Behavioral Activation Therapy: Removing the Cognitive from CBT

By: Garry Cooper, LCSW

Reprinted with permission from Psychotherapy Networker magazine. Copyright, Psychotherapy Networker, Inc.

 

Cognitive-behavioral therapy (CBT) has amassed impressive empirical support for treating depression, but some researchers believe that the effective components are its behavioral interventions, rather than its cognitive aspects. A study in last August’s Journal of Consulting and Clinical Psychology compares cognitive therapy (CT), antidepressants, and Behavior Activation Therapy (BA)—an approach developed from the behavioral elements of CBT—for treating people with major depression. The results: among the most severely depressed, B.A. was as effective as antidepressants, and both of them far outperformed CT.

The new study, led by Sona Dimidjian, an assistant professor at the University of Colorado, strongly suggests we may have underestimated the importance of the behavioral strategies of CBT in treating depression. BA is based on the notion that depressed individuals withdraw from people and activities when their lives are stressful and unrewarding. This can increase their depression and make life problems harder to solve, because encounters with others and engaging in activities are the building blocks of positive mood.

BA helps people locate activities that fit their goals, are rewarding, and enable them to solve problems that are contributing to their depression. It encourages people to take action by developing practical, doable steps to feeling better that they can take between sessions. For instance, someone whose job is unfulfilling might be encouraged to find a new one by looking in the employment section of the newspaper to see what’s of interest there.

“If they’re depressed while doing the activity,” says Dimidjian, “we ask them to move their attention to the direct, immediate experience.” If a depressed dad is playing catch with his child and finds himself ruminating on how lonely he is, for instance, the therapist might help him to practice focusing on throwing and catching the ball or on the look on his son’s face.

BA studies may help explain why other suggestions for treating depression, such as exercise or engaging in altruistic activities, have a high success rate. The common element may be to motivate people to get up and do something.