“From the outside in” –a new type of treatment for depression
“A study in The Lancet showed that behavioural activation (BA) therapy is as effective as cognitive behavioural therapy (CBT) in treating depression. The focus is placed on activities that create positive emotions and well-being.”
The way we feel affects our behaviour. When you feel low or depressed, you often become more passive and withdrawn. This can in turn make you feel even more depressed and it all becomes a vicious circle. This can, for instance, be one of the consequences of long-term sick leave. Compare this to when we feel good: we are often more active, do things that make us happy and meet people who affect us in positive ways. This leads to better self-confidence, feelings of belonging and personal growth. A relatively new type of treatment, so-called behavioural activation (BA) therapy, focuses on doing active things that have made you feel good in the past. Starting these activities again will gradually help create positive emotions, stabilise your mood and improve mental well-being, which in turn makes you even more active. In this way, it becomes a virtuous circle. Many people believe it’s important that things start “from the inside out,” but this type of therapy takes the opposite approach. You start with external activities that create inner well-being and positive emotions and thus counteract depression and low mood.
“The theory behind BA therapy is that actions help to create different types of emotions. By doing the things we enjoy, we strengthen our mental well-being. Simple as this might sound, those struggling with motivation and/or mental health may need support in getting started.”
There are different types of treatment for depression such as medication and physical activity. Another type of treatment is cognitive behavioural therapy (CBT), which attempts to change negative thought patterns. This is an evidence-based treatment method for depression and has good results, but it is expensive, staff-intensive and the waiting lists are often long. In 2016, the medical journal The Lancet published a study showing that BA therapy was as effective in treating depression as CBT. The study included 440 people with diagnosed depression who all underwent 20 hours of therapy for 16 weeks. By means of a lottery, half underwent CBT with a licensed therapist and the other half received BA therapy, through which they were encouraged to do activities they enjoyed, such as reading, exercising or being with friends. The good news is that BA therapy is much cheaper and can be performed by a broader staff group. In this way, it becomes more accessible to more people. A study from 2021 has also suggested that BA therapy could be used online during the pandemic with good results.
BA therapy: a simple guide
For a period of time, make a note of the activities you do. Try to connect each activity with the way it makes you feel. Identify activities that make you happy and that boost mental well-being.
Look for activities that make you feel good, and that are compatible with your values and the life you want to lead. These are unique to everyone.
Start to carefully build these activities into your day-to-day life. It’s important to be specific, set aside time in your schedule, and take small steps. Always be realistic with what you can achieve.
Make sure you follow through on the activities you choose, and that they actually do shape your emotions positively.
The activities we choose to focus on will vary from person to person. They can be reading a book, having a coffee with a friend, going to a dance class, practising something you like, voluntary work, etc.
My advice:
This method can benefit anyone and everyone in preventing mental illness. It’s easy to think you don’t have time for things you like doing, but by being one step ahead and prioritising specific positive activities, we can build resilience against future health problems. See it as a worthy investment! If you’ve been diagnosed with depression, never change your treatment without discussing it with your doctor. I believe we will gain far more expertise in BA therapy going forwards and that it will also be used more widely for the people it is suitable for.
