DEPRESSION

Group Members
Petreamma mene 25
Bhakti panchmia 29
Raakkhi pohuja 32

Definition
According to APA, Depression is extreme sadness or despair that lasts more than days. It
interferes with the activities of daily life and can cause physical symptoms such as pain,
weight loss or gain, sleeping pattern disruptions, or lack of energy.
Depression (major depressive disorder) is a common and serious medical illness that
negatively affects how you feel, the way you think and how you act. Fortunately, it is also
treatable. Depression causes feelings of sadness and/or a loss of interest in activities you once
enjoyed. It can lead to a variety of emotional and physical problems and can decrease your
ability to function at work and at home.

Various forms of depression

● Major Depressive Disorder (MDD): Also known as clinical depression, this is one
of the most common and severe forms of depression. It involves persistent feelings of
sadness, hopelessness, and a loss of interest or pleasure in activities that were once
enjoyable. MDD can significantly interfere with a person's ability to function in daily
life.

● Persistent Depressive Disorder (PDD): Formerly known as dysthymia, PDD is a

milder but more chronic form of depression. Individuals with PDD experience
depressive symptoms that are less severe than MDD but last for an extended period,
typically two years or more. It may lead to persistent feelings of inadequacy and low
self-esteem.

● Bipolar Disorder: This is characterised by episodes of depression alternating with

periods of mania or hypomania. During the depressive phase, the individual
experiences symptoms similar to those of MDD. However, during the manic or
hypomanic phase, they may feel excessively energetic, impulsive, and experience an
inflated sense of self.

● Seasonal Affective Disorder (SAD): This form of depression is associated with

changes in seasons, typically occurring during the fall and winter months when there
is less natural sunlight. SAD can lead to feelings of fatigue, low energy, and increased
sleep, among other symptoms.

● Postpartum Depression (PPD): PPD is a type of depression that affects some

women after childbirth. Hormonal changes, sleep deprivation, and the challenges of

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 caring for a newborn can contribute to this condition. Symptoms may include mood
swings, anxiety, and difficulty bonding with the baby.

● Psychotic Depression: In this severe form of depression, individuals experience

symptoms of major depression along with psychotic features, such as hallucinations
or delusions.

● Atypical Depression: Atypical depression is characterised by symptoms that differ

from those of classic depression. Individuals with this form may experience increased
appetite, weight gain, excessive sleep, and a specific pattern of mood reactivity
(feeling better in response to positive events).

● Situational Depression: Also known as adjustment disorder with depressed mood,

situational depression is a short-term condition triggered by significant life changes or
stressors, such as the death of a loved one, divorce, or job loss.
● Premenstrual Dysphoric Disorder (PMDD): This is a severe form of premenstrual
syndrome (PMS) that can cause intense mood swings, irritability, and feelings of
hopelessness in the days leading up to menstruation.

Symptoms

● Persistent sad, anxious, or “empty” mood

● Feelings of hopelessness or pessimism
● Feelings of irritability, frustration, or restlessness
● Feelings of guilt, worthlessness, or helplessness
● Loss of interest or pleasure in hobbies and activities
● Decreased energy, fatigue, or feeling slowed down
● Difficulty concentrating, remembering, or making decisions
● Difficulty sleeping, waking early in the morning, or oversleeping
● Changes in appetite or unplanned weight changes
● Physical aches or pains, headaches, cramps, or digestive problems that do not have a
clear physical cause and do not go away with treatment
● Thoughts of death or suicide or suicide attempts

Depression can also involve other changes in mood or behaviour that include:
● Increased anger or irritability
● Feeling restless or on edge
● Becoming withdrawn, negative, or detached
● Increased engagement in high-risk activities
● Greater impulsivity
● Increased use of alcohol or drugs
● Isolating from family and friends
● Inability to meet the responsibilities of work and family or ignoring other important
roles

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 ● Problems with sexual desire and performance

CAUSES

Researchers don’t know the exact cause of depression. They think that several factors
contribute to its development, including:

● Brain chemistry: An imbalance of neurotransmitters, including serotonin and

dopamine, contributes to the development of depression.

● Genetics: If you have a first-degree relative (biological parent or sibling) with

depression, you’re about three times as likely to develop the condition as the general
population. However, you can have depression without a family history of it.

● Stressful life events: Difficult experiences, such as the death of a loved one, trauma,
divorce, isolation and lack of support, can trigger depression.

● Medical conditions: Chronic pain and chronic conditions like diabetes can lead to
depression.

Cognitive Behavioral Therapy:

Cognitive behavioral therapy (CBT) is a form of psychological treatment that has been
demonstrated to be effective for a range of problems including depression, anxiety
disorders, alcohol and drug use problems, marital problems, eating disorders, and
severe mental illness. It is a common type of talk therapy which is structured and goal
oriented. It focuses on understanding the client’s emotions,beliefs,thoughts and
behavioral patterns.

CBT,given by Aaron T Beck, is commonly used for treating mental illnesses along with
non-psychological conditions such as chronic pain, insomnia and emotional concerns or
challenges.

CBT is based on a few core principles

1. Psychological issues are partly based on problematic or unhelpful patterns of

thinking
2. Psychological issues are based on learned patterns of unhelpful behavior
3. People experiencing psychological issues can learn better ways of coping with
them and relieve symptoms, hereby improving mental and emotional concerns.

During CBT sessions, the psychotherapist helps the client to take a closer look at their
thoughts and emotions that make clients understand how their thoughts affect their

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actions. CBT helps to unlearn negative patterns of thought and behavior of the present,
while adopting healthy thinking patterns and habits for the future. CBT can prove to be
more helpful when combined with other therapies and medications (psychiatric or
other). The therapist customises a treatment plan based on the issue being addressed.

Following a set session structure helps to maximise efficient use of time during therapy
and also helps to make therapy sessions clearer to clients.

MENTAL ILLNESS improved through CBT-

● Depression
● Anxiety
● PTSD
● Eating disorders
● Sleep disorders
● Sexual disorders
● Schizophrenia
● Obsessive-Compulsive disorder (OCD)
● Bipolar disorder
● Substance use disorders

CBT may help an individual - (EMOTIONAL CHALLENGES)

● Manage symptoms of mental illness

● Prevent relpase of symptoms
● Cope with grief or loss
● Resolve relationship conflicts
● Overcome trauma caused due to abuse or violence
● Manage physical symptoms

COMPONENTS OF CBT-

1. Psychoeducation- It is the knowledge about anxiety and feared situations which

includes goal setting and self awareness of thoughts, feelings and behavior
2. Cognitive restructuring- It is to address maladaptive thinking and learning
coping skills and focused thinking
3. Somatic Management Techniques-(relaxation training)
● Deep breathing
● Progressive muscle relaxation (PMR)
● Guided imagery

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 4. Gradual Systematic Exposure to feared situations-
● In vivo (in the real situation)
● Imaginal (imagining the situation)
● Live modeling (demonstration of non fearful response)
5. Behavioral Activation-
● Increasing engagement in adaptive activities (things that increase pleasure or
mastery)
● Decrease engagement in activities that maintain or increase the risk for the
symptoms
6. Relapse prevention- booster sessions of CBT

AUTOMATIC THOUGHTS AND COGNITIVE DISTORTIONS-

Thoughts can often come automatically, and CBT challenges us to think more closely
about these thoughts. Some automatic thoughts are true, but many are either untrue
or have just a grain of truth. CBT requires patients to use a structured method to
evaluate their thinking. Otherwise, their responses to automatic thoughts can be
superficial and unconvincing and will fail to improve their mood or functioning.
Typical automatic thoughts (also called cognitive distortions) include:

1. Catastrophizing- Viewing a situation in only two categories instead of on a

continuum.
2. Labeling- You put a fixed, global label on yourself or others without considering
that the evidence might more reasonably lead to a less disastrous conclusion.
(eg- I am no good)
3. Overgeneralisation-You make a sweeping negative conclusion that goes far
beyond the current situation. (eg-Because I felt uncomfortable at the meeting ,I
don’t have what it takes to make friends
4. Disqualifying the positive- Unreasonably telling yourself that positive
experiences, deeds, or qualities do not count. (eg- I did that project well, but that
doesn’t mean I’m competent; I just got lucky.)
5. Magical thinking- Believing that the course of events in the world depends on
your actions and thoughts.

GOALS OF CBT-

The automatic negative thought is a concept in which patients experience a trigger and
enter the same negative thought pattern over and over again. Inevitably, this leads to
self-destructive behavior.

The 3 main goals of CBT-

1. Establishing Problem Solving Skills- Cognitive behavioral therapy centers on

establishing problem solving skills and showing patients how to cope with their

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 problems in a more positive manner. This does not mean relentless optimism or
saying everything is going to be okay. Cognitive behavioral therapy principles
promote healthy, objective thought processes. It is also not about ignoring problems;
it is about overcoming them in a way that builds up the person rather than delivering
them into the same self-destructive cycles.
2. Adjust Negative thinking- The core focus of cognitive behavioral therapy is changing
the negative thinking patterns patients have. Psychotherapists will work to understand
how a patient thinks when they are confronted with a stressful or triggering situation.
They will then seek to help the patient challenge those thought processes by
eliminating factual inconsistencies.
3. Getting to a daily routine- People who are considering entering a cognitive behavioral
therapy program are likely struggling to maintain a productive daily routine. Their
issues have likely reached the point where they can no longer function at their best on
a daily basis. This is especially the case when it comes to people who are suffering
from active addictions. The therapy focuses on giving patients the tools they need to
return to their daily routines. By changing their thoughts and self-destructive
behavior, using that person’s own natural capacity for change, they can reclaim a
normal life.

LIMITATIONS OF CBT-

Cognitive behavioral therapy does come with its limitations, however. This is a type of
talking therapy, therefore it requires the full cooperation of the patient. A therapist is only
there to help and advise. Patients should not undergo cognitive behavioral therapy unless they
are fully committed to the program. This is also a highly structured form of therapy. People
with more complex mental health needs or those with learning difficulties may find the
structured nature of the program to be unsuitable. These programs are intensive and it is
advised that the person finds the time necessary to go through the exercises given to them.
Lastly, CBT has a mechanistic approach and fails to address concerns of the client as a
“whole”.

INTERPERSONAL THERAPY
Interpersonal Psychotherapy provides an introduction to the theory, history, research, and
practice of this effective, empirically validated approach. Gerald L. Klerman and Myrna M.
Weissman initially created interpersonal psychotherapy (IPT) as a brief approach for treating
depression, but it has since been adapted for use with a wide variety of client presenting
problems and in longer-term situations.
Interpersonal therapy (IPT) is a short-term form of psychotherapy, usually 12 to 16 sessions,
that is used to treat depression and other conditions interpersonal relationships and social
interactions—including how much support you have from others and the impact these
relationships have on your mental health.When IPT was first developed, many mental health
professionals conceptualized depression as "person-based." That is, depression was not
considered to be based on a person's environment. IPT, on the other hand, recognizes that a
person's relationships can have a huge impact on mental health.

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Interpersonal therapy is also sometimes used in a modified form of couple's therapy, such as
when marital troubles are contributing to depression.
Types of Interpersonal Therapy

1) Dynamic Interpersonal Therapy

Dynamic interpersonal therapy (DIT) is also sometimes referred to as psychodynamic
interpersonal therapy or mentalization - based therapy. DIT is designed to help you better
understand your own thoughts and feelings, as well as the thoughts and feelings of others. It
generally consists of 16 sessions over the course of five months.

2) Metacognitive Interpersonal Therapy

Metacognitive interpersonal therapy (MIT) is an integrative approach to address personality
disorders with prominent emotional inhibition (holding back your emotions) or avoidance.
One 12-week study found that engaging in MIT helped reduce depression symptoms and
improve the ability to identify emotions.

Interpersonal Problem Areas: In IPT, the therapist selects one of four interpersonal problem
areas as the focus for treatment. The four IPT problem areas are:

Grief or Complicated Bereavement

Role Dispute
Role Transition
Interpersonal Deficits
Grief is chosen as a problem area when the onset or maintenance of the depressive episode is
associated with the death of a person close to the patient.

Role Dispute is chosen as a problem area when the onset or maintenance of the depressive
episode is associated with an unsatisfying interpersonal relationship characterized by non-
reciprocal role expectations between the two parties.

Role Transition is chosen as a problem area when the onset or maintenance of the depressive
episode is associated with difficulty coping with changes in current life circumstances. Role
transitions may occur in many domains including employment, relationship status, physical
health, living conditions, socioeconomic status, etc. The transition is conceptualized as
moving from one social role to another social role (i.e., from a student to an employee, from
military to civilian status, from single to married, etc.).

Interpersonal Deficits is chosen as a problem area when there is no clear acute interpersonal
event associated with the onset or maintenance of the depressive episode and the individual
describes a long standing history of impoverished or contentious interpersonal relationships.
Although many patients seeking IPT treatment have deficits in interpersonal functioning, the
interpersonal deficits category is reserved for cases where no other treatment focus is
apparent. Not surprisingly, patients with chronic impairment in social functioning who lack
the life events on which IPT focuses fare worse in IPT.

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Diagnosis-targeted: IPT has demonstrated efficacy as an acute and as a maintenance
treatment for major depression, and for patients from adolescence to old age; with adaptation,
as an adjunct to medication for bipolar disorder; for bulimia and binge-eating disorders; and,
with less research support, for posttraumatic stress disorder (PTSD) and anxiety disorders.

Benefits of Interpersonal Therapy

Interpersonal therapy can have a number of important benefits, including:

Improved relationships: IPT can help patients understand how their relationships affect their
life. The goal is two-fold: to help patients function better socially and to reduce their feelings
of depression.
Decreased depression: This form of psychotherapy is based on the notion that depression
occurs in the context of relationships. In other words, your relationships can potentially
increase or decrease your depression, and feeling depressed can impact your relationships. As
such, the goal of IPT is to relieve your depressive symptoms by improving the way you
interact with others.Unlike some of the other forms of psychotherapy for depression, IPT
does not attempt to delve into your inner conflicts resulting from past experiences. Rather, it
focuses primarily on your current relationships, how they may be impacting your depression
symptoms, and ways that you can improve your interactions for a healthier state of mind.
TECHNIQUES
Some of the techniques that are used in interpersonal therapy include:

● exploring your thoughts and feelings about yourself and your relationships
● Learning how to communicate effectively with others
● learning how to set boundaries in your relationships
● exploring your childhood experiences and how they have affected your current
relationships
● learning how to handle conflict in your relationships
● learning new skills for interacting with others
● practicing these skills in therapy sessions
● discussing your progress with the therapist on a regular basis.
Ultimately, the goal is to help you understand yourself and your relationships better. This
self-awareness can then be used to make positive changes in your life.

How IPT Therapy Work

A typical 12-16-week course of interpersonal psychotherapy consists of weekly, one-hour

sessions. The treatment plan may be extended for an additional four or more weeks,
depending on the severity of the depression.

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Interpersonal therapy consists of three stages: formulation, middle, and graduation.
Depending on the intensity of your symptoms and the level of interpersonal anxiety, each
phase can last three to five sessions.5

Formulation Phase
In the first stage, you evaluate your state of mind and current circumstances. The therapist
also learns about your history, sources of social support, and previous relationships. The
psychoeducational component of relating symptoms to situations and relationships is also
present.

Middle Phase
In the second stage, the therapist applies various treatment approaches when dealing with one
of the four categories of distress: grief, role dispute, role transition, and interpersonal deficit.
Every session normally starts with a question from the therapist regarding recent happenings
in your life. The attention then shifts to how things have changed, whether you’ve noticed
progress, and whether relationships have benefited. Your therapist will work with you to
pinpoint interpersonal difficulties if there hasn’t been any improvement or if symptoms have
worsened.

Graduation Phase
The focus on your increased confidence and sense of independence signals the conclusion of
interpersonal treatment. If there hasn’t been a change, the therapy—not you personally—is to
blame for the lack of improvement. If your symptoms do not go away throughout treatment,
this does not indicate a personal failure. A client will frequently change therapists and
develop a new treatment plan.

Interpersonal psychotherapy can be done online or in person. Although every therapist does
their first session differently, you can anticipate being asked questions about yourself and
discussing some of your stresses. You might also receive a structured questionnaire regarding
your symptoms. Your therapist will make a connection between a diagnosis and a recent
disturbing event in your life using an interpersonal psychotherapy approach. They will also
list your close relationships, social networks, and relationship-specific behavioral patterns.

The initial sessions – which usually last about three to four weeks – evaluate your depression,
familiarize you with the IPT protocols and procedures, and pinpoint any interpersonal issues
or problems you’re experiencing. With the therapist, you will list your interpersonal
problems, rate them, and choose one or two that seem to be the most pressing regarding your
negative emotions.

The following sessions are devoted to dealing with those problems, learning more about
them, looking for changes you can make, and then applying those changes. The therapist’s
job during interpersonal therapy sessions is to be realistic and refrain from being overly
instructive or reactive. Instead, therapists actively use various psychotherapy techniques, such
as direction, teaching, reassurance, and behavioral strategies.

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Interpersonal psychotherapy techniques could include the following:

Clarification
Assists you in recognizing and overcoming your biases when it comes to comprehending and
explaining your interpersonal problems
Supportive listening
Role-playing
Communication analysis
Encouragement of effect
A procedure that enables you to feel uncomfortable or undesirable sentiments and emotions
related to your interpersonal problems in a secure therapeutic setting. Doing so simplifies
accepting such sensations and feelings as a natural part of your life experiences.

What Are Its Limitations?

Like all therapies, interpersonal therapy has some limitations. These include:

The length of therapy may be too short for some people. This is because the therapist will
want to see if there is improvement after a few sessions. If there is no improvement, they may
recommend that you try another therapy.
It may not be suitable for people who are in a very bad place mentally or emotionally. This is
because the therapist will need you to be able to talk about your thoughts and feelings.
Some people find it difficult to open up about their personal lives. If this is the case, you may
find it hard to get anything out of therapy.
It may not be suitable for people who have been through traumatic experiences. This is
because IPT can involve talking about these experiences, which can be difficult for some
people.
It may not be suitable for people who have very serious mental health conditions such as
schizophrenia or psychosis. This is because the therapist will need you to be able to talk
about your thoughts and feelings.

Conclusion
Interpersonal therapy is a type of therapy that can be used to treat mental disorders and
improve areas of life that are beneficial for our overall mental and emotional well-being. It
has been found to be helpful in preventing relapse and is suitable for people who are able to
talk about their thoughts and feelings. Ultimately, interpersonal therapy can be an effective
way to improve your mental health and wellbeing. So if you think it could be helpful for you,
don’t hesitate to reach out to a therapist today..

Behavioural Activation Therapy (Petreamma Mene 25)

Behavioral Activation Therapy is structured therapeutic approach that aims to

(a) increase engagement in adaptive activities.

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 (b) decrease engagement in activities that maintain depression or increase risk for
depression.
(c) solve problems that limit access to reward or that maintain or increase aversive
control
(Dimidjian et al., 2011).

It is an evidence based approach therapy used to treat depression. Behavioural

activation (BA) is a specific CBT skill but also used as a whole therapy approach or can also
be used alongside other CBT skills such as cognitive restructuring.BA helps to understand
how behaviours influence emotions, ust like cognitive work helps us understand the
connection between thoughts and emotions. It focuses on helping individuals to alleviate
depressive symptoms by engaging them in positive and rewarding activities which often are
those associated with the experience of pleasure or mastery.

ORIGIN
Cognitive-Behavioral Therapy (CBT): CBT, which integrated cognitive and
behavioural approaches, gained prominence in the 1970s. CBT recognized the
interaction between thoughts, emotions, and behaviours, and aimed to modify
dysfunctional thought patterns and behaviours. This approach influenced the
development of BAT by incorporating cognitive elements while maintaining a focus
on behaviour change.

Peter Lewinsohn: The specific concept of Behavioral Activation Therapy is often

associated with the work of Peter Lewinsohn, an American psychologist. In the
1970s, Lewinsohn developed a behavioural approach to treating depression. He
proposed that depression was linked to a reduction in positive reinforcement due to
decreased engagement in pleasurable activities. His research and clinical work
emphasised the importance of increasing activity levels and reintroducing enjoyable
experiences to alleviate depressive symptoms.

Jacobson and Martell: In the 1980s and 1990s, Michael E. Addis, Christopher R.
Martell, and Neil S. Jacobson expanded upon Lewinsohn's ideas and developed a
more structured and manualized approach to Behavioral Activation Therapy for
depression. Their work contributed to the development of BAT as a distinct
therapeutic intervention within the broader context of cognitive-behavioural
approaches.

Objectives:

• To understand the important clinical components and applications of behavioural

activation strategies in brief CBT

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 . • To learn skills and techniques to effectively use behavioural strategies for positive
patient change (especially related to increasing pleasant events)

why is it important?

Behavioral activation includes a set of procedures and techniques aimed at increasing

patient activity and access to reinforcing situations that improve mood and
functioning. Behavioral activation amounts to the "B" in CBT interventions. From
this behavioral standpoint, depression, for example, contains a host of characteristics
that function to maintain depressive affect (e.g., passivity, fatigue, feelings of
hopelessness) and decrease chances of adaptive coping by increasing avoidance. The
key here is that difficulty with mood often serves to increase avoidance of adaptive
coping, including pleasant events, which help to alleviate and avoid depression.
Reintroducing pleasant events (one form of behavioral activation) can serve to
improve mood in many different ways -
1) reversing avoidance,
2) increasing physical activity,
3) increasing self-confidence and
4) increasing feelings of usefulness and purpose.

Recent empirical evidence suggests that behavioral interventions improve mood

symptoms but also reduce maladaptive thought patterns (Jacobson et al., 1996).

An important point for therapists:

Behavioral activation (alternatively referred to as increasing pleasant activities)

consists of a host of possible behaviors including, but not limited to,
1. Re-introducing prior pleasant activities
2. Introducing new pleasant activities
3. Active coping (e.g., taking some form of behavioral action) to alleviate or reduce a
life stressor; examples of active/behavioural coping that are not pleasant-event driven
include
• Filing or getting taxes done
• Cleaning out a messy closet
• Calling an estranged family member The goal of active coping is to decrease stress
through accomplishment or overcoming avoidance.

When? (Indications/Contraindications)
Because of its relatively simple and straightforward approach, behavioral activation
is a good technique for initial stages of treatment and can be highly effective for
patients with limited insight into their difficulties. Activation is also easily measured
(e.g., number, frequency, or duration of activities) and therefore can be used to
document and convey progress to patients (e.g., to increase treatment investment and
improve patient self confidence and control over symptoms). Behavioral interventions

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 are particularly powerful for depressed mood. Activation for depression generally
serves to get the patient moving. Almost all behaviors that include physical activity,
planning, or accomplishing tasks are appropriate here. The use of behavioral
activation for anxiety conditions requires a little more detail. Patients with anxiety
symptoms often avoid situations out of fear of negative consequence occurring in
response to engaging in a particular activity. Although behavioral activation can aid
these patients, you must also understand that the activity itself is not reinforcing
(pleasant) but rather feared. It is only the resulting completion of the task that may
generate positive affect (e.g., I faced my fear, and nothing terrible happened). This
response differs from depression in that depressed patients will often look at
behavioral activation as a positive outcome in and of itself (e.g., "exercising is
enjoyable" or "I love talking with my grand-daughter"). To effectively apply
behavioral activation with anxious patients, it is important to monitor anxiety and
combine behavioral activation with relaxation techniques to increase patient comfort
and control. Similarly, be careful not to allow behavioral activation procedures to
further aid in the patient’s avoidance of fearful situations (e.g., presenting problem is
avoiding interpersonal difficulties with spouse, and patient chooses to shop or be on
the internet for pleasure but specifically when spouse is in the house to avoid
confrontation/talking about issues).

How? (Instructions/Handouts)

Step #1: Provide patient with rationale for behavioral activation. It is important to
educate the patient as to what behavioral activation is and how it can be useful for
improving depression and anxiety. Let him/her know that when feeling a little down
or having a bad day and not feeling well physically can make it more likely that he or
she will stop doing many activities that used to be pleasurable. When this happens, the
patient can get into the habit of avoiding pleasant activities that might actually help
him/her feel better. It is also important for the patient to understand the connection
between what he or she does and how he/she feels, both mentally and physically. You
are encouraged to explain to the patient that increasing activity and/or taking action,
even when we do not feel like it, help one to feel better physically, as well as decrease
depression

Therapist: I would like to talk a little about what your day looked like yesterday. Walk me
through your day (e.g., what did you do in the morning, afternoon, evening)

Patient: Well, in the morning I woke up at 10 am and ate breakfast. I watched TV until noon.
Then I ate lunch. Around 2:30 I took a shower. At 3:00 I went for a walk with my dog.

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 Therapist: Okay, thanks. How did you feel in the morning? Patient: Tired. I just couldn't get
motivated and did not want to do anything. I guess I was feeling sorry for myself – depressed,
I guess.

Therapist: You say you were feeling depressed. If you had to rate that feeling on a scale of 0
to 100 (100 is the worst depression) what would you say your depression was?

Patient: 65.

Therapist: What about in the afternoon after your shower and walk? How would you rate
your depression?

Patient: 20.

Therapist: To what do you attribute this change in your depression?

Patient: I guess I just got off my couch and started moving which helped me feel better.

Therapist: That would be my guess as well. (subsequently, explain the connections between
mood and behaviour and encourage use of behavioural activation)

The figure below visually describes the connection between mood and behaviour and
can be an effective aid in communicating with patients. To maximise the utility of the
figure, you are encouraged to use the patient's own examples. For example, you and the
patient can work together to complete a daily activity log.

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 If depressed persons increase their activities on a daily basis, it improves mood
and decreases symptoms of depression.

Step #2: Identifying Behaviors -

Discussing Activities. Identification of potential activities begins by exploring with

the patient activities that would be most meaningful. Have a general discussion of
types of things he/she would like to do but have not been able to do and activities
he/she already does but would like to do more often within the context of values or
goals that are important to him/her. You might want to ask if there is something that
he or she needs to do that he/she has been unable to do or has been avoiding. Some
patients may want to accomplish something rather than focus on doing something
pleasant.
Possible questions might include:
• "Can you think of any activities or hobbies that you used to enjoy doing but have
now stopped doing?"
• "Can you think of any activities or hobbies that you would like to do but have never
done?
• "Are there things in your life that you would like to change? If so, what would you
like to do about these issues that you have previously not done?"
For patients who have difficulty identifying activities, you can introduce a behavioral
activity checklist (see Appendix). Before completing the next steps (e.g., setting a
plan), it is important to discuss the potential importance of the behavior with the

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 patient. If he/she reports low importance, encourage the patient to find another, more
meaningful activity

Step #3: Setting an Action Plan. Once the patient has identified a meaningful
activity to focus on, help shape this work into a meaningful therapeutic goal. Action
plans are one mechanism of creating meaningful behavioral goals for therapy. Action
plans in their most basic form stipulate the specific goal to be obtained, defined in
terms of observable and measurable characteristics and a timeframe for monitoring
progress.
Example: Goal: To read at least three times per week (a minimum of 30 minutes per
reading session). Timeframe: Patient will complete three reading sessions over the
next week.

An expanded action plan might also include:

a) Additional details of the plan – e.g., how the goal will be obtained
b) Possible barriers to reaching the goal and ways to address barriers if they arise
c) Possible facilitators of obtaining the goal, e.g., important people or situations that
might aid the patient
d) Patient's confidence in reaching the goal in the timeline established; if confidence
is low, you might wish to alter the plan to increase chances of success.
e) Skills that the patient might want to enlist to help reach the goal (e.g., relaxation
skills, problem-solving skills, etc.)

Step #4: Monitor progress in mood, mastery, and confidence

It is important to monitor the patient's mood and feelings of mastery and confidence.
Outcomes such as improvement in mood, mastery, or confidence can be best
identified through patient homework assignments that ask the patient to document the
frequency and use of the behavioral activity and any corresponding emotions or
feelings of mastery or confidence. On the basis of this monitoring of outcomes,
evaluate the action plan and the patient's ability to work towards achieving goals. If
problems arise, make changes accordingly (e.g., breaking down goals into smaller
steps, determining patient perceptions of importance and changing goals accordingly).
Monitoring shows the patient that you continue to believe in the importance of the
technique/exercise and also serves to further motivate many patients by increasing the
effectiveness of the intervention.

Tips for Managing Barriers to Doing Activities

1) Help the patient break down more difficult activities into smaller steps. Look for
alternative behaviors to accomplish a goal prohibited by a chronic illness or other
physical limitations. For example, a structural/mechanical engineer who was forced to
retire because of a physical limitation may feel that his/her life is no longer
productive. Although the patient is physically unable to fulfill prior job duties, you

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 can work with him/her to identify meaningful activities related to the prior
occupation. In this case, the patient might benefit from volunteering at a university,
providing consultation (e.g., over email or telephone calls), or volunteering for a local
school, youth or church organization (e.g., talking about engineering).
2) It is also helpful and supportive to look for ways that others can help. Family or
other social networks that the patient has not yet fully engaged might exist, which
might assist the patient in moving forward on goals.
3) Pleasant activities are the best first step. Pleasant activities are doubly beneficial to
the patient, as they increase activity and feelings of pleasure. Activities designed to
overcome avoidance or increase a sense of accomplishment should be entertained as
the first goals only if highly important to the patient or apparently salient to the
attainment of future goals.

Summary of Steps

Step 1. Introduce behavioural activation and its potential influence to the patient.
Step 2. Use patient examples to show the relationship between mood and behaviour.
Step 3. Identify pleasant activities/active-coping behaviours.
Step 4. Set an action plan.
Step 5. Monitor progress.

BEHAVIORAL ACTIVATION THERAPY IS EFFECTIVE ACROSS AGE GROUP

Behavioral Activation Therapy has been found to be effective across a range of age groups,
including adults, adolescents, and older adults. However, the specific techniques and
strategies used in BAT might need to be tailored to the developmental and cognitive levels of
different age groups. Additionally, the therapeutic relationship and communication style may
need to be adjusted to accommodate the needs and preferences of different age groups.
For children, adolescents, and older adults, modifications and adaptations to the therapy may
be necessary to ensure its effectiveness. Therapists who are experienced in working with
different age groups can make appropriate adjustments to the treatment approach to suit the
individual's developmental stage, cognitive abilities, and personal circumstances.
It's important to note that while BAT can be effective for many individuals, not every
therapeutic approach works equally well for everyone. The choice of therapy should be based
on a comprehensive assessment of the individual's needs, preferences, and clinical
presentation, as well as the expertise of the therapist. If you or someone you know is
considering Behavioral Activation Therapy, it's advisable to consult with a mental health
professional who can determine the most appropriate treatment approach for the specific age
group involved.

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Examples of Homework Assignments :

1. What activities did you previously use to enjoy that you would like to start
participating in again?

2. List activities that you need to do to better your current situation (enrol in school,
get your inspection sticker, etc.).

3. Create a schedule of the new activities you will perform. Which ones did you
accomplish? Were there any barriers? Why? How did you handle them?

LIMITATIONS

Behavioral activation can be a very useful tool, but it does have some limitations. This does
not mean that it will not help, but it does mean that some people may find that it works best
in combination with other approaches.

For people with mental health conditions that are influenced by their thoughts, BAT may not
be enough to create long-term change.

Focus on external behavior

Behavioral activation alone only focuses on behavior and mood, not on how someone thinks.
It can disrupt negative thinking patterns as they are happening, but it does not attempt to help
someone unlearn them.
For people with mental health conditions that are influenced by their thoughts, this may not
be enough to create long-term change. It is for this reason that behavioral activation is often a
part of CBT, which focuses on how thoughts, feelings, and behaviors are all connected.

Gaps in research
Another drawback is that most research into behavioral activation has only assessed if it
works rather than compared it with other treatments. For this reason, it is unclear whether it is
more or less effective than other treatment approaches.
One 2021 systematic review of past research found that many previous studies had not been
able to establish a causal relationship between behavioral activation and symptom
improvements.

No consideration of other factors

Many factors can contribute to depression. Although some people may respond well to
behavioral changes alone, others may need a mixture of therapies to help.
For example, if someone develops depression following a traumatic event, they may benefit
from a combination of behavioral activation to reduce their day-to-day symptoms and trauma
therapy to help them process what happened.

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A person’s relationships, physical health, environment, and medications can all influence
mood disorders. If behavioral activation alone does not help with a person’s symptoms, it is
important to remember that it is not the only approach.
A mental health professional may be able to treat the condition more holistically in
partnership with someone’s medical team.

Reference:-

CBT

Clinic, A. R. (2020, October 26). The Goals Of Cognitive Behavioral Therapy? Aquila
Recovery Clinic. https://www.aquilarecovery.com/blog/what-are-the-goals-of-cognitive-
behavioral-therapy/#:~:text=The%20core%20focus%20of%20cognitive

Cognitive Behavioural Therapy (CBT). (2021, November 26). PsychDB.

https://www.psychdb.com/psychotherapy/cbt

Fann, J. (2018, August 7). What Are the Goals of Cognitive Behavioral Therapy? BrainLine.
https://www.brainline.org/qa/what-are-goals-cognitive-behavioral-therapy

Weinstock, M. (2015, June 24). Staff perspective: CBT for Depression – elements of session
structure | center for deployment psychology. Deploymentpsych.org.
https://deploymentpsych.org/blog/staff-perspective-cbt-depression-elements-session-structure

Interpersonal Psychotherapy

Cuijpers, Pim, et al. “Interpersonal Psychotherapy for Mental Health Problems: A

Comprehensive Meta-Analysis.” American Journal of Psychiatry, vol. 173, no. 7, 2016, pp.
680–87. Crossref, https://doi.org/10.1176/appi.ajp.2015.15091141

Hees, Madelon L. J. M. van, et al. “The Effectiveness of Individual Interpersonal

Psychotherapy as a Treatment for Major Depressive Disorder in Adult Outpatients: A
Systematic Review.” BMC Psychiatry, vol. 13, no. 1, 2013. Crossref,
https://doi.org/10.1186/1471-244x-13-22.

Markowitz, John C., and Myrna M. Weissman. “Interpersonal Psychotherapy: Past, Present
and Future.” Clinical Psychology & Psychotherapy, vol. 19, no. 2, 2012, pp. 99–105.
Crossref, https://doi.org/10.1002/cpp.1774.

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Saling, Joseph. “Interpersonal Therapy for Depression.” WebMD, WebMD LLC, 27 Sept.
2020, www.webmd.com/depression/guide/interpersonal-therapy-for-depression.

Schimelpfening Nancy. “How Interpersonal Therapy Works.” Verywell Mind, Dotdash

Media, Inc., 12 Aug. 2021, www.verywellmind.com/interpersonal-therapy-1067404.
Powell, Alisha. “Interpersonal Therapy: How It Works, Cost, and What to Expect.” Choosing
Therapy, Choosingtherapy.com, 25 Feb. 2021, www.choosingtherapy.com/interpersonal-
therapy.

Whisman, Mark A., and Steven R. H. Beach. “Couple Therapy for Depression.” Journal of
Clinical Psychology, vol. 68, no. 5, 2012, pp. 526–35. Crossref,
https://doi.org/10.1002/jclp.21857.

Behavioral Activation Therapy

Behavioral activation: How it works, examples, and more. (2021, October 25).
Www.medicalnewstoday.com. https://www.medicalnewstoday.com/articles/behavioral-
activation#limitations

Hopko, Lejuez, Ruggiero, et al. Contemporary behavioral activation treatments for

depression: procedures, principles, and prognosis. Clin Psychol Rev 2003; 23 (5): 699-717
Maria José Santos, Puspitasari, A. J., Nagy, G. A., & Kanter, J. W. (2021). Behavioral
activation. 235–273. https://doi.org/10.1037/0000218-009

National institute of Mental Health. (2023, April). Depression. National Institute of Mental
Health. https://www.nimh.nih.gov/health/topics/depression

Santos, M. M., Puspitasari, A. J., Nagy, G. A., & Kanter, J. W. (2021). Behavioral activation.
In A. Wenzel (Ed.), Handbook of cognitive behavioral therapy: Overview and approaches
(pp. 235–273). American Psychological Association. https://doi.org/10.1037/0000218-009

Turner, J. S., & Leach, D. J. (2012). Behavioural Activation Therapy: Philosophy, Concepts,
and Techniques. Behaviour Change, 29(2), 77–96. https://doi.org/10.1017/bec.2012.3

Uphoff, E., Ekers, D., Robertson, L., Dawson, S., Sanger, E., South, E., Samaan, Z.,
Richards, D., Meader, N., & Churchill, R. (2020). Behavioural activation therapy for
depression in adults. Cochrane Database of Systematic Reviews, 7(7).
https://doi.org/10.1002/14651858.cd013305.pub2

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