Behavioral activation (BA) is a treatment modality that helps clients modify their behavior with the ultimate goal of using a values-based approach to overcome depression by placing the client in a more comprehensive context than just the triggering event. Depressive symptoms, for example, while brought on by a life-changing incident such as job loss, are looked at within the larger context of the client’s environment, community, and life history. In the context of social work, BA is consistent with the guiding principles of social service, justice, integrity, and competence that drive an overall goal of serving vulnerable, oppressed, or disenfranchised populations and individuals.
One of the primary impediments to achieving positive behavior outcomes that are in line with a client’s values is the practice of avoidance, leading mindfulness and acceptance practice to be particularly effective in correcting the maladaptive behavior tendencies that can result from depression. Like ACT, BA calls upon the therapist and client to identify what is personally meaningful to the client.
An example cited in the new volume edited by Matthew Boone, LCSW, Mindfulness and Acceptance in Social Work, features a Hmong immigrant who has recently lost his job (Kanter, Puspitassari, Santos & Nagy 2014). After experiencing potential discrimination and microaggressions on the job, then being let go, he is depressed and unable to pursue other employment opportunities. Refocusing on his values—his dedication to his family, for example—allows him to better contextualize his job loss and employment search, aligning them with what brings his life true meaning. BA calls upon the social worker to help the client act according to his or her values, instead of trying to avoid the uncomfortable, painful, or negative emotions that could arise from action.
Kanter et al highlight five main skills of BA:
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Identifying the depressing life context by asking the client what prompted him or her to seek treatment;
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Identifying and discussing responses to these negative experiences by asking the client how he or she feels or what actions result from this event;
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Validating the client’s experience and reaction, responding with genuine understanding as to why the client acts the way he or she does;
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Explaining how the behavior can impact his or her life and ultimately exacerbate the depressive cycle; and
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Helping clients identify and participate in personally meaningful behaviors that will help them solve problems and build better, more satisfying, values-considered lives.
Kanter et al. also identify assessment and activity scheduling as important pieces of behavioral activation. Assessing the client involves information-gathering, learning about his or her values, and what activities will resonate with them. It also involves forming a comprehensive picture of the client’s life history, community, environment, and behavioral tendencies over the long-term. This approach not only increases success, but allows you to work collaboratively with them, another key part of social work.
Selecting activities that will actually allow the person to participate fully in line with his or her core issues is extremely important, and will allow the social worker to examine how specific behaviors impact the client’s depression. As Kanter et al. describe, “the heart of BA is concrete activity scheduling based on the client’s goals and values. Each session is devoted primarily to scheduling activities and reviewing the client’s success with activities scheduled from the previous session. [it] is an iterative, evolving process.” When facing a big activity, such as searching for a job, it can be helpful to chunk it into smaller pieces. To the depressed client, the thought of going out and finding a job can seem incredibly daunting, so developing stratified steps can make the process more manageable. First activities may include looking through at least one newspaper a day for possible job openings, then building from there. Making plans for targeted, concrete steps will mitigate overwhelm and, hopefully, increase chances for success.
For overviews of several more strategies, such as stimulus control, skills training, and strategies targeting avoidance, we encourage you to check out the full volume, Mindfulness and Acceptance in Social Work: Evidence-Based Interventions and Emerging Applications. Again, it’s important to underscore the importance of helping the client behave in ways that align with their values—and hopefully, be able to listen to them instead of their moods.
References
Kanter, J.W., Puspitassari, A., Santos, M., Nagy, G. 2014. Social work and behavioral activation. In M. S. Boone (Ed.), Mindfulness and acceptance in social work (pp.101-122). Oakland, CA: New Harbinger Publications.
Part 2: What to Do When a Client Is Participating in Self-Judgment?