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CBT and Behavioural Activation for Depression

In the last year or so, my mental health journey has involved a lot of cognitive behavioural therapy (CBT), but with a different lens than I had been used to. As a quick summary, CBT focuses on how thoughts (cognitions), actions (behaviours), and feelings interact. In other words, what we think ends up affecting how we act and feel, just as what we do ends up affecting how we think and feel, and how we feel affects how we think and act. Some like to think of it as a three-way cycle: thoughts create feelings → feelings create behaviours → behaviours reinforce thoughts, and so it continues. Thus, CBT aims to tackle this cycle in two different ways: 1) if we challenge our perceptions and the thoughts we have, this can eventually help change how we feel and the behaviours that we act on 2) if we change some of our behaviours, this can eventually help change the way we feel and the thoughts we have.

When I was a teenager, I did a lot of CBT work related to my anxiety, OCD, and eating disorder. This time around, I learned more from a depression perspective. The particular component that I’m going to discuss in this blog is something called “behavioural activation”. In this context, behavioural activation is based on the idea that when we suffer from mental illness, there will be things we stop doing as a result of how we’re feeling. The problem is that these changes in behaviour and activity create a negative feedback loop, in two main ways: 1) they reinforce our negative feelings, e.g. withdrawing from activity is going to make us feel more lethargic, more lonely, more down on ourselves, etc. 2) and they limit our opportunities for positive experiences. The goal of behavioural activation is that — instead of waiting for our mood to improve before we engage in tasks, activities, etc. — we engage in activities despite how we feel, and this will give us the opportunity to improve our mood by allowing ourselves to have experiences where there can be positive reinforcement.

In this particular therapy program, we talked about how depression causes us to gradually withdraw from activities and people, and how it ultimately leads to operating at low (or lower than our usual) levels of activity. It can become an incredibly difficult cycle to get out of, especially when a key factor in depression is low energy and negative emotions, so some of the most “basic” tasks can feel incredibly overwhelming. Knowing this fact, we learned that in order to take control back from depression, it is essential that we focus on self-care — and this approach to self-care is all about going back to basics. We focused on eight main areas:  1. Grooming and personal hygiene 2. Healthy sleep 3. Nutritious eating 4. Exercise 5. Fun and enjoyment 6. Rest and relaxation 7. Socialization 8. Productivity 

With each of these main areas in mind, we were taught to see how “depression uses a lot of tricks to maintain itself in our lives”. We discussed the messages that depression tells us, what our depression has us do as a result, and then a healthy alternative or opposite action we can engage in to try and minimize depression’s impact in that situation. So, an example for socialization could be: “I’ll be bad company, I don’t have the energy for it” → which leads to withdrawing, isolating, procrastinating responding to messages, etc. → instead, we can try to engage in some form of regular social contact (ideally, each day), even if that’s just one text or one wave at someone across the street. 

Essentially, behavioural activation is all about doing the opposite of what our depression is telling us to do, breaking things down into small and manageable steps, and gradually building upon them, one step at a time. It’s working to teach ourselves that we do matter and that we’re worth taking care of. It’s about building positive habits back into our lives so that eventually, they might not feel so damn uncomfortable and foreign. Plus, like I mentioned earlier with the negative feedback loop, when we cut ourselves off from activities as an attempt to reduce our stress and suffering, we actually end up depriving ourselves of the good things too — and you deserve good things! 

So, what are some ways that you can build behavioural activation into your life?