Core intervention: Behavioural activation

with NiceDay version 1.0 - February 2023

What is behavioural activation?

Behavioural activation is an intervention for depression. Depressive behaviour can arise from insufficient positive experiences due to the client's passive behaviour. The level of client activity further decreases, as well as positive experiences. This, in turn, leads to increased levels of depression. Behavioural activation is implemented to break the cycle of passive behaviour, reduce sadness, and increase energy.

How do you carry out behavioural activation in NiceDay?

Send the vicious cycle of behaviour in advance, discussing the relationship between mood, enjoyable activities, and satisfaction. During the session, you discuss this cycle or fill it out together using screen sharing.
Collaboratively plan enjoyable activities that are 100% achievable in the client's Task list. If your client finds this difficult, you can use the following tools:
- You can have your client record "must-do" activities and enjoyable activities along with their mood.
- Review the list of enjoyable activities and note which activities your client likes or used to enjoy. You can also assign this as a task.
- Brainstorm concrete activities that align with the client's life goals. You can optionally use the life balance tool for this.
Integrate activities into the client's daily routine. Schedule activities and have them recur daily/weekly. Clearly establish which activities are to be completed before the next session and have your client check them off.

Pitfalls and tips for behavioural activation

When behavioural activation is not working well, you need to investigate why. You can assess several factors:
- Difficulties in performing the behaviour: For example, the client may want to take better care of themselves but keeps forgetting to buy healthy food. You can, for instance, create a shopping list together.
- Lack of skills: The client may lack the necessary skills to carry out the activity. Ask if the client has ever done the activity before or what is needed to perform it, such as social or organisational skills.
- Passive behaviour is rewarded: Does the depressive behaviour lead to positive reinforcement from the environment? For instance, if you stay in bed, others may take care of you. This reinforces passive behaviour, procrastination, rumination, complaining, staying in bed, or substance use.
- Unhelpful thoughts about oneself: The client may have unhelpful thoughts, core beliefs, or rules that discourage them from engaging in the activity.
- Setting overly ambitious goals: If the client aims for too much or too quickly, the goal should be adjusted. Choose something that is 100% achievable.

The process of behavioural activation occurs in steps and may take several sessions, so be careful not to rush.
It is important to be critical: What may feel like a pleasurable activity for the client may not always be a positive one. For example, watching series in bed when the client has been in bed all day. The goal is to break inactivity.
There is a tendency for the client to wait until they feel like doing the activity. Explain to the client that it is best to simply start, regardless of their mood.
Incorporate variety into activities. Alongside individual activities (such as walking), plan social activities (such as visiting friends).
By using a functional analysis, you can clearly identify avoidance behaviour (depressive behaviour) and what the behaviour yields in the short and long term.

Sources:

Bockting, C., Rijsbergen, van G. & Huibers, M., Protocollaire behandeling van patiënten met een depressieve stoornis. In: Keijsers, G. P. J., Van Minnen, A., Verbraak, M., Hoogduin, C. A. L. & Emmelkamp, P., (2021). Protocollaire behandelingen voor volwassenen met psychische klachten.