Faced with depression and its negative symptoms, behavioral activation is today a first-line treatment whose effects continue to be highlighted in the scientific literature. Theorized in the 1950s, developed in the 1970s and popularized in the 1990s, behavioral activation shows equivalent effects to antidepressants and cognitive therapy, while simplifying the patient’s therapeutic path. Spotlight on this technique still too little known.

1. What is behavioral activation?

Behavioral activation is a therapeutic technique aimed at increasing an individual’s engagement in adapted activities, most often with a strong positive impact allowing for reinforcement.

Patients, especially those with anxiety-depressive disorders, have a high level of avoidance. The symptoms of the disorders often lead to a decrease in activities by avoiding the associated unpleasant emotions. Frustration, fear, fatigue, sadness are among the anticipated consequences and it becomes preferable for patients to reduce their activities and actions rather than risk being exposed to these consequences.

Derived from cognitive-behavioral therapies, the goal of behavioral activation is to reintroduce appropriate behavioral habits into the patient’s life, reduce avoidance, and bring back positive emotions associated with different activities. 

More simply, we will use the pleasure associated with the practice of sports, hobbies, positive social interactions, as well as the feelings of self-reward felt after completing chores or difficult tasks to reinforce these behaviors and get out of inactivity.


2. When should behavioral activation be used?

Behavioral activation is primarily used in the treatment of depressive symptomatology. Fatigue generated by the illness, as well as negative-focused thinking patterns and expectations of the worst, will lead to avoidance of many situations and actions. Individuals suffering from depression, by using avoidance as a coping strategy for potential unpleasant situations, will reduce the frequency and intensity of their active behaviors, which will lead to a worsening of depressive symptoms.

This same pattern of avoidance is found in anxiety disorders, including social phobias and generalized anxiety disorder.

It can therefore be used in the treatment of these two families of disorders, as well as with any patient whose avoidance leads to a strong decrease in activity and global functioning.

3. What are the effects?

Behavioral activation will reduce avoidance behaviors. These short-term coping strategies (management of emotions) are effective in avoiding potential unpleasant emotions, but lead to the appearance and maintenance of a vicious circle that sustains anxiety and depressive symptoms. Behavioral activation allows the patient to recognize his or her avoidance behaviors and to replace them with active behaviors by focusing on the reward and positive emotions associated with the realization of these actions.

Indeed, behavioral activation allows the reintroduction of sensations of pleasure or control, which are mostly absent in people suffering from anhedonia and subject to avoidance. These pleasurable sensations will participate in the reinforcement of active behaviors and increase their frequency and their positive impact on the mental health of patients.


4. What are the stages of behavioral activation?

The first step will be to teach the patient to recognize his or her symptomatology and to understand the mechanisms of avoidance and reinforcement, in order to better identify which situations are the most sensitive to them. We can work in mindfulness to facilitate the recognition of these processes that may have become automatic over time. 

After learning about and recognizing the disease, values are defined with the patient, which will serve as a compass during therapy and will facilitate the perception of rewards and pleasant emotions during activities.

Once the psychoeducation is completed, the active part of the therapy will consist of identifying the traps that lead to avoidance in order to face them, and then to take action, by reintroducing activities progressively. The goal is to go at the patient’s pace, according to his or her abilities, and the difficulty should not be too high so as not to set the patient up for failure, while allowing him or her to find rewards in the effort made.

After working on these aspects, the goal will be to consolidate this mode of functioning over the long term, and to transform it into a complete and functional lifestyle. We will make sure that the rest of the patient’s life environment is compatible with good mental health and we will make the necessary changes (stopping substance use, healthy sleep, etc.)

5. Behavioral activation and virtual reality

Recent studies on the use of virtual reality in behavioral activation, in particular on the practice of physical activities in virtual reality (walking, cycling, etc…) have shown that thanks to its playful and motivating aspect, the benefits on mood and motivation were greater than during a simple physical activity.

In addition to offering tools for well-being and cognitive and behavioral therapy, virtual reality can therefore also be considered in the case of behavioral activation for the treatment of anxiety and depression.