Behavioural
Activation
Patient
booklet
1
This workbook has been designed to be used as an aide to your work with your therapist. You and your therapist
Contents
will use your sessions to discuss and work through some of the tasks, however some of the tasks will need to be
completed between your sessions.
Page 3- 5
Understanding your problem
Your vicious cycle
Goal setting
Filling in a diary of your general week.
Page 6-8
How does behavioural activation work?
Behavioural Activation worksheet 1
Behavioural Activation worksheet 2
Page 9-13
Useful tips to remember
Diary week 1
Diary week 2
Diary week 3
Diary week 4
Page 14
Looking to the future
2
Understanding your problem is central to being your own therapist. When
you understand your problem, then you can work on it. Anxiety and
depression have three different but related parts:
thoughts;
physical symptoms; and
Behaviour.
Below is an example of a vicious cycle of depressed or anxious:
Autonomic (Physical
Symptoms)
tiredness;
palpitations (heart beating
fast);
butterflies in the stomach;
difficulty sleeping;
poor concentration;
restlessness; and
tearfulness.
Behaviours
Cognitive
have difficulty in motivating
yourself;
I am a failure;
feel everything is an effort;
I am weak;
avoid things;
everything I do goes wrong;
withdraw from friends and
I am a hopeless mother; and
family; and
I cannot cope with this.
not enjoy activities you usually
find pleasant.
Thoughts, physical symptoms and behaviour are all linked and affect one
another. Having physical symptoms of anxiety and depression is likely to
lead to changes in your behaviour or unhelpful thoughts. In the same way,
anxiety and depression will lead to changes in your behaviour, which will
affect your physical symptoms and lead to more unhelpful thoughts.
These unhelpful thoughts will lead to changes in behaviour and physical
symptoms.
3
Your cycle: Here you can fill in your own vicious cycle:
Autonomic (Physical Symptoms)
Behaviours Cognitive
4
Goal setting
What would you like to achieve by the end of your sessions?
1
2
5
Baseline diary
Filling in this diary helps you to recognise what you are doing or not doing.
You need to fill this in making no changes to your activities.
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Morning
Afternoon
Evening
6
How does behavioural activation work?
When people are depressed they feel physically unwell, have negative
thoughts and change the way they behave. People who are depressed
reduce the frequency and type of their usual behaviours. They commonly
stop going out with others, reduce interactions with friends, work
colleagues and family, and make little effort to do things they may have
previously enjoyed. By avoiding effort, people experience relief from
burdensome activity, which leads to more avoiding of effort. Avoidance is,
therefore, negatively reinforced, i.e. the frequency of avoidance
increases.
As people avoid, they also reduce their opportunity for social and personal
activities which bring them pleasure and achievement. They experience
less positive reinforcement for these activities and thus these
activities reduce further. Depression is, therefore, a vicious circle of
negatively reinforced avoidance and reduced opportunity for positive
reinforcement. Both these forces lead to reductions in usual activity for
people who are depressed.
1. Some of the things people avoid
are just routine activities such
as cleaning the house, doing
the ironing, washing up. Other
routines are disrupted such as
the time they go to bed or get
up, when they eat and how they
cook for themselves. These are
the important life routines that make people comfortable in their
surroundings.
2. Other activities that get disrupted are things people do for pleasure
such as seeing friends, enjoying a day out with families or playing
games with children. These are the things that often make people
feel well.
3. A third area where people avoid activities is in important necessary
things such as paying bills or confronting difficult situations at work.
These are activities which are important and if neglected may lead
to an adverse consequence.
The stages of behavioural activation
Identifying routine, pleasurable and necessary activities
Making a hierarchy of routine, pleasurable and necessary activities
Planning some routine, pleasurable and necessary activities
7
Implementing behavioural activation exercises
Reviewing progress
Behavioural Activation worksheet 1
List some routine activities here: e.g. washing up, cleaning the house.
List some pleasurable activities here e.g. going out with friends, going
to the cinema
List some necessary activities: e.g. paying bills, dealing with difficult
situations.
8
Behavioural Activation worksheet 2
Put your list in order of difficulty, mixing up the different routine,
pleasurable and necessary activities.
The most
difficult
Medium
difficulty
The easiest
Useful tips to remember when filling in the following
diaries
9
Do what is important to you.
Make sure you vary your
activities each week. You
need to add routine,
pleasurable and necessary
activities.
It’s important to follow your
diary rather than how you
feel on the day.
If practically you can’t carry
out an activity you have
planned, refer back to your list
of activities and pick another.
Plan time in for yourself to do something you enjoy
Take Things Slowly- It is important to set reasonable goals and take
things slowly. Start off with just a few activities and from there, slowly
build up the number of activities you engage in each week. Even
engaging in a small amount of activities can have a big impact on your
mood. Just going for a 5 minute walk can help
Rating your mood after each day
You can rate your mood in 2 ways:
Using a scale from 0-10 (0 being the lowest and 10 feeling good)
Write briefly in each box:
What you did (brief description), one word that describes your Mood,
and rate the intensity of your mood on a scale of 0 – 100%,
- Your sense of Achievement for the activity on a scale of 0-10 (A0 – 10)
- Your sense of Closeness to others (C0 – 10)
- And your sense of Enjoyment (E 0-10).
10
Diary Week 1
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Morning
Afternoon
Evening
Rate your
mood after
each day
11
Diary Week 2
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Morning
Afternoon
Evening
Rate your
mood after
each day
12
Diary Week 3
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Morning
Afternoon
Evening
Rate your
mood after
each day
13
Dairy week 4
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Morning
Afternoon
Evening
Rate your
mood after
each day
14
This workbook has given you a tool box, and shown you how to use those
tools. Now you need to go away and use them!
Eventually, you will be able to use the tools almost automatically, but this
will take repeated practice.
Look back through the work you have completed and consider the
following questions:
Questions Responses
What have I learnt from the
sessions?
What was most useful?
What can I continue to do to avoid
a setback?
What are my high risk situations?
What are my signs that a setback
might happen/ be happening?
What can I do to feel more in
control?
What could I do if I felt out of
control?
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