Have you ever noticed a significant boost to your emotions or mood when you do certain things like work out or meet up with a friend? Many of us can fall into the trap of weighing the pros and cons to determine whether these things are even worth our time. However, when we fall out of engaging in activities that bring us these boosts to our emotions for long periods, this can leave us feeling emotionally down — without us really understanding why.
This article will explore the concept of behavioral activation, how behavioral activation interventions using exercise are helpful for anyone — but especially for those with depression — and will finish up with some tips for using these principles to increase our positive emotions.
Note that this article is for educational purposes only and is not to be used as a form of treatment. If you are experiencing depression or any other mental health concern, please reach out to a mental health provider for treatment so they can tailor interventions to your particular needs.
What is Behavioral Activation (BA)?
The roots of behavioral activation (BA) can be found in Cognitive Behavioral Therapy (CBT), a specific type of talk therapy intervention. In essence, CBT suggests that our emotions, behaviors, and thoughts are all interconnected and all impact one another. For example, when we are feeling really anxious about meeting new people (emotion), we have a tendency to think about all the things that could go wrong (thoughts) and avoid situations where we have to meet new people (behavior). CBT helps the individual to recognize how we are able to do something different to ideally see changes in all three areas. Because we actually have little control over our emotions (they tend to be automatic), CBT focuses on intervention at two points: thoughts and behaviors. BA specifically aims to intervene on the behavioral side to also see changes in thoughts and emotions. Learn more about how CBT affects thoughts here.
However, to explain how BA impacts depression, we have to back up a bit and talk about the theory of why CBT therapists believe depression develops. For most people, when we engage in certain actions, the positive experience — and boost in emotions we experience as a result — reinforces that behavior, meaning we tend to want to do it more. For example, when we go out with friends and have a great time, those positive emotions make us want to do it more often.
The reinforcement theory of depression suggests that people who are depressed tend to have a lack of this response-contingent positive reinforcement (Mazzucchelli et al., 2010). This means that they no longer feel rewarded by engaging in those behaviors anymore, and they have a tendency to engage in those behaviors less often and sometimes stop them altogether. They then have fewer opportunities for that mood-enhancing reward and experience the positive emotions less frequently, contributing to depression. Depression also tends to mean that people filter the world through a negative lens (negative attributional bias), making it difficult for people with depression to consider how socializing might be positive.
Behavioral activation, then, is a specific CBT skill that gets people to engage in the behaviors that will lead to greater reward. People are encouraged to engage in meaningful activities that provide positive emotions and make them feel accomplished or connected to others, in order to have an “antidepressant” effect. Many people wait until they feel better or more motivated before they start to engage in these types of activities, but because we know that it is a bidirectional relationship (mood impacts behaviors and vice versa), changing behaviors first can help us feel better right away. It is a common experience that doing just a little bit of a particular activity (a 5-minute walk, for example) makes us want to do more and more if we find that rewarding.
It is important to note here that while BA was created as a treatment for folks with depression, these principles can actually be helpful for anyone. Research shows that BA increases well-being and is equally effective for people with and without depression (Mazzucchelli et al., 2010).
Why BA plus exercise is particularly helpful
So, what does this have to do with fitness?
One of the most common behaviors that people stop engaging in (regardless of whether they have depression or not) is exercise. Remember the pros and cons list I talked about in the introduction? Well, it is easy for the perceived “cons” of exercise to outweigh the “pros.” When exercise makes us feel tired, drained, short on time, and/or hard to engage in other behaviors we like more, we tend to let it go.
As a result, many researchers have examined the impact of BA plus exercise on depression levels and other health outcomes in patients. BA interventions are equally as effective as many other mental health interventions for depression, but have been linked with more long-lasting increases in well-being compared to other interventions (Mazzucchelli et al., 2010).
Research shows that behavioral activation interventions combined with exercise improves both the individual’s depression levels as well as markers of inflammation within their body long-term (Euteneuer et al., 2017). Other studies have shown that behavioral activation exercise interventions have been particularly helpful for increasing exercise enjoyment and reducing exercise avoidance in women with both type 2 diabetes and depression (Schneider et al., 2016). Therefore, BA is a helpful intervention to also prevent the health outcomes that often co-occur with major depression (like inflammation, cardiovascular issues, and diabetes).
Behavioral activation how-to
If you have put exercise on the backburner (or any other activities/tasks) and need to use these BA principles to get you back into the swing of things, here are a few tips on how to go about it:
- Brainstorm activities: The first step in BA is to brainstorm what tasks or activities you might find enjoyable, energy boosting, or contributing to a feeling of mastery/competence. This can be a really fun step and you don’t have to limit yourself to things you have ever done before. Create a list that has a wide variety of activities. For example, if exercise is your goal, create a list of ways to move your body that you can test out in the next step to see if you enjoy them. Try dancing in your living room, playing frisbee with your partner, doing one of Fitness Blender’s many workouts, or going for a walk. It is important to note in this step that you want a mix of things that you find interesting or enjoyable with other things that make you feel accomplished, confident, or relaxed. We need all of these factors in our lives to promote our well-being.
- Conduct an experiment: In this next step, you get to act like a scientist and experiment with all the activities you listed in the first step. Engage in these activities one at a time (this could take a while) and find a way to track the things you found enjoyable or motivating and which things you didn’t enjoy at all. This list will help you out in the future so you know what types of things you will want to schedule into your weeks/days.
- Schedule rewarding behaviors: Start very small (5 minutes) by scheduling some of these activities into your daily or weekly schedules. Schedule them into your days/weeks so you can first test them and then refine your activities based on what you find. Scheduling the activities makes it more likely that you will do it. I often find with myself and with clients that when I commit to 5 minutes (I can do almost anything for 5 minutes), I end up wanting to do more by the end. That’s how BA works!
- Continual evaluation: Evaluate both in the short- and long-term how these tasks are working for you. In the experiment phase, evaluate which ones are worth your time and energy and which ones you could do without. Stick with the ones you find enjoyable and/or rewarding. In the long-term, continue to re-evaluate these tasks to see if your enjoyment has waned over time. If so, that is normal. You can start this process over to figure out what you want to do moving forward.
Eventually, many people find themselves getting a certain amount of momentum with the behavior when they intentionally apply BA principles to their life. It becomes easier to do these things, we have more opportunities for reward in our life, and we generally feel better overall. So, give these tips a try and let us know how it goes in the comments!
References
Euteneuer, F., Dannehl, K., del Rey, A., Engler, H., Schedlowski, M., & Rief, W. (2017). Immunological effects of behavioral activation with exercise in major depression: An exploratory randomized control trial. Translational Psychiatry, 7(5), 1-10.
Mazzucchelli, T. G., Kane, R. T., & Rees, C. S. (2010). Behavioral activation interventions for well-being: A meta-analysis. The Journal of Positive Psychology, 5(2), 105-121.
Schneider, K. L., Panza, E., Handschin, B., Ma, Y., Busch, A. M., Waring, M. E., Appelhans, B. M., Whited, M. C., Keeney, J., Kern, D., Blendea, M., Ockene, I., Pagoto, S. L. (2016). Feasibility of pairing behavioral activation with exercise for women with type 2 diabetes and depression: The get it study pilot randomized controlled trial. Behavior Therapy, 47, 198-212.