Question
What is Behavioral Activation and how can I incorporate it into my OT intervention to help my elderly clients with depression?
Answer
The basic premise is that when we are depressed, we get into negative habits and negative cycles of thinking. Behavioral activation is simply a technique that asks the patient to identify their mood and rate it, then identify fun and pleasant events to participate in and keep track of their mood while participating in this activity. Once there is recognition that “I do feel better,” you are breaking a negative pattern. This can be a very good habit to get into.
There are six steps to behavioral activation. For example, in treatment I would say to my patient, “I’m going to ask you to rate your mood on a scale of 1 to 10 where 10 is the best you’ve ever felt and 1 is the worst. How would you rate your mood when you woke up this morning? When you finished your self-care this morning? After your last therapy session? Before you went to sleep last night?” This is my starting point as a therapist to identify low mood and high mood points. Then I can probe further and ask “What were you doing at the time your mood was positive? Or negative? I want you to know that your mood is not static.” Even that single point can be a therapeutic one in your interaction with the patient. The patient will recognize with this level of structure that their mood is better when they do a certain activity. Again, it is important to have a reinforcement of pleasant events.
Editor’s note: This Ask the Expert was adapted from the course, Detecting and Treating Depression in Older Adults that is available in text, video, and audio course formats.
