Beat Depression With This Novel Behavioral Approach

Date: February 1, 2017      Publication: Bottom Line Health      Source:  Christopher Martell, PhD, University of Massachusetts      Print:

The evidence for this novel therapy continues to grow…

If you think of therapy for depression as all talk and no action, here’s a pleasant surprise—a simple, short-term and inexpensive new form of therapy helps people with depression feel better and improve their states of mind by “doing.” Doing what? You’ll see…


Behavioral activation (BA), as the approach is called, helps people re-engage with others and with activities that they enjoy—or used to enjoy—rather than focusing on their inner thoughts and feelings.

When people are depressed, they naturally withdraw socially and from activities they used to enjoy—and get pulled in by their negative moods. This sets up a bad cycle.


That’s where BA comes in—breaking this negative cycle. It targets inertia, encouraging people to treat their depression through their behavior.

Let’s say you enjoy, or used to enjoy, quilting. (In fact, it could be any activity you like, either alone or with others—cooking with friends, hiking, playing piano, being in a book club, drawing, etc.) With BA therapy, you would be encouraged to pursue that pastime in a small, incremental way—perhaps, say, by searching online for local quilting clubs to join. The next step might involve choosing a particular club and making inquiries about when it meets and whether it’s open to new members. When internal barriers arise—if you can’t mobilize your efforts because you feel so down and tired, for example—you and the therapist would try to identify what’s really standing in your way and what you can do to get around those obstacles.


BA therapy has developed in its current form only within the past 20 years, so it is not as thoroughly researched as other forms of therapy. But there’s a growing body of supportive evidence…

  • It works as well as cognitive behavioral therapy (CBT), according to a recent study published in The Lancet. When 440 adults who met a primary diagnosis of depression but who were not yet getting any treatment received at least eight weekly sessions of CBT—a well-established approach that focuses on changing thought patterns and behaviors—or BA, the therapies were found to be equally effective.
  • It works in older people. A recent study from the Weill Cornell Institute of Geriatric Psychiatry in White Plains, New York, published in The American Journal of Geriatric Psychiatry, looked at 48 adults over age 60 with mild-to-moderate depression. After the patients were treated with nine weekly sessions of BA, they were engaged, participating in many more personally rewarding activities—and they experienced a sharp decline in their depressive symptoms.


There’s another potential benefit offered by BA. If this therapy could help people with depression become more physically active, the effects could be profound.

Here’s why: According to a recent study published in Psychosomatic Medicine, 30 minutes of brisk exercise three times a week is not only as effective in treating depression as major antidepressants but also much more effective in preventing the return of depression. Six months after treatment ended, only 8% in the exercise-only group had their depression return, compared with 38% in the drug-only group.



Even though BA isn’t successful for everyone, when it works, it can work very quickly. The exact mechanism of action isn’t clear, but reengaging in activity can increase positive feelings—and the negative thinking that’s associated with depression can change as you change your behavior.

While each patient and each therapist is individual, a typical course of BA consists of weekly 50-minute sessions for up to 24 weeks. It is a nondrug approach but can also work for individuals who are being treated with psychiatric medications, such as antidepressants.

To find a BA therapist, the best place to start is with a therapist trained in CBT (most therapists trained in CBT can do BA). To find a CBT therapist, click on “Find Help,” then on “Find a CBT Therapist” at, the site of the Association for Behavioral and Cognitive Therapies. Like other psychotherapies, BA is generally covered by insurance.

And the good news is that the key to this therapy is doing what you enjoy!


Source: Christopher Martell, PhD, clinic director of the Psychological Services Center at the University of Massachusetts, Amherst, author of two textbooks on behavioral activation (BA) for therapists and coauthor (with Michael Addis, PhD) of the client workbook on BA, Overcoming Depression One Step at a Time: The New Behavioral Activation Approach to Getting Your Life Back.