Behavioral Activation Therapy
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).
While committed behavior therapists continued to utilize this approach much more research was conducted on cognitive-behavioral treatment for depression, which incorporated behavioral activation but focused mainly on the typical distortions in thoughts and beliefs that are characteristic of depressed individuals. Throughout the 1980s and 1990s CBT became the most widely studied treatment and consistently demonstrated effectiveness in treating depression, anxiety and other disorders.
In 1996 Jacobson and colleagues (Jacobson, et al, 1996) conducted a study of the effective ingredients in CBT for depression. They found that there were no differences in treatment outcome between CBT compared to behavioral activation (BA) alone. Another major study comparing BA, CT, and Antidepressant Medication was conducted by Jacobson and colleagues, and continued after the untimely death of Neil Jacobson in 1999. A description of BA as developed in that study was published in a refereed journal (Jacobson, Martell, & Dimidjian, 2001) and in the book Depression in Context: Strategies for Guided Action (Martell, Addis, & Jacobson, 2001). Results of that study showed BA to be as efficacious as antidepressant medications and to have slight advantage over CT in the treatment of moderate to severe depression (Dimidjian, et al., in press)
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.