Behavioral activation and depression: a contextual treatment approach

Depression is a widespread psychological disorder that affects approximately one in five North American. Typical reactions to depression include inactivity, isolation, and rumination. Several treatments and psychological interventions have emerged to address this problematic. Cognitive behavioural therapies have received increasingly large amounts of empirical support. A sub-component of cognitive behavioural therapy, behavioural activation, has been shown to in itself effectively treat symptoms of depression. This intervention involves efforts to re-activate the depressed client by having them engage in pleasant, gratifying, leisure, social, or physical activities, thereby counteracting the tendency to be inactive and to isolate oneself. Clients are guided through the process of establishing a list of potentially rewarding social, leisure, mastery-oriented or physical activities, to then establish a gradual hierarchy of objectives to be accomplished over the span of several weeks. Concrete action plans are devised, and solutions to potential obstacles are elaborated. The client is the asked to execute the targeted objective and to record their mood prior to and following the activity. Behavioural activation effectively reverses the downward spiral to depression. Interestingly, studies show that behavioural activation has a positive effect on cognitive activities. It has been shown to reduce rumination and favour cognitive restructuring, without requiring cognitively-based interventions. The advantage of this treatment is therefore that it is simpler to administer in comparison to full-packaged cognitive behavioural therapies, it requires a lesser number of sessions and can be disseminated in a low-intensity format. This article begins by summarizing the origins of the behavioural model of depression, which serves as a basis to the understanding of behavioural activation. This is followed by a detailed explanation of the different phases involved in a behavioural activation intervention. Empirical support for behavioural activation is then presented in regards to depression as well as comorbid physical and psychological health problems. The results of meta-analyses and randomized controlled trials are presented. Behavioural activation is then discussed within the framework of third-wave therapies, discussing the potential role of mindfulness in behavioural activation objectives. Specifically, it is suggested that mindfulness, although not necessarily direc