Behavioral Activation

INTRODUCTION

Most of the September, 2017, issue of the journal Psychotherapy is devoted to a section on behavioral activation (hereafter, BA). BA is a psychotherapy technique used to encourage clients to approach internal and external experiences that have been so consistently avoided that the avoidance itself has contributed to the development of depression , anxiety , and relationship problems. Avoidance can be very tempting because it reduces immediate stress in the short-term; however, it also, unfortunately, increases long-term issues. As avoidance becomes more habitual, engagement with the many supports and reinforcers available in the outside world shrinks, while isolation and suffering increase (Boswell, Gallagher, & Farchione, 2017).

CLINICAL APPLICATIONS

Originating decades ago as a cognitive behavioral technique, BA was first used to target the lack of positive affect associated with depression. A depressed person's lack of motivation and withdrawal results in less positive as well as less negative actual experience. Consequently, attention to internal suffering increases in forms such as sadness, despair, and emptiness (Dimaggio & Shahar, 2017). Research has shown that when people stop taking part in activities they formerly enjoyed, depression follows within a year (Cruwys, Haslan, & Dingle, 2014).

More recently, the use of BA has generalized to other clinical conditions in addition to depression. Anxiety disorders reduce the interface with the outside world for fear of imagined catastrophes. This reduction increases the focus on possible threats and decreases rewarding experiences (Dimaggio & Shahar, 2017). "Both unipolar depression and anxiety disorders are characterized by diverse avoidance behaviors" (Boswell, Gallagher, &Farchione, 2017, p. 23).

It stands to reason that avoiding other people will result in relationship issues associated with increasing social isolation. Those who have social anxiety and those who are depressed experience shrinking social support as they pull away from others. In addition, not dealing with important issues that are present in ongoing relationships augurs the deterioration of these relationships. As a result. there can be a  significant diminution of social reinforcement, which feeds into more anxiety, depression, and/or relationship problems.

CLINICAL EFFECTS

Early in the use of BA in cognitive behavior therapy, the active ingredient was believed to be confined to the replacement of avoidance behaviors with approach behaviors. Because of this replacement, contact with positive experiences could increase and depression would decrease (Boswell, Iles, Gallager, & Farchione, 2017; Farchione, Boswell, & Wilner, 2017). However, as time has gone on and other psychological theories have adopted BA, additional effects have been posited. For example, both cognitive behavior and psychodynamic therapies see BA as able to disrupt maladaptive self-concepts while substituting more adequate and flexible ideas about the self (Dimaggio & Shahar, 2017).

This substitution often happens as therapist and client collaborate to process the client's experiences before and after BA. The best BA offers some action that can expand coping strategies but also activates the client's difficulties in doing so. This material very well might not have been available without BA (Yoemans, Delaney, & Levy, 2017).

CONCLUSION

Actually no matter the outcome of a BA exercise, it can be helpful. It does encourage the replacement of avoidance with approach strategies, which can in the long run reduce emotional discomfort. It also can be used to help explore the associated thoughts, feelings, and interpersonal issues involved. This exploration can lead to grater self-awareness of one's inner life and relationship patterns. (Gordon-King, Schweitzer, & Dimaggio, 2017).

If you think BA might be helpful to you, please contact me.

REFERENCES

Boswell, J. F., Iles, B. R., Gallagher, M. W., & Farchione, T. J. (2017).Behavioral activation strategies in cognitive-behavioral therapy for anxiety disorders. Psychotherapy, 54 (3), 231-236. http://dx.doi.org/10.1037/pst 0000119

Cruwys, T., Haslam, S. A., & Dingle, G. A. (2014). The new group therapy. Scientific American Mind, 25 (5), 60-63.

Dimaggio, G., & Shahar, G. (2017). Behavioral Activation as a common mechanism of change across different orientations and disorders. Psychotherapy, 54 (3), 221-224. http://dx.doi.org/10.1037/pst0

Farchione, T. J., Boswell, J. F., & Wilner, J. G. (2017). Behavioral activation strategies for major depression in transdiagnostic cognitive-behavioral therapy: An evidence-based case study. Psychotherapy, 54 (3), 225-230. http://dx.doi.org/10.1037/pst0

Gordon-King, K, Schweitzer, R. D., & Dimaggio, G. (2017). Behavioral activation in the treatment of metacognitive dysfunctions in inhibited-type personality disorders. Psychotherapy, 54 (3), 252-259. http://dx.doi.org/10.1037/pst0

Yeomans, F. E., Delaney, J. C., & Levy, K. N. (2017). Behavioral activation in TFP: The role of the treatment contract in transference-focused psychotherapy. Psychotherapy, 54 (3), 260-266. http://dx.doi.org/10.1037/pst0

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