible reasons that behavior activation is effective at reducing client distress are it instills a sense of hope within the client and it is centered on positivity. Behavior activation is also about the client’s choice. According to Wright et al, the therapist is giving the client the choice of positive activities in order to show the client that he or she can experience good moments. Activity helps the client to get out and do things while trying to distract him or her from negative thoughts. If the client is engaged in a positive activity, then he or she is unlikely to be ruminating about negative experiences. Positive activity also can boost the client’s mood and motivate him or her to continue with the activity and perform the activity more frequently.
    Beck points out that behavior activation allows the client to test out his or her automatic thoughts. The client is able to test an idea out in his or her life and evaluate the validity of his or her automatic thought. Behavior activation also allows the client to gauge his or her levels of happiness versus depression. If the person thinks that he or she will be less likely to enjoy an activity that he or she previously enjoyed, then he or she can test the idea by performing the activity and then rating the level of pleasure. The therapist can then discuss with the client the differences between his or her expected enjoyment levels and actual levels of enjoyment for the activity. This leads to the client realizing that he or she can experience enjoyable moments in the future and gives hope to the client that he or she will no longer be depressed.
    Beck and Wright et al suggests activity scheduling assignment for behavior activation. Wright et al also suggests rehearsing the activity in therapy before attempting the activity outside of therapy. This suggestion makes sense in that the therapist will be able to evaluate whether or not the client can perform the activity outside of therapy or may need some more practice before implementation of the activity.

    Reply

    • Venessa Wiafe
      Oct 06, 2017 @ 22:57:48

      Hi Steph,
      I really like how you mentioned that behavior activation is about the client’s choice . It is important to rememeber that therapy is for the client and that he is the focal point. It is good that the client doesn’t have to be told what activities he must engage in during behavioral acituvation. The fact that the client has the choice of what he would want to do to assist himself in a positive manner makes therapy much better and worthwhile for him. The client is able to help cease rumination by engaging in activities that is a best fit for him and he would enjoy. This also helps the client grasp a sense of autonomy over his issue, over therapy, and also establish rapport as he works with his therapist.

      Reply

    • Shay Young
      Oct 07, 2017 @ 13:15:07

      Hey Steph,

      I liked that you mentioned that behavioral activation is a distraction from ones negative thoughts. I think this is an interesting thought. I imagine it is much easier to ruminate on negative thoughts and ideas if there is limited activity in one’s day. I never really thought to much in depth on that idea, even if its obvious. A severely depressed person who is pretty confined to the limits of their bed or their home, most likely are further inhibiting themselves due to the fact that they are alone with their thoughts more often. I think about when i’m laying In bed or lounging around the house. This is when my mind wanders and I am overanalyzing things, mostly because i’m not doing anything productive. I would think the same would be true for a depressed patient. Doing nothing allows more time for excessive thoughts. So you are right in the sense that encouraging activity may be important just to distract someone from their thoughts. More than that, I think behavioral activation would also challenge invalid thoughts about pleasure.

      Reply

  6. Shay Young
    Oct 04, 2017 @ 19:14:55

    Behavioral activation is a procedure that entails stimulating the client with a sense of positive movement and hope. The therapist will help the client choose two actions or activities that could improve their emotions and thoughts. I think Behavioral activation is effective at reducing client’s distress for numerous reasons. Most often, if someone is in therapy they have some inclination that there is some type of problem. I think for depressed patients, they may have some idea that their behavior is atypical. Their anhedonia or lack of interest in pleasurable activities may be particularly alarming for patients who developed depression later on in life. They may recall how active they once were and feel like they have regressed in life. Doing behavioral activation may revive a sense of healthiness and functionality in patients. They may begin to feel like they are living their life the way it is meant to be lived. Patients will become more hopeful. Usually behavioral activation is done with clients who are depriving themselves of obtaining a sense of pleasure and achievement, both two very important components of one’s livelihood. Instilling a sense of purpose and pleasure can be incredibly helpful. Beck mentions that activation not only improves ones mood, but also gives them a sense of self-efficacy and self-esteem.
    Personally, I think activation seems like a necessary step for a lot of depressed and anxious clients. We know with some severely depressed patients that even the idea of just getting out of bed is overwhelming. Targeting these refusal/ avoidance behaviors may be a necessary first step before any therapy can be done. If someone cannot brush their teeth or take a shower, it may be harder to really tackle any core beliefs or negative thoughts. I can also picture it as a hierarchy of needs. Someone who is sleep derived and not eating, may need to focus on targeting those behaviors before really sitting down in an office and tackling automatic thoughts and core beliefs. Sure, the two can be done simultaneously, but I think often it’s more practical for clients to rejuvenate a sense of interest in activities before asking them to analyze thoughts. They may not have enough energy or care to do so before behavioral activation. Wright even mentions that usually behavioral activation is done within the first session. The timing and the essentialness of Behavioral activation definitely depends on how severely depressed or anxious the client is. Those who are less severely depressed, and are still able to perform daily functions, may not need behavioral activation right away or at all. All In all, behavioral activation seems like a great way to energize clients, and to get them reinterested in what life has to offer.

    Reply

    • Sarah Hine
      Oct 06, 2017 @ 13:59:33

      Shay,
      I agree with your thoughts on the necessity of behavioral activation for depressed clients, and I like that you mention it being like the first step on a hierarchy of needs. According to the hierarchy of needs, humans need to meet basic needs before mental and emotional needs can be met. I think this idea should certainly be taken into consideration by therapists. Helping the client engage in self-care not only gets them to a place where they can work in therapy, but it also helps them improve their physical health. If a person feels better physically, they will probably be more capable of tackling topics like automatic thoughts and cognitive errors.

      Reply

  7. Alana Kearney
    Oct 04, 2017 @ 20:01:34

    Behavioral activation is an important part of the early stages of cognitive behavioral therapy. By the time a client enters a therapeutic setting, he/she has realized (or been told by and influential figure) that he/she has a problem and must look for ways to improve his/her behaviors. So during that first session, the client is looking for suggestions on how to make changes in daily life. By coming to therapy, they have usually accepted that they cannot solve their problems on their own and are looking for guidance to initiate this process and reduce their distress.
    Behavioral activation allows a client to feel secure in the changes he/she is making. It acts as a motivational technique to initiate positive actions that are meant to improve one’s thoughts and feelings. If the client understands the rationale behind why he/she should make the behavioral changes and what the possible outcomes of the changes would mean for him/her, then he/she will have a desire to try to change. This step reduces a client’s distress because they begin to understand what change will entail and can fully grasp what will be expected of them in therapy. This process also gives clients the ability to chose activities that they think they will be capable of completing. Not only does this give the client control of his/her own life and decisions, but it also places responsibility on the client. The client can work with the therapist to consider making changes that the therapist sees as important, but ultimately the client has the freedom to say yes or no, which prevents them from feeling bullied into certain actions that they may not be comfortable with. This amount of control allows the client to feel more in control and comfortable with the choices the two parties make together. It also prepares the client to respond to potential automatic thoughts that may get in the way of change. During the activational process, the client and therapist create a schedule of activities the client should try to do every day. By creating this schedule, the client must already think ahead to possible situations that may prevent him/her from implementing the behavioral changes. In order to do so, he/she must consider potential automatic thoughts and how to respond in a way that will continue the positive behavioral change. This allows the client to consider possible stressful situations and prepare himself/herself to respond to any stressors presented.
    Behavioral activation is an important start to behavioral change. It is the first time that clients understand why change is necessary and what it means to initiate a change in one’s life. It becomes the preparation for future actions and a means for guiding therapy each week. It acts as a motivator to continue to attempt change in daily life and a positive reinforcement when one can succeed with the planned tasks. All of these qualities hopefully decrease the amount of distress the client will endure.

    Reply

    • Sarah Hine
      Oct 06, 2017 @ 13:44:28

      Alana,
      You point out that it is important to remember what expectations the client has as they enter therapy. As therapists we should take this seriously; if we work with the initial expectations and hope the client already has, we can use that to increase motivation and keep the client engaged. I think if a client comes ready to act, but the therapist is not willing to incorporate behavioral activation into the beginning of therapy, the client may feel disheartened and even feel invalidated. You also mention that behavioral activation is a way to prepare clients for future actions. This is important to remember and even to remind clients of who are reluctant to try behavioral activation or who may want big changes at the start of therapy.

      Reply

    • Matthew Collin
      Oct 07, 2017 @ 09:41:17

      Hi Alana,
      I like how you mentioned how behavioral activation is also about planning ahead. A client can seemingly begin to problem solve before intense therapy starts. Like you also said, it seems like it can be a great motivator at the very beginning of therapy. I’m assuming it’s also good for the client to see that the therapist is also dedicated to alleviating his/her stress from the beginning as well. Having the therapist assign behavioral activation tasks probably conveys this to the client.

      Reply

  8. Olivia Grella
    Oct 04, 2017 @ 21:31:06

    Behavioral activation has been shown to be effective in reducing client distress. A few reasons as to why this is comes to mind. Behavioral activation is a procedure that encourages the client towards change and gives them positive feelings that they can overcome certain difficulties. This feeling of hope and optimism that can come out of behavioral activation is one of the factors as to why I believe it is effective in reducing client distress. If a client is continually being shown that they have the ability to do things they believed they were not capable of doing can be extremely motivational to them. Also, behavioral activation starts at the beginning of therapy. So throughout the course of treatment, they are consistently working and strengthen their skills alongside their therapist who can help them process any complications or help them develop different approaches if one is not working effectively. Having these positive experiences from the start can not only strengthen the relationship between the client and the therapist, but it can also ease the client as they begin to accomplish certain goals.
    Also, behavior activation can help a client overcome any fears they may have or challenge any anxious or depressed emotions they may have. Through behavioral activation, they can work with their therapist to challenge these thoughts and feelings to see that they are not valid like they believe them to be. Even though going through these situations can make them feel uncomfortable or nervous, being able to slowly work towards these goals and see that they are capable of doing so can alleviate some of the distress they are feeling. Through these exposures, they are seeing for themselves that not only are they developing the skills to overcome negative automatic thoughts but they are also witnessing that a life without those negative thoughts and emotions is possible and achievable.

    Reply

    • Luke Dery
      Oct 06, 2017 @ 15:29:15

      Olivia,

      To your point about behavioral activation being used to challenge fear and negative emotions, I think an underrated part of change in therapy involves acceptance of natural, human emotional responses. I think we get into the habit of seeing any emotions that make us feel icky as inherently bad and that they must be removed. I think challenging clients to experience emotions and engage in behaviors that induce emotional responses is a healthy practice and a form of exposure.

      Reply

    • Shay Young
      Oct 07, 2017 @ 13:23:49

      Hey Olivia,

      I like that you mentioned that role of collaboration in behavioral activation. Dr. V made this point and class, and I think it is an important one. Being that behavioral activation happens early on, the client is more likely to feel an immediate connection to their therapist. This is because behavioral activation empirically works. When the therapeutic relationship is such a key to successful therapy, it makes sense to begin therapy which a technique where the relationship is almost guaranteed to prosper (obviously this should only be used for certain clients). The individual will most likely feel better as they begin to partake in more activities and more responsibilities, and some of this newfound interest and efficacy would be attributed to not only therapy, but to the therapist’s effectiveness.

      Reply

  9. Sarah Hine
    Oct 04, 2017 @ 23:00:03

    Behavioral activation typically occurs in the early stages of therapy, and involves the client and therapist choosing a task that the client can work on that is relatively straightforward and is aimed at helping improve mood. There are several benefits to using behavioral activation in therapy, the first being engaging the client at the beginning of therapy and decreasing negative symptoms. For clients who are experiencing symptoms like depression who are hopeless and have withdrawn from the very activities that will help draw them out of that depression, behavioral activation helps them to take those first steps to improving mood. In the beginning of therapy, a successful behavioral activation can reduce negative symptoms and increase positive feelings, creating a sense of hope in the client and encouraging them to continue in the process. When a client is able to experience some hands on, practical experience in therapy through behavioral activation, their focus and motivation may increase to participate and engage in other aspects of therapy. In our readings Wright also suggests that this may increase a client’s trust in the therapist, possibly decreasing anxieties they may have about therapy and increasing their interest in participating.
    While behavioral activation may not be as involved as some of the other methods of behavioral interventions mentioned in this week’s readings, it lays the foundation for the processes of working through thoughts, decreasing distress, and problem solving throughout therapy. Practical, hands on application can reinforce concepts learned throughout therapy even in the first few sessions. These behavioral exercises also give concrete instances that the therapist and the client can work on together in therapy. Because the client has an actual experience to talk through and relate concepts of CBT to, what they are learning in therapy is more likely to be retained and practically applied. The therapist can also help the client to identify strengths and successes in these tasks, something that may be difficult for clients with feelings of hopelessness or anxiety. Identifying behavioral activations that were pleasurable or successful can help determine methods of intervention that may be successful further down the road, and can even demonstrate to depressed clients that experiencing pleasure and getting better is possible. Going over behavioral activation tasks in therapy can also reduce distress because the client can begin the process of breaking down their behaviors, identifying problems or positive results and working toward solutions. Behavioral activation seems like a helpful way to boost clients’ confidence about their abilities to participate in behavioral interventions that will be helpful when working on more complex problems later in therapy.

    Reply

    • Julie Crantz
      Oct 06, 2017 @ 13:50:24

      Hi Sarah,
      I appreciate your comment about how a therapist can help a client with identifying strengths and successes with tasks that are a part of the behavioral activation process. It is a great opportunity for therapists to provide encouragement to clients when they are engaging in these initial activities. This will strengthen the therapeutic relationship and reinforce the collaborative focus of therapy. Having some basic activities that can help to bring some joy to a depressed client is a huge benefit. And, helping the client become aware of feelings during the activities will be good practice for more advanced techniques that will be learned during therapy in the future.

      Reply

    • Alana Kearney
      Oct 07, 2017 @ 08:37:37

      Hi Sarah,
      You described this process to be a foundational part of therapy. This is extremely important because one of the first things the client and therapist must do is establish a trusting relationship. In the beginning, when the two parties are unfamiliar, the client cannot fully trust the therapist until he/she is proven that the therapist is worthy of trust. For many people, therapy can be used as a coping strategy to just go hide in an office and talk with someone. In those first session, this might hold true for many people as the therapist takes control of the conversations to build rapport. However, when behavioral activation begins, the client really gets to see if the therapist knows what he/she is talking about and will have to put his/her trust into the therapist. This process take a leap of faith of the client, and becomes the first time they realize they do, in fact, have the ability to change on their own.

      Reply

    • Matthew Collin
      Oct 07, 2017 @ 09:34:13

      Hi Sara,
      I really like that you mentioned that it can be a way to parse out strengths and weaknesses in a client – especially if he/she doesn’t know what those strengths are. I also like how you said it is a skill that may help clients problem solve. As you also mentioned, it’s a good way to also get clients to articulate their thoughts, behaviors, and emotions in a way that they haven’t before.

      Reply

  10. Luke Dery
    Oct 05, 2017 @ 00:53:55

    Behavioral activation is an intervention used to engage the client in the therapeutic process of change and help them develop a sense of positive movement and hope. It is especially effective and essential for depressed clients. Most depressed individuals have given up activities that used to give them pleasure and have, to some extent, withdrawn from being active participants in their world via isolation and avoidance. The behaviors they still carry out, such as staying in bed all day or other idle activities, often keep them trapped in their depressed state. Behavioral activation is aimed at slowly getting these individuals back into habits and activities with the hope that they can improve their mood. This intervention is often helpful in providing depressed clients evidence that they can actively control their emotions and that they are capable of experiencing pleasure. A client who plans with his/her therapist to go shopping for an hour during the day may have a positive experience where the activity makes them feel excited or happy and reduces their negative emotions or thoughts. This, over time, can provide the client will evidence that he/she can independently make efforts to change his/her emotion state. Additionally, giving the client the power to do this on their own is effective in increasing self-efficacy, which is often lacking in depressed individuals and people seeking therapy in general. For this reason, it is best to use behavioral activation at the start of therapy to get the client in a progress-focused and active state, and to give them confidence they can use when engages in future interventions in therapy. A positive experience with this intervention at the start of therapy can also give the client confidence that the therapist can be trusted to help them, and can often help a nervous client break out of their shell in the therapeutic relationship.

    Reply

    • Olivia Grella
      Oct 05, 2017 @ 21:58:05

      Hi Luke, I like how you incorporated in your answer how behavioral activation works (and works well) with a client who has depression. As we learned through this week’s readings and in class today, this procedure can be motivational to clients with depression. Seeing that they are capable to handle even small tasks can help lessen those emotions and thoughts they are experiencing. This makes behavioral activation very effective for clients with depression.

      Reply

    • Noella Teylan-Cashman
      Oct 07, 2017 @ 14:30:40

      Luke,

      I really liked how you referenced behavioral activation as a way of presenting evidence to the client. As aspiring CBT practitioners, we know the value of evidence based practice and the importance of empirical support. However, I do think it is important to point out that behavioral activation can also serve as confirmatory evidence for individual’s with low levels of self-efficacy if it is done incorrectly. Clinicians need to be mindful to ensure that the client’s goals for behavioral activation are attainable and not too difficult initially. If a vulnerable client (as most are at the beginning of therapy) attempts a difficult behavior and fails, he/she will use it as evidence to confirm their beliefs of incompetence, which will further deplete their low levels of self-efficacy.

      Reply

  11. Luke Gustavson
    Oct 05, 2017 @ 10:42:44

    Based on the readings, it seems as though behavioral activation is exposure therapy for doing things. Exposure therapy treats anxiety while behavioral activation treats vegetative symptoms of depression, but both utilize levels of intervention in order to ease clients into a full schedule (or a room full of snakes – I’m not sure which one I’m talking about now). The procedure for behavioral activation could not be simpler: choose an activity or two that the client can easily complete and that could influence how they feel, complete, rinse and repeat (but add a few on).

    Even a technique as simple as activity assessment and scheduling can be incredibly effective. The question is how. On the outside, scheduling a few activities and following through is child’s play. However, from the perspective of a severely depressed individual who lays in bed all day, getting up, taking a shower, and putting on clothes can seem like a lot.

    This brings me to self-efficacy, a term I have written no less than 20 times in the past week. When we complete a task, we feel good, and this raises our self-efficacy: we learn we can complete this behavior successfully and can reasonably expect to do so in the future. However, a severely depressed person is likely to have no self-efficacy related to self-care behaviors or social behaviors at all.

    My main hypothesis, then, is that working on a few simple activities to start and slowly working others in is a way to tap into an individual’s self-efficacy, to give them evidence that they are capable of completing the activities they once performed. As their self-efficacy builds from these first few steps, they begin to take larger risks, set higher goals, and become more motivated to keep going. Building self-efficacy also increases the likelihood that coping behaviors are utilized. There may be other factors such as the movement of the body feeling good and the general pleasure and mastery one gets from certain activities, but I do think that this all boils down to the building of self-efficacy more than anything else.

    Reply

    • Noella Teylan-Cashman
      Oct 07, 2017 @ 14:10:48

      Luke,

      I appreciated how you tied the process of behavioral activation into the concept of increased self-efficacy. From previous readings, it has become evident to us that levels of self-efficacy can be a large predictor for therapy outcomes. As you stated, behavioral activation can serve as the first step towards building an individual’s confidence level and encouraging him/her to set supplemental goals. Once an individual believes they are capable of achieving a goal, they will be more willing to take action towards attempting the goal and will be more perseverant in the face of obstacles.

      Reply

  12. Chiara Nottie
    Oct 05, 2017 @ 11:52:19

    Behavioral activation can be effective at reducing client distress. An initial effect behavioral activation has on the depressed population is increasing activity. Most depressed individuals have withdrawn from some amount of activities that once lifted their mood and gave them a sense of enjoyment, and achievement (Beck, 2011). CBT focuses on the interplay of thoughts, feelings, and behavior. If an individual is feeling depressed, then they stop being productive, therefore remaining depressed. If CBT can get an individual to become more active then down the line feelings of joy and worth can return, because activities once again bring a sense of enjoyment and achievement. This shows how a negative consequence of feelings can affect behaviors (feeling sad leading to being inactive) and how a positive consequence of behaviors can alter feelings (being active leads to feeling more optimistic). Thoughts can be included in this model, for example an individual may have the thought of I am boring, then have the feeling of sadness in response to that thought, and finally choice to avoid activities with others because they feel sad or they think they will further prove how boring they are. Behavior activation can reverse this (Beck, 2011). An individual may be encouraged to join others in activities, which can lead them to feeling happier, which may lead to new thoughts of, I can be a fun person. Behavior activation can take a while to show effects, and may be challenged by negative core beliefs. However, it is a great way to approach a case. Some of the desired effects of behavioral activation come from improving an individual’s energy, problem-solving abilities, and ability to complete tasks (Wright, 2006). A body out of motion becomes lethargic, while a body in motion, stays in motion. Depression leaves individuals to physically get used to lethargy, which influences how they feel and think. However, if behavioral activation can be utilized to engage individuals in activities their bodies will become used to being in motion, start to regulate metabolism and sleep better, which will perk up feelings and thoughts too. Individuals with anxiety, depression, or other forms of mental illness can get ‘stuck’ because of a performance deficit. Individuals with performance deficits do in fact possess problem-solving skills, that are difficult to access and utilize because of their mental illness (Wright, 2006). Issues that may block problem solving skills include fatigue, emotional overload, cognitive distortions, social anxiety, etc. Behavioral activation helps directly work on accessing these skills. Some steps taken by behavioral activation towards accessing problem solving skills include: slowing down and sorting things out, picking a target to focus on, define the exact problem, generate solutions, choose the most reasonable solution, put solution into effect, evaluate outcome and repeat any steps if necessary (Wright, 2006). You can see how these steps are typically what adaptively functioning individuals do ‘automatically’. Helping an individual with mental illness to practice these steps hopefully increases their abilities to problem-solve efficiently and independently (which should reduce symptoms of mental illness). Behavioral activation can be a good technique to use to challenge struggles individuals with mental illness are having. Cognitive and emotional challenges can be used in therapy as well but sometimes it is easier for individuals to start with behavioral challenges. This works out well because CBT believe that behaviors, emotions, and thoughts are all linked together and mutually influential. Therefore, if you work on behavior improvement, consequentially emotional and cognitive improvements will occur. Eventually behavior activation may improve an individual’s well-being enough for needed emotional and cognitive challenges to take the lead in treatment.

    Reply

    • Luke Dery
      Oct 06, 2017 @ 15:11:23

      Chiara,

      I liked the point you made at the end about how the reciprocal nature of thoughts, feelings, and behavior highlights the importance of behavioral activation. I like the fact that CBT is very action-focused because I feel that a lot of other orientations are all talk and no action. If changing thoughts can help us change our feelings, it makes sense that changing our behavior has an impact on our thoughts and feelings as well given their reciprocal nature.

      Reply

  13. Lindsey
    Oct 05, 2017 @ 15:07:40

    Behavioral activation is utilized during the early stages of therapy to illustrate a relationship between behavior and the relationship. It comprises of one or two action steps for the client to improve their personal mood/emotion state. These action steps not only help the client feel more in control early in the therapeutic relationship but they also establish the basic tenets of collaborative empiricism. Together, the therapist and client create and implement a plan of action for improvement. Behavioral activation provides instant gratification during the beginning stages of therapy in hopes of motivating the client to continue with the therapeutic process. In addition to it being a rapport building opportunity, behavioral activation tasks offers structure for the client during times of angst.

    Reply

    • Venessa Wiafe
      Oct 06, 2017 @ 23:12:36

      Hi Lindsay,

      I love how you pointed out one of the main goals for the client to accomplish during therapy, which is having control. It is vitial for the client to gain control of his life again after going through so many hardships and dealing with so many negative thoughts, behaviors, and events. When engaging in behavioral activation, the client obtains control over his actions by refuting the negative behaviors and utilizing positive activities to stir his behavior in a much healthier direction. Being in therapy is like a new beggining for the client. He has the chance to assess all of his issues, evaluate their conditions and meanings , and change his lifestyle into a much healthier and optimistic one. The client knows that he is not alone through the process, but at the same time, he is aware of the fact that at the end of the day, therapy is about him and his needs and being able to attend to his needs. He must focus on himself and changing his life for the better and learning how to do it even when therapy terminates.

      Reply

    • Stephanie Welch
      Oct 07, 2017 @ 20:36:53

      Lindsey,
      I liked that you pointed out that behavioral activation establishes collaborative activation. The therapist and client are working together to test out the client’s thoughts and form a hypothesis about how the activity will play out. When the client comes back to therapy after completing the activity, he or she can work with the therapist to determine how valid the original thoughts and hypothesis was. I also agree with your point that instant gratification is important for the therapeutic relationship. The client is given the hope that the outcome of therapy will decrease his or her depressed mood and that hope strengthens the therapeutic relationship.

      Reply

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Top Clicks

  • None

Adam M. Volungis, PhD, LMHC

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Join 43 other followers

%d bloggers like this: