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5 Steps To Manage Depression Using Behavioral Activation: No Pills Required!

Updated: Jul 30, 2023



It’s no secret that our mood impacts our energy. When we are feeling depressed we become less active. The less active we are, the fewer opportunities there are for positive and rewarding things to happen to us. And the fewer rewarding things that happen to us, the lower our mood becomes.


It becomes a vicious cycle, which seems to reinforce upon itself over time. We dig deeper and deeper until we’re in the abyss feeling stuck and overwhelmed.


The relationship between what we do and how we feel


There is a close relationship between our activity and our mood. When we are feeling good, we are more social, want to do activities that energize us, and take on new tasks and adventures that challenge us as individuals.

Stress significantly affects energy. As stress tolerance diminishes, the less capacity we have to mobilize into action. It also impacts how we learn, remember things, and feel about ourselves.

There is also a positive feedback effect when we are active:

  • Doing things we enjoy gives us feelings of pleasure

  • Challenging ourselves means that we have a chance to grow and develop, and gives us a sense of mastery

  • Having positive relationships with other people makes us feel connected and valued


The reverse is also true. People who are depressed tend to do less overall and so they have fewer opportunities to feel pleasure, mastery, and connection – the things we need to feel good. It is easy to fall into a trap:


Resource: Elfrey MK, Ziegelstein RC. The "inactivity trap". Gen Hosp Psychiatry. 2009 Jul-Aug;31(4):303-5. doi: 10.1016/j.genhosppsych.2009.05.001. Epub 2009 Jun 9. PMID: 19555788; PMCID: PMC2752478.


What is Behavioral Activation?


Some people wait until something external improves their mood –a new relationship, a change in job, or moving. This might initially feel motivating and increase energy and improve our mood. However, this approach is passive and it can leave one feeling dependent on something or someone to “fix” us. Another problem with the passive approach is that you are likely to be waiting for a long time (“when I feel X, then Y…”)

But there's a better, more sustainable way.

A more proactive way of breaking the vicious cycle of depression is to increase our level of activity even if we don’t feel like it to begin with. This approach is called Behavioral Activation (BA) and it is a psychological treatment for depression with one of the biggest evidence bases to demonstrate how effective it is.


Several studies have demonstrated BA's efficacy for the treatment of depression dating back to the 1970's, including its consistent finding that among more severely depressed patients, behavioral activation was comparable to antidepressant medication.


Behavioral activation is about making your life meaningful and pleasurable again, it involves these steps:

  • Learning about the vicious cycle of inactivity > depression > inactivity and understanding that we need to activate ourselves to feel better again

  • Monitoring our daily activities to understand the relationships between our activity and our mood

  • Identifying our values and goals (working out what really matters to us)

  • Simple activation (scheduling and carrying out meaningful activities to boost our experiences of pleasure and mastery)

  • Problem-solving any barriers to activation


Essential steps to get you started with behavioral activation.


Step 1: Activity monitoring: recording what you do and how you feel

The first step in behavioral activation therapy (after understanding the cycle of inactivity and mood) is to monitor your activity and mood. This is called Activity Monitoring.

You can use an activity monitoring worksheet to record what you do each waking hour every day for a week. Here, you will record everything you do in a day, hour by hour, from the time you wake up until you go to bed. Our mood changes as we do different activities, so in addition to tracking the activity, you rate your mood for each time slot on a scale of 0 (very depressed) to 10 (very good). You don’t need any fancy journal or planner. You can do this on a blank piece of paper, or a note-taking app on your phone.





Step 2: Review your Activity Monitoring

Once you have monitored your activity for a week you can use your activity monitoring record to look for patterns between your activity and your mood. Look at your completed behavioral activation worksheet and ask yourself these questions:

  • What activities were associated with your highest mood? What were you doing when your mood was highest?

  • What activities were associated with your lowest mood? What were you doing when your mood was lowest?

  • What do you notice about the relationship between your mood and how active you were?

  • Were there any days when you didn’t leave the house? What was your mood like on those days?

  • What was your mood like on the days when you were most active?

Now make a list of activities which helped you to feel good, and which made you feel bad. You will use this list in one of the later steps.



Step 3: Understand your Values

Our values reflect what we find most important and meaningful in life. They are what you care about, deep down, and what you consider to be important. Everybody’s values are different, and they can change over time. They reflect how we want to engage with the world, with the people around us, and with ourselves. When our values are aligned with our behaviors, we are more likely to feel content, satisfied, and fulfilled.

Values are different from goals.

Goals are outcomes to be achieved, whereas values are more like a compass which navigates directions toward our goals. For example we might have the value of being a good parent which may require a lifetime’s effort, and the specific achievable goal of getting my children to school on time. Or we might have the goal of going to the gym while placing value upon our physical health.

Common Values include:

  • Family

  • Marriage/Partner/Intimate relationship

  • Parenting

  • Health/wellbeing

  • Friendships

  • Education/Personal Development

  • Career

  • Recreation/leisure

  • Spirituality

  • Citizenship/Environment/Community

Take a moment and think about each value listed. Which values are important to you? How successfully are you living your life in alignment with your values in the past month?

Value:_________________________________________________________________

Description of the value:_________________________________________________

_______________________________________________________________________

Importance (Rate 0-10):__________________________________________________

Success (Rate 0-10):_____________________________________________________


Step 4: Behavioral Activation

The next step of behavioral activation is to get active. This starts with planning ang literally Nike-ing it: “Just do it!”

I can’t tell you how many times I’ve had to talk myself into just showing up to class, the gym, the meeting, the event, and other activities I didn’t feel like doing. But, you know by now that it is important to increase your level of activity even if you don’t feel like it to begin with.

Behavioral activation is learning to kick-start your activity by planning it and sticking to the plan, regardless of how you think or feel in the moment. I sometimes imagine myself to be like a robot and put my thoughts and emotions on the shelf and just focus on the behavior (i.e., put gym clothes on, walk to my car, etc.).

Get a piece of paper and write down a selection of possible activities.

Good places to get some activation targets for your activity plan are:

  • Get activation targets from your activity monitoring worksheet: Which activities were best at improving your mood?

  • Get activation targets from your values assessment worksheet: Which values matter to you the most? What activities could you do that would be in line with your values? For example, if family is something you value perhaps you could plan to spend time with them doing something specific.

  • Make sure that you are doing the basics: Be sure to include targets like washing and brushing your teeth every day, doing laundry every week, cooking meals, shopping for food, and to include some activities that are social and which mean you will have contact with other people.

  • Use an activity menu: Use a list of activities that have helped you, or use activities that other people shared which you think might lift your mood.

Activities menu

  • Exercise

  • Think of 3 people you’re grateful for and text them

  • Meet a friend for coffee

  • Meal prep

  • Clean the house

  • Take a shower

  • Listen to a podcast you like

  • Do something nice for someone


Step 5: Activity hierarchy

Once you have written down a selection of possible activities it is time to create an activity hierarchy. Basically, do the hard things first. Get it out of the way!

To create your activity hierarchy, write a list of activities and rank them according to how difficult you think they will be to accomplish (0 = not at all difficult, 10 = very difficult).




Getting the hard things done early in the day has been a life hack. For example, I personally don’t always love cardio, so I do it first thing in the morning when my energy is highest. As the day goes on, cortisol will fluctuate as will motivation, making it more challenging to do it later. It’s also super rewarding to get to the middle of your day knowing that at least the toughest stuff is done deeZy!!

Tips for getting the most out of behavioral activation

  • Don’t start too hard: Life is a marathon, not a sprint. The new level of activity has to be more than your “motivation level” but it also has to be realistically achievable. Set yourself up for success, not failure.

  • Break activities down into smaller steps: Let’s say you had identified a value of becoming healthier, but have a daily habit of watching late night TV and comfort food to reward yourself at the end of a long day. Some tangible steps towards your value of being healthy might be to cancel that subscription to Netflix, and doing some activity planning or value assessing as outlined above.

  • Reward yourself: Make the effort to acknowledge when you have completed something, and don’t just rush on to the next target. What would a fair reward be if you completed all of your planned activities? Make sure your reward is reflective of your values, and reflects self care NOT self indulgence.

  • Remind yourself why you’re doing this: Thoughts like “I’ll do it when I feel better” are insidious and can keep us stuck. Remind yourself often that it’s important to get active even if you don’t feel like it and that behavioral activation is one of the most effective treatments for combatting depression, anxiety, and worry.

  • Get support. Find your tribe of like minded people. If you don't have anyone, talk to a therapist, listen to motivating podcasts, and read material to help you stay consistent.

I’m all about skills not pills, when possible. And if the research is saying this works, why not try it? Try these strategies out and let me know how it works for you. Let me know your thoughts and comments. I love hearing from you!



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