What Is Behavioral Activation, and Is It Actually Better Than CBT?


Image credit: Poodar Chu

If you keep on top of mental health news, you’ve probably seen a lot of headlines this week about Behavioral Activation (BA), and how it has apparently been found to be better and cheaper than Cognitive Behavioral Therapy (CBT).

The reason for those headlines is a recent study published in The Lancet. In a randomized, controlled clinical trial with 440 participants, researchers studied the outcomes of participating in either BA or CBT for a maximum of 20 sessions over 16 weeks. They looked at clinical outcomes for participants after 12 months and found that the two groups responded about equally well to treatment – not that BA was superior, but that it wasn’t inferior.

They also found that BA was more economically feasible for participants to maintain, as it can be delivered by mental health professionals with less experience and training than those that offer CBT.

All of this is great news, but it comes with a few major caveats. Behavioral Activation is a treatment option for depression. So is Cognitive Behavioral Therapy, but CBT is also used to treat many other issues, including anxiety disorders, eating disorders, psychosis and PTSD.

The study only looked at major depressive disorder, so it does not in any way suggest that BA is a good treatment for any other issues. Beyond that, it’s only a single study, without replication — like many studies that also get a lot of news coverage. With only a single, fairly uniform sample to look at, we can’t assume that the study’s results are applicable to everyone who is dealing with depression.

That said, the results are promising, and may eventually lead to a shift in treatment recommendations if they hold up to further study. Beyond that, they do highlight a treatment that may interest you if you’re dealing with depression and looking for options.

So what is Behavioral Activation?

Here’s a rundown of BA from TherapistAid:

The behavioral activation model suggests that negative life events such as grief, trauma, daily stressors, or a genetic predisposition to depression can lead to a person having too little positive reinforcement. Additionally, a person might turn to unhealthy behaviors–drug use, sleeping late into the afternoon, social withdrawal, etc.–in an attempt to avoid the negative feelings. These behaviors provide temporary relief, but ultimately result in more negative outcomes, and worsening depression.

When using behavioral activation, a clinician intervenes in two primary ways: They increase the amount of positive reinforcement a person experiences, and they end negative behavior patterns that cause depression to worsen.

In other words, BA encourages you to do things you would normally enjoy or that are beneficial instead of doing things that only help you avoid negative feelings or experiences. Instead of staying in bed all day, you might go for a walk, call a friend, or try a hobby you normally enjoy (not one that you just use to distract you from feeling lousy). Instead of skipping lunch, you might force yourself to nibble on a healthy snack. Whatever the positive behaviors are, they are meant to be rewarding and sustainable. That way you won’t feel completely overwhelmed, and those positive behaviors will have a chance to work their magic.

Given how simple that sounds, you might be skeptical about its efficacy. No need: Behavioral Activation is a solid, research-backed treatment that’s already employed by many therapists to help people who are dealing with depression. It may or may not be a good fit for you, and that might be worth looking into. That said, the results of this study definitely don’t imply that you should drop your current depression treatments to try it out. No treatment is right for everyone, and you should always work with a mental health professional if you’re considering making changes to your treatment plan.

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