Michael O’Sullivan, author of ‘Working with compassion’, explores how behavioural activation can help us take actions that make us happy
"In cognitive behavioral activity, the word 'cognitive' comes before the word 'behavior'. For me, this order of words does raise a question. Are we prioritizing thoughts over actions? Or are actions more important?
Certainly our mood states are part of our actions. As Albert Ellis said, “The trouble with most therapy is that it helps you feel better. But you don't get better. You have to back it up with action, action, action. ”
The fact that actions matter is particularly important for depressed people who may believe that nothing they do works.
When thoughts and feelings are not enough
Behavioral activation (BA) is about ‘doing’. Thoughts and feelings are not enough. The philosopher John Gray, says: “Human beings are more likely to find ways of living well if they do not spend their lives aiming to be happy.”
BA thinks about the actions which might make us happy rather than aiming at being happy. How does it work?
Positive and negative reinforcement
Each new action reinforces the reasons for previous action. A reinforcement is like a reward. If I walk anywhere each step I take is a reward because I am closer to my destination. These rewards or reinforcers can be both positive and negative.
Negative reinforcement takes away bad feelings. If I am scared of social events I will avoid them and then be rewarded because my anxiety goes down. I continue to avoid social events because of the reward of the removal of anxiety. However I pay the price.
As my anxiety goes down, my world “shrinks” and my depression increases.
Positive reinforcement means getting something back rather than having something taken away.
One of the reasons for turning up for work is getting paid. Positive reinforcement is generally more anti-depressant and can take two forms. We feel good when we achieve and we feel good when we do something pleasurable.
Both are different. Cleaning the kitchen is an achievement but will not necessarily be much fun whilst eating ice cream will be pleasurable but will not necessarily feel like an achievement. Sometimes, there are behaviors which are about both such as sports.
In BA, we aim to find out what these activities are and to do more of them.
The effect is cumulative. By building these types of activities into our daily schedule we can make a difference to our mood over time. In the long term BA asks us to focus on what we value in life. Our values are, as Carl Rogers states- “… a direction not a destination.”
I value “fitness”. This is a direction of travel as no one achieves optimum fitness. However a specific goal such as a daily walk might take me in the “direction” of my values.
BA helps us manage our day to day mental health and allows us to plan for the long term. It is an approach which is gaining ground. In 2016, research from Exeter University illustrated that it was as effective as CBT for depression.
It is certainly less complicated than CBT, is easier to teach to other mental health workers and is significantly cheaper.
Ultimately, it begs the question, why is training in BA not being rolled out across the UK?"