®How does the cycle work?
- Your mood drops; tiredness and lack of motivation set in.
- You do less; you pull back from friends, hobbies and tasks.
- The sense of enjoyment and achievement fades; put-off tasks pile up.
- You feel worse, and the cycle starts again.
Behavioural activation breaks the cycle at the second step: without waiting for motivation to arrive, you get moving again with small, planned steps. Motivation often comes after action.
Let’s do it together
Build your week in small steps
1. Choose a step
Try to choose steps of all three kinds. Keep each step small enough to do today.
2. When?
Choose one or more days. At first, 3–5 steps a week is enough; don’t overfill the plan.
3. My plan for this week
When you have done a step, tap “Done” and rate your mood before and after.
4. What did you good?
Your plan and ratings are stored only on this device and are not sent anywhere.
How to use it
Three kinds of step
Routine tasks make life easier (washing, cooking), necessary tasks grow the longer they are put off (paying a bill), and enjoyable activities bring connection and enjoyment. Choose from all three.
Make it smaller
Wash five plates, not the whole kitchen; read five pages, not a chapter. Aim for time rather than amount: 10 minutes is enough.
What, when, where, with whom
Be specific, for example “Wipe the worktops in the kitchen at 7 pm, on my own”. Don’t overfill the plan in the first weeks.
Rate before and after
Rating your mood before and after each step shows you which activities do you good. Review your plan once a week.
What did the research find?
In a meta-analysis covering 26 studies and 1,524 people, behavioural activation reduced symptoms of depression markedly compared with control groups. Most studies were of low quality and follow-up periods were short.
- In the COBRA trial of 440 adults with depression in the UK, behavioural activation delivered by mental health workers after five days of training was as effective as cognitive behavioural therapy delivered by therapists.
- At 12 months, the depression score fell from 17.7 to 8.4 in the behavioural activation group and from 17.4 to 8.4 in the cognitive behavioural therapy group.
- Behavioural activation cost about 21% less.
- The UK depression guideline lists individual behavioural activation among the treatment options.
Frequently asked questions
I really don’t feel like it; should I still do it?
Yes, with a small step. When mood is low, motivation usually comes after you get going, not before. Whatever you feel, make the step as small as you can and do it; even 5 minutes counts.
What if I can’t do what I planned?
You lose nothing. Move the step to another day or make it even smaller. Rather than blaming yourself, try to notice what got in the way.
Can this replace treatment?
Behavioural activation is an effective therapy for depression and is usually carried out with a professional. This planner can help you get started on your own; but if your symptoms are marked or are affecting your daily life, see a doctor or a mental health professional.
Where is my data stored?
Only on this device, in your browser. It is not sent anywhere. You can delete it at any time with the button at the bottom of the planner.
Make movement one of your steps: Exercise for mental health. To track your mood every two weeks, see Check your mood; for a difficult day, the DOST break.
When should you seek help?
- If you have thoughts of harming yourself or ending your life, call 112 or go to the nearest emergency department straight away.
- If you have had weeks of unhappiness, hopelessness, loss of interest in things you used to enjoy, or changes in sleep or appetite, see a doctor or a mental health professional.
- If you cannot manage even the smallest steps, that is a sign you need support; don’t struggle alone.
Sources
- Ekers D, Webster L, Van Straten A, Cuijpers P, Richards D, Gilbody S. Behavioural activation for depression; an update of meta-analysis of effectiveness and sub group analysis. PLoS One. 2014;9(6):e100100.
- Richards DA, Ekers D, McMillan D, et al. Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial. Lancet. 2016;388(10047):871–880. Summary: NIHR Evidence, Simpler, cheaper therapy – behavioural activation – can be as good as CBT for treating depression, 5 October 2016.
- National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222). 2022.
- East London NHS Foundation Trust. Behavioural activation.
- Healthy WA (Government of Western Australia). Behavioural activation: fun and achievement.