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8 Tips for Using Behavioral Activation to Treat Depression

By Matthew Tull, PhD

Behavioral activation is a basic coping strategy, as well as a short-term treatment, that can have a tremendous effect on your mood. When you feel depressed or anxious, you may be less likely to do the things you enjoy or avoid other potentially pleasurable activities.

The consequences of this are often a worsening of mood, feeling more detached from others, and an increase in anxiety. In addition, as you feel more and more isolated, you may begin to be at risk for depression.

If you're already getting treatment for depression and/or post-traumatic stress disorder (PTSD), studies show that behavioral action can be an effective part of that treatment.

How Behavioral Activation Works

Behavioral activation is designed to increase your contact with positively rewarding activities. In behavioral activation, you identify specific goals for the week and work toward meeting those goals.

These goals take the form of pleasurable activities that are consistent with the life you want to live. For example, if you want to live the life of a compassionate person, you might choose goals focused on volunteering, helping a friend out, or donating to charity. Particularly when you notice yourself feeling anxious or depressed, you should work on an activity. This teaches you that your behavior can affect your mood.

Tips to Enhance Behavioral Activation

Although behavioral activation is a pretty simple coping skill, it can be difficult to do, especially when you're not feeling motivated. However, there are some ways you can make your behavioral activation more effective. Here are some tips for "super-charging" behavioral activation.

Identify Activities That Are Uniquely Important to You

When implementing behavioral activation, sometimes people identify activities that are important to other people. Basically, people identify activities based on what they think they should be doing as opposed to what they want to do. If you come up with activities that aren't important to you, it's going to be difficult to foster motivation and to really feel connected to the activities you're engaging in.

When you're picking your activities for behavioral activation, try to think of what's uniquely important to you. What matters to you? What kind of life do you want to build for yourself? Come up with specific activities that really matter to you and that are about your values and desires. This will help give you that extra boost of motivation when your mood is down or you're experiencing high levels of anxiety.

Make Sure Activities Are Specific and Progress Is Measurable

Come up with specific activities where you can measure your progress. That is, can you quickly determine whether or not you have accomplished a task? If the answer is "no," then the activity you identified is likely too vague.

For example, let's say that you came up with the activity, "Get organized." What does this mean? What do you want to organize?

If you organize your bills, does this mean that you have accomplished this task, or is there more to organize? Instead, you may want to come up with the activity, "Organize my kitchen." This is an activity that is specific and its completion can easily be measured. When activities are specific and measurable, it can give you more direction in doing behavioral activation.

List Activities From Easiest to Hardest

Although behavioral activation may sound easy, it can be hard to do when you're feeling down or very anxious. Therefore, you want to make sure you can see progress quickly. If you're experiencing very low motivation or high levels of anxiety, the most important thing is to get moving to make sure that avoidance behavior doesn't set in.

You can do this by ranking your list of activities from easiest to hardest. Once you have this list set up, choose a couple of activities that are going to be very easy for you to accomplish. In doing so, you can make sure that you get active but also don't stress yourself out too much.

It's important that behavioral activation doesn't become overwhelming or a source of stress for you. By starting out with some easy activities, you can also foster motivation that can eventually make it easier to tackle the harder activities.

Come up With a Variety of Activities

You also don't want behavioral activation to become boring. Mix it up when it comes to the activities that you choose. Come up with a variety of activities across a number of different life areas, such as work, relationships, personal care, and family/friends.

The more variety you have, the more balanced your life will become and the more likely your motivation to continue to use behavioral activation as a coping strategy for your PTSD and depression will continue.

Enlist the Support of Others

If you're finding that it's difficult to be motivated when it comes to behavioral activation, ask others for support. Establish a contract with a friend or family member. Let him or her know about your activities and what you would like to accomplish during the week.

Your friend or family member can then help you accomplish that activity or check in with you during the week to see how your progress is going. He or she can also serve as a cheerleader for you, increasing your motivation.

Be Mindful

Even when people are active and engaging in pleasurable activities, they can still exhibit avoidance behaviors. They may be stuck in their heads, worrying, or ruminating about the past. This is going to make it difficult to connect with the positive aspects of engaging in a meaningful activity.

Being mindful ​and present when you're engaging in behavioral activation can ensure that you fully experience and engage in your chosen activities.

Take Things Slow

Behavioral activation is an excellent way of addressing some of the symptoms of PTSD, including avoidance behavior and symptoms of emotional numbing. In addition, behavioral activation can reduce your risk for depression and, if you have depression, help treat it. Although behavioral activation may sound simple enough, it can be difficult to do, especially if you're experiencing low motivation or a high level of anxiety.

Therefore, it's important to set reasonable goals and take things slow. 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 number of activities can have a big impact on your mood.

Reward Your Progress

Finally, remember to reward yourself for the progress that you make. Recognize your accomplishments. Doing so can increase your motivation to keep moving forward, especially during those times when your mood is down.

With one step at a time, you can use behavioral activation to build a more meaningful and fulfilling life.

Forest Bathing - Time in Nature combats Depression and Anxiety

We all know how good being in nature can make us feel. We have known it for centuries. The sounds of the forest, the scent of the trees, the sunlight playing through the leaves, the fresh, clean air — these things give us a sense of comfort. They ease our stress and worry, help us to relax and to think more clearly. Being in nature can restore our mood, give us back our energy and vitality, refresh and rejuvenate us.

But what exactly is this feeling that is so hard to put into words? I am a scientist, not a poet. And I have been investigating the science behind that feeling for many years.

In Japan, we practice something called forest bathing, or shinrin-yoku. Shinrin in Japanese means “forest,” and yoku means “bath.” So shinrin-yoku means bathing in the forest atmosphere, or taking in the forest through our senses.

This is not exercise, or hiking, or jogging. It is simply being in nature, connecting with it through our senses of sight, hearing, taste, smell and touch. Shinrin-yoku is like a bridge. By opening our senses, it bridges the gap between us and the natural world.

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Never have we been so far from merging with the natural world and so divorced from nature. By 2050, 66% of the world’s population is projected to live in cities. According to a study sponsored by the Environmental Protection Agency, the average American spends 93% of his or her time indoors.

But the good news is that even a small amount of time in nature can have an impact on our health. A two-hour forest bath will help you to unplug from technology and slow down. It will bring you into the present moment and de-stress and relax you. Numerous studies I’ve conducted have shown that shinrin-yoku has real health benefits.

So how does one go about forest bathing?

First, find a spot. Make sure you have left your phone and camera behind. You are going to be walking aimlessly and slowly. You don’t need any devices. Let your body be your guide. Listen to where it wants to take you. Follow your nose. And take your time. It doesn’t matter if you don’t get anywhere. You are not going anywhere. You are savoring the sounds, smells and sights of nature and letting the forest in.

The key to unlocking the power of the forest is in the five senses. Let nature enter through your ears, eyes, nose, mouth, hands and feet. Listen to the birds singing and the breeze rustling in the leaves of the trees. Look at the different greens of the trees and the sunlight filtering through the branches. Smell the fragrance of the forest and breathe in the natural aromatherapy of phytoncides. Taste the freshness of the air as you take deep breaths. Place your hands on the trunk of a tree. Dip your fingers or toes in a stream. Lie on the ground. Drink in the flavor of the forest and release your sense of joy and calm. This is your sixth sense, a state of mind. Now you have connected with nature. You have crossed the bridge to happiness.

When it comes to finding calm and relaxation, there is no one-size-fits-all solution – it differs from person to person. It is important to find a place that suits you. If you love the smell of damp soil, you will be most relaxed where the natural landscape provides it. Then the effects of the forest will be more powerful. Maybe you have a place in the countryside that reminds you of your childhood or of happy times in the past. These places will be special to you and your connection with them will be strong.

When you have been busy at work all week, it can be hard to slow down. You may have been rushing around so much you no longer know how to stand still. Walking with a guide who is a trained forest therapist can help you feel more comfortable and find the right environment to fit your needs. In one of my favorite forests, Iinan Furusato-no-Mori, the forest-therapy program includes guided walks. Doctors are on hand to offer general health assessments. When you arrive, you are given a physical health check and a psychological questionnaire. The therapist then works out the best walking plan for you.

But it is just as easy to forest-bathe without a guide. And there are many different activities you can do in the forest that will help you to relax and to connect with nature. Here are some of the things people do: forest walking, yoga, eating in the forest, hot-spring therapy, T’ai chi, meditation, breathing exercises, aromatherapy, art classes and pottery, Nordic walking and plant observation. It doesn’t matter how fit – or unfit – you are. Shinrin-yoku is suitable for any level of fitness.

You can forest-bathe anywhere in the world – wherever there are trees; in hot weather or in cold; in rain, sunshine or snow. You don’t even need a forest. Once you have learned how to do it, you can do shinrin-yoku anywhere – in a nearby park or in your garden. Look for a place where there are trees, and off you go!

From FOREST BATHING: How Trees Can Help You Find Health and Happinessby Dr. Qing Li, published on April 17, 2018 by Viking, an imprint of Penguin Publishing Group, a division of Penguin Random House LLC. Copyright © Qing Li, 2018.