9 Beh activation/actvity scheduling Flashcards
Behavior Activation
PART 1
• Offer rational for monitoring- helps build our awareness
- Record some of the activities to build up awareness
- Help build attention about your day to increase memory for events- common things you lose whilst depressed
- Overall rating at the end of the day- mood rating
- Patterns between activities in day and mood
• Clarifying understanding of the task and checking for obstacles
• Aim to start reintroducing activities that have value and meaning to us
• Troubleshooting potential obstacles- what obstacles may potentially get in the way
PART 2
Reviewing the weekly activity monitoring - find relationships
PART 3
Introduce BA
• Activities that give the most bang for your buck
• Reintrodcuing activities into routine
• Identifying and scheduling potential activities
• Need to do these activities regularly
History and theoretical foundation
Jacobson et al: Assissted persons with depression in approaching and accessing potential sources of positive reinforcement while avoiding unpleasant and punishing events
- The act of approaching and accessing positive reinforcers was regarded as having natural antidepressant functions
Roots of behavioural activation in theories of depression
- Fester: Functional analysis model: Link between depression and environmental factors and central role of passive responding
- Avoidance
- Escape and withdrawal in the development and maintenance of depression - Lewinsohn: Behavioural theory of depression: low rate of response contingent positive reinforcement (RCPR) in the development and maintenance of depressive symptoms
- Low rates of RCPR result in low rates of behaviour and thus a lack of reducing opportunities to receive positive reinforcement:
o extinction of some classes of behaviour (like positive ones) - MacPhillamy & Lewinsohn: The pleasant Events Schedule: Clinical measure for evaluating pp in pleasant activities
- Therapeutic strategy for promoting behaviours that produce positive reinforcement
Differences between Lewinsohns’ approach and the behvaioural activation approach
• Lewinsohn assumes the existence of intrinsically pleasant and reinforcing events or activities for all people
• BA classifies events as reinforcing only when clearly influencing the individual’s behaviour
- BA assumes that depression is primarily the result of problematic life events and circumstances, not the result of deficits of dysfunctions that resides within the person
Support for behaviorl activation as an effective therapy for depression
Research findings show that BA may be the most important ingredient of cognitive behavioural treatments for depression:
- Jacobson et al: The addition of cognitive treatment elements to BA interventions does not add significant therapeutic benefit
- Dimidjian et al: In an experiment with 3 experimental groups (antidepressant medication, behavioural activation, cognitive therapy) it appeared that outcomes associated with BA were similar to AM and both BA and AM were superior to CT
- Some evidence for the effectiveness of BA for reducing depression among hospitalised inpatients in comparison with standard supportive treatments
Central assumptions of the BA approach
• A central assumption: Factors that contribute to the development and maintenance of depression reside in the environment, not within the person
• They are also related to the outcomes of the person’s actions
- Depression results from person-environment interactions
• Risk factors for depression: Contextual change = increase in situations that place an individual at greater risk for depression (life stressors; divorce, illness)
• BA for depression aims to increase activity, counteract avoidance behaviour and increase the individual’s access to positive reinforcers
- BA therapy is focused on the context of and associations with the content of the client’s thoughts
- Focused on where and when the thoughts occur, and the effects of the thoughts on the client’s feelings and behaviours
BA approach to therapy for depression
- Primary goal of BA: facilitate engagement in activities or entry into contexts that are reinforcing, mood enhancing, or congruent with an individuals’ long term goals or values
- Duration: +/- 16-24 weeks
Components of BA therapy
Phase 1
Phase 1: Self-Monitoring Activities and Mood and the associations between the two:
- Activities directly influence thoughts and feelings
- Behavioural patterns associated with depressed mood are precursors to changing those patterns
- Comparing positive and negative current life events
- Comparing depressed and nondepressed occasions – Activity monitoring form
1. Describing one’s activities and associated in detail, on an hour-to-hour basis each day for at least 1 week
o Helps reveal the client’s current level of activity, connections between activity level and mood and level of engagement in avoidance behaviours
2. Look for patterns
o Revelation of depression loops
Components of BA therapy
Phase 2
Phase 2: Using problem solving and behavioural experimentation to identify activities associated with positive mood
- After identifying activities associated with depressed mood-> problem solving by coming up with enjoyable alternative activities associated with positive mood
1. Brain storm: writing down whatever possible alternatives come to mind
2. Evaluate: evaluating the possibility of the activities - Narrowing the list
- Interrupting depression loops might lessen the likelihood of deepening one’s depression further, and create the opportunity to experiment with alternative coping behaviours
- The goal of changing an activity is to make several contextual changes or shifts in a gradual and systematic fashion and make sustained/modest steps in a valued direction
Components of BA therapy
Phase 3
Phase 3: Blocking avoidance and facilitation approach behavior
Avoidance precludes the opportunity to actively address or solve life problems related to emotional distress or depression
1. Conceptualise avoidance patterns TRAP T Trigger R Response A Avoidance P Pattern -It is important to examine the function of avoidance and escape behaviours, in order to evaluate whether such a behaviour is adaptive or maladaptive
- After identifying TRAP, helping the client get back of TRAC
T Trigger
R Response
A Alternative (Active response -> Accepting the emotional reaction
C Coping and other response, while continuing to act in accordance to one’s goals) - Overall process of identifying and overcoming avoidance coping= ACTION
A Assess behaviour and mood
C Choose alternative behaviours
T Try the selected alternative behaviours
I Integrate the alternative behaviour into a regular routine
O Observe the outcome of behaviour
N Never give up
• Graded task assignment: strategy for taking small significant steps towards a goal or overcoming avoidance patterns by approaching avoided activities in small units (it is important to encourage the client to make changes one step at the time)
• During BA therapy the mental rehearsal is central
- The therapist encourages the client to imagine and mentally rehearse activities he/she will perform, including the setting and the actual behaviours
• Subjective Units of Distress (SUDS) rating
- While the client is imagining certain activities, he/ she sould be asked to rate the level of distress the client experiences on a scale from 0-100
• Countering mood-dependent behaviours as a strategy for blocking avoidance
- Go forward and participate in valued activities despite presence of a negative mood, to learn that it’s possible to behave independently of acute moods and that it could even result in a mood change
• Acting ‘as if’ -> Another strategy for countering mood dependent behaviour patterns: Acting as if the obstacles blocking actions are not present
By intentionally acting differently wen feeling blocked by negative moods one might learn that gaols are obtained regardless of emotional states and thoughts and that pursuing valued goals often change mood and thinking in desirable directions
Components of BA therapy
Phase 4
Phase 4: Decreasing vulnerability to future episodes of depression
Reducing relapse
- Skills generalisation: Encourage clients to apply principles of BA to other areas of their lives
- Reducing vulnerability for a depressed mood: By identifying life circumstances ect that increase clients’ vulnerability for future episodes of depression -> Reduce the influence of the past
- Establish regular routines: Regular routines provide a regulation function and (through positive reinforcement) keep individuals in regular contact with events that maintain behaviour
Ch6
Behavioral Activation
- One of the most important initial goals for depressed patients is scheduling activities
- Most have withdrawn from at least some activities that had previously given them a sense of achievement or pleasure
- And they frequently have increased certain behaviors (staying in bed, watching tv, sitting around) that maintain or increase their current dysphoria
- They often believe that they cannot change how they feel emotionally
- . Helping them to become more active and to give themselves credit for their efforts are essential parts of treatment, not only to improve their mood, but also to strengthen their sense of self-efficacy by demonstrating to themselves that they can take more control of their mood than they had previously believed.
- When considering engaging in activities, patients’ depressed automatic thoughts frequently get in their way.
- Patients’ relative inactivity then contributes to their low mood, as they have a lack of opportunities to gain a sense of mastery or pleasure, which leads to more negative thinking, which leads to increased dysphoria and inactivity, in a vicious cycle
- When scheduling activities it is important to anticipate automatic thoughts that could interfere with patients’ initiation of activities, as well as thoughts that could diminish patients’ sense of pleasure or achievement during an activity
Ch 6
Behavioral Activation Pt.2
• The easiest way to get patients behaviorally activated is to review their typical daily schedule. The following questions can guide you in this process:
o Which activities are patients too little of, thus depriving themselves of obtaining a sense of achievement (mastery) or pleasure?
o Do patients have a good balance of mastery and pleasure?
o Which activities are lowest in mastery and/or pleasure?
• On a certain point your patient has to draw conclusions about their own typical day.
o The most important thing is that the patient is committed to implement specific changes and identify automatic thoughts that might interfere.
o You can propose behavioral experiments to test the validity of your patient’s negative predictions.
o The patient has to give himself credit whenever he is doing something active.
• After make an activity chart
o This is a day and week schedule where you can schedule activities from hour to hour
o Make it very specific
o Also make activities small esp for severe depressed patients
Lec
Depression: cognitions and behaviour
Cognitive conceptualization of depression:
- Focus on content of thoughts (loss as the main theme)
- Self-critical thoughts
- Prediction of effectiveness of behaviour
Behavioural conceptualization of depression:
- Focus on behaviours
- Development and maintenance of depression lie in the environment
- A person’s actions
- Contextual changes (e.g. loss)
Lec
Behavioral aspect of depression
• Depression is regarded as an extinction phenomenon
• Lack of response contingent positive reinforcement (RCPR)
- Extinction of healthy behaviour
- Increase of depressed behaviour
• Excess of negative reinforcement
- Personal (e.g. self talk)
- Social (e.g. interaction)
