Fells and Dales CPD group. 15/2/19
Today we reviewed Behavioural Activation Treatment for Depression: Returning to Contextual Roots by Neil S Jacobson , Christopher Martell and Sona Dimidjian 2001. Along with this we looked at the NHS guidelines on the stepped process of mental health care and how Behavioural Activation fits within step 3 of the model.
Behavioural Activation is a stand alone treatment for depression which attempts to help depressed people to re-engage in their lives through focussed activation strategies. Rumination and worry is seen as an avoidance strategy and the contents of the worries are not considered relevant to this approach.
Deficiencies are seen as residing in the life of the sufferer rather than within that individual where avoidance patterns narrow the repertoire of behaviour for the individual eg they may stay in bed.
The significance of a persons behaviour is largely driven by the reinforcers maintaining them and stopping the avoidance behaviours is seen as key to the recovery of the depressed client. The acronyms TRAP and TRAC are used to conceptualise the old and new behaviours as Trigger, Response leading to avoidance pattern leading to response leading to avoidance behaviour (TRAP) and graded activities are created to promote the alternative Trigger, Response leading to alternative coping (TRAC) which in turn leads to breaking the feedback loop and modifying the contextual trigger .
Behavioural activation is seen as necessary and sufficient in and of itself in the treatment of depression and challenging core schema and automatic negative thoughts as in classic CBT are unnecessary.
We considered the effectiveness of such an approach if only parts of it are integrated into therapeutic counselling such as psychoeducation, exercising more, recognising and exploring avoidance patterns and how that can be rationalised along with the need to believe the whole of the paradigm in order for any of it to be effective.
We then considered the underlying principles of therapeutic change for each of us and the importance of being genuine and congruent and not necessarily instrumental in our approach. We looked at how elements can be ethically integrated without totally believing in the paradigm.
A limit of the approach is the presupposition that a person is able to engage in activities and will be compliant with home work assignments such as keeping a diary or exercising regularly. Its overt directivity is also noted setting the therapist as expert who may even contact the client in-between sessions to check on compliance with activities.
It was noted that as it is straight forward to conceptualise Behavioural Activation can be and is included in the NHS stepped care process and psychological wellbeing practitioners (PWP’s) who deliver first step are trained in the approach and the ethic of using this approach for all when it might not be suitable considered.