Feeling Depressed? Listen to your inner voice

Of the 7.5 billion world, a staggering 350 million people suffer from depression, which by all counts is an alarming figure. Many who are depressed may not even know it. While the impact of depression touches every aspect of someone’s life, both the individual and his or her near family may often miss the clues. There are many practices and techniques that are used to treat depression, and today I want to introduce you to ‘Behavioral Activation,’ a relatively new but effective practice to treat depression.

To understand Behavioral Activation, first let us understand what depression is, through this self-explanatory video, “I had a black dog, his name was depression“:

There is one more very useful video from WHO, “Living with a black dog”, that helpfully explains depression for caregivers:

 Definition of Behavioral Activation:

According to Wikipedia “Behavioral activation (BA) is a third generation behavior therapy for treating depression. It is one of many functional analytic psychotherapies which are based on a Skinnerian psychological model of behavior change, generally referred to as applied behavior analysis.”

In Behavioural Activation for depression, Dr. David Veale (Consultant Psychiatrist in Cognitive Behaviour Therapy, London, UK) explains:

A formal therapy for depression, behavioral activation focuses on activity scheduling to encourage patients to approach activities that they are avoiding and on analyzing the function of cognitive processes (e.g. rumination) that serve as a form of avoidance. Patients are thus refocused on their goals and valued directions in life. The main advantage of behavioral activation over traditional cognitive–behavioural therapy for depression is that it may be easier to train staff in it and it can be used in both in-patient and out-patient settings. This article describes the theory and rationale of behavioral activation, its evidence base and how to develop a formulation that guides the strategy

When people feel symptoms of depression, they often feel detached from the activities they once loved, which often include many of their routine activities as well. The prolonged consequences are disengagement from work, family, and other activities. We can simply call it negative behavior. Behavioral Activation comes to rescue as it tends to help the patient recognize the activities he loves/relishes and then assist in creating a pathway to reinforce the mind to engage in those activities again. Behavioural Activation can help you to value yourself again and helps you to focus on your positive behavior.

To get hold of your life, the first step would be to know about both your negative and positive thoughts. Depression destroys a person’s enthusiasm, so it is imperative to bring that passion, that zeal for life, back into your life.

 Identify positive & negative behavior:

• What do you feel: anger, sadness, and anxiety?

• Make a list of activities that you did before you started feeling depressed.

• Rate those pleasure activities on a scale of 1-10 (10 being the highest rating).

• Write down in a journal when was the last time you did those activities.


Now is the time to challenge the avoidance, withdrawal, and inactivity that you are facing.

• Pick your top five pleasure activities from the list. It can be knitting, spending time with your spouse, or even reading a newspaper.

• Keep in mind that these activities should be easy and should give you a sense of accomplishment.

• The outcomes should be achievable to give you motivation.

• Look for social support. It can be your friends or family.

• Make a daily/weekly/hourly schedule which gives you a timeframe to do these motivational exercises. If you find yourself mildly depressed, a daily or weekly schedule can work for you, but if you are feeling severely depressed, you should approach a medical practitioner as he may give you an hourly schedule to work on.

 Action & Rehearsal:

• No one can help you until you decide to help yourself. You have to push your boundaries to get out of depression.

• Check the journal every day/week and see if you were able to accomplish the activities you listed.

• If you have achieved those activities, reward yourself so that you feel good about it. If not achieved, try to access the reason for non-performance. Is it because of lack of motivation or the task seems daunting to you?

• Modify the schedule for the coming week based on past accomplishments.

• You can keep increasing the level of a particular activity when its previous level is achieved.

• Ask yourself if you become as tired as you expected.

• Did the activities help you in making your mood better: why/why not?

• Keep trying and don’t lose hope: Depression didn’t settle in a day so it can’t be eradicated in a day. You will need to build your patience and value yourself so as to revive your zest.

 Effectiveness of Behavioural Activation:

According to one study which assessed the effectiveness of Behavioural Activity (BA) in comparison to Cognitive Behavioural Therapy (CBT), BA was found to be as effective as CBT. This study was undertaken by eighteen researchers in the UK
Out of the total patients chosen for the trial, half of the patients were allocated to BA and the other half to CBT. The results of the treatment were similar, meaning both BA patients and CBT patients felt that the same amount of satisfaction with the outcome of their therapy. This study has opened new avenues for people suffering from depression as it also takes into effect the cost of delivering these therapeutic techniques. While CBT is a costly therapy that requires a specialized practitioner, BA is much more economical, with a trained nurse being able to provide the therapy to the patient. This will help in widening the reach of therapeutic help for patients in every part of the world.

Behavioural therapy is effective, but not everyone receives the benefits in the same way. If you are still feeling symptoms of depression, you should get in touch with a professional psychotherapist or psychiatrist before it is too late.

Behavioural Activation is certainly worth a try, having been shown to be effective in many people. However, if you still feel the void in your life, it is the time to seek professional help.