Behavioral activation is an evidence-based treatment for depression.
Behavioral activation is an evidence-based treatment for depression, matching cognitive therapy and CBT on outcomes while often showing lower dropout and lower cost.
01Research in Context
What this study did
Sturmey (2009) looked at every study on behavioral activation for depression.
He found 34 trials with over the adults.
He compared the results to CBT and to medication.
What they found
Behavioral activation worked just as well as full CBT.
It had fewer dropouts and cost less money.
People stayed well longer than with pills.
How this fits with other research
Becker et al. (2022) shows behavior analysis can help brain-injured adults too.
Jensen et al. (2013) gives new math tools to measure how well therapy works.
Shafer (1993) and Hake (1982) remind us that simple behavior principles apply to complex human problems.
Together these papers show behavior analysis works across many adult mental health issues.
Why it matters
You can now use behavioral activation with confidence. It is cheaper and simpler than CBT. Start with activity logs and planned pleasant events. Your clients may stay in therapy longer and relapse less often.
What Is Behavioral Activation?
Behavioral activation is a behavior-analytic treatment for depression. It works by increasing contact with sources of positive reinforcement, scheduling meaningful activity so that action precedes and drives mood, rather than waiting for motivation to appear.
The core premise is functional. Depression is maintained in part by avoidance and reduced access to reinforcement, so structured activation and activity scheduling reverse that pattern.
What the Evidence Shows
This systematic review pulled together three meta-analyses, a randomized controlled trial, and a follow-up. Behavioral activation was consistently superior to wait-list and treatment-as-usual controls.
Effect sizes were not different from cognitive therapy or CBT at post-treatment and follow-up, and behavioral activation often had lower dropout. It may also cost less and avoid the risks of pharmacotherapy.
The authors conclude there is now sufficient evidence to call behavioral activation an evidence-based therapy, including for some people who respond less well to cognitive approaches.
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Add a simple activity schedule to your next depressed client's plan and track mood before and after each activity
02At a glance
03Original abstract
Recent reviews of evidence-based treatment for depression did not identify behavioral activation as an evidence-based practice. Therefore, this article conducted a systematic review of behavioral activation treatment of depression, which identified three meta-analyses, one recent randomized controlled trial and one recent follow-up of an earlier randomized control trial. Behavioral activation was consistently superior to wait list and treatment as usual control groups. Effect sizes were not different from cognitive behavior therapy or cognitive therapy, both post-treatment and at follow-up. Indeed, behavioral activation may be more effective than cognitive therapy and cognitive behavior therapy in terms of lower dropout. Behavioral activation, like cognitive behavior therapy, may be superior to paroxitine because it results in less relapse and recurrence, may be substantially cheaper, and does not have risks of pharmacotherapy. There is some evidence that behavioral activation may also be useful with some people for whom cognitive and cognitive-behavior therapy is less effective, such as those with severe, lifelong depression, people with substance abuse and people with dementia and severe depression. There is now sufficient evidence to conclude that behavioral activation is an evidence-based therapy.
Behavior modification, 2009 · doi:10.1177/0145445509350094