Treatment: Behavioral Activation for Depression
2015 EST Status: Treatment pending re-evaluation Very strong: High-quality evidence that treatment improves symptoms and functional outcomes at post-treatment and follow-up; little risk of harm; requires reasonable amount of resources; effective in non-research settings
Strong: Moderate- to high-quality evidence that treatment improves symptoms OR functional outcomes; not a high risk of harm; reasonable use of resources
Weak: Low or very low-quality evidence that treatment produces clinically meaningful effects on symptoms or functional outcomes; Gains from the treatment may not warrant resources involved
Insufficient Evidence: No meta-analytic study could be identified
Insufficient Evidence: Existing meta-analyses are not of sufficient quality
Treatment pending re-evaluation
1998 EST Status: Strong Research Support Strong: Support from two well-designed studies conducted by independent investigators.
Modest: Support from one well-designed study or several adequately designed studies.
Controversial: Conflicting results, or claims regarding mechanisms are unsupported.
Strength of Research Support
- Basic premise: When people get depressed, they may increasingly disengage from their routines and withdraw from their environment. Over time, this avoidance exacerbates depressed mood, as individuals lose opportunities to be positively reinforced through pleasant experiences, social activity, or experiences of mastery.
- Essence of therapy: Behavioral Activation (BA) seeks to increase the patient’s contact with sources of reward by helping them get more active and, in so doing, improve one’s life context. One version of BA (BATD) is briefer, focusing specifically on identifying values that will guide the selection of activities. In addition to a focus on increasing activities, the second version of BA also works on identifying processes that inhibit activation/encourage avoidance and teaching problem solving skills.
- Length: Full BA: 20-24 sessions; BATD: 8-15 sessions
Editors: Rachel Hershenberg, PhD; Stephanie Goldstein, BS
Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice
Treatment Manuals / Outlines
- Brief Behavioral Activation Treatment for Depression (BATD; Lejuez, Hopko, & Hopko, 2000)
- Brief Behavioral Activation Treatment for Depression: 10 Year Revision (Lejuez, Hopko, Acierno, Daughters, & Pagoto, 2011)
- Brief Behavioral Activation Treatment for Depression – Revised (Lejuez & Hopko, 2013)
- Behavioral Activation for Latinos (Kanter, Santiago-Rivera, Santons, Hurtado, West, Nagy, et al., 2014)
- Group Behavioral Activation Treatment (Porter, Spates, & Smitham, 2004)
Books Available for Purchase Through External Sites
- Depression in Context: Strategies for Guided Action (Addis, Jacobson, & Martell, 2001)
- Behavioral Activation for Depression: A Clinician’s Guide (Martell, Dimidjian, Herman-Dunn, & Lewinsohn, 2013)
- Behavioral Activation with Adolescents: A Clinician’s Guide (McCauley et al., 2016)
Training Materials and Workshops
- Sign up here for a free training program for providers specifically working with firefighters
- To access free BA training designed for employment counselors, click here
- Initial development of an online training program (Puspitasari, Kanter, Murphy, Crowe, & Koerner, 2013)
Measures, Handouts and Worksheets
- Review of Measures (Manos, Kanter, & Busch, 2010)
- Behavioral Activation for Depression Scale
- Environmental Reward Observation Scale
- Reward Probability Index
- The Coalition for the Advancement and Application of Psychological Science provides dozens of free patient handouts for adults, adolescents, and children as well as guidance about how to flexibly adapt handouts to meet different client needs
- Overcoming Depression One Step at a Time: The New Behavioral Activation Approach to Getting Your Life Back (Addis & Martell, 2004)
- Activating Happiness: A Jump-Start Guide to Overcoming Low Motivation, Depression, or Just Feeling Stuck (Hershenberg, 2017)
- Building a Meaningful Life (BAML) Through Behavioral Activation
Important Note: The books listed above are based on empirically-supported in-person treatments. They have not necessarily been evaluated empirically either by themselves or in conjunction with in-person treatment. We list them as a resource for clinicians who assign them as an adjunct to conducting in-person treatment.
- Moodivate (Dahne, Lejuez, & Kustanowitz), a self-help Brief Behavioral Activation mobile app.
- ¡Aptívate! (Dahne, Lejuez, & Kustanowitz), a Spanish-language self-help Brief Behavioral Activation mobile app.
- Behavioral Apptivation (Dahne, Lejuez, & Kustanowitz), a Brief BA mobile app that is intended to be used in conjunction with ongoing in person Brief BA therapy (i.e., with a therapist). It consists of a mobile app for the patient and a website that therapists can use to track patient progress through the treatment.
Important Note: The apps listed above are based on empirically-supported in-person treatments. They have not all been evaluated empirically either by themselves or in conjunction with in-person treatment. We list them as a resource for clinicians who assign them as an adjunct to conducting in-person treatment.
- Derek Hopko role plays how to discuss the treatment rationale with a patient; to purchase the whole video, click here
Videos from the Coalition for the Advancement and Application of Psychological Science featuring Dr. Chris Martell
Brief videos (~15 min) outline components:
- Case conceptualization and rationale
- Developing and assigning homework
- Troubleshooting barriers
Longer videos that show more of the full sessions:
- Case conceptualization & rationale – long version
- Developing and assigning homework – long version
- Troubleshooting barriers – long version
- Behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of major depression (Dimidjian et al., 2006)
- Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression (Dobson et al., 2008)
- Brief behavioral activation and problem-solving therapy for depressed breast cancer patients: Randomized trial (Hopko et al., 2011)
- Behavioural activation versus mindfulness-based guided self-help treatment administered through a smartphone application: A randomised controlled trial (Ly et al., 2014)
- A Randomized Hybrid Efficacy and Effectiveness Trial of Behavioral Activation for Latinos with Depression (Kanter et al., in press)
Meta-analyses and Systematic Reviews
- Behavioral activation treatments of depression: A meta-analysis (Cuijpers et al., 2007)
- A meta-analysis of randomized trials of behavioural treatment of depression (Ekers et al., 2008)
- Behavioral activation treatment for depression in adults: A meta-analysis and review (Mazzucchelli et al., 2009)
- Behavioral activation interventions for well-being: A meta-analysis (Mazzucchelli, Kane, & Rees, 2010)
Other Treatment Resources
- Contemporary behavioral activation treatments for depression: Procedures, principles, and progress (Hopko et al., 2003)
- Behavioral activation is an evidence-based treatment for depression (Sturmey, 2009)
- What is behavioral activation?: A review of the empirical literature (Kanter et al., 2010)
- The origins and current status of behavioral activation treatments for depression (Dimidjian et al., 2011)
- Behavioral Activation. In A.M. Nezu, and C.M., Nezu (Eds.) The Oxford Handbook of Cognitive and Behavioral Therapies. (Hopko et al., in press)
- Behavioral Activation: Distinctive Features (CBT Distinctive Features), available for purchase.
- Developmental considerations in conducting behavioral activation with youth (Coalition for the Advancement and Application of Psychological Science)