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BEHAVIORAL ACTIVATION: WAYS TO BEGIN TO GET OUT OF ANXIETY AND DEPRESSION


A client, we will call Timothy, made an initial appointment with me at Florida Counseling Centers several years ago to talk about his struggle with symptoms of anxiety and depression. Timothy’s story was not all that unusual in many ways. He struggled to sleep through the night, his appetite was off, his thoughts about his future lacked hope, and he was feeling negative about many of his relationships at work and at home. Perhaps the most problematic issue Timothy was having was a severe lack of motivation and energy for life. He was struggling to get up and go to work in the morning and described the misery of trying to get through a workday faking interest in the project he was working on and in interacting with his team. Accordingly, he described the “heaviness” of the depression as the one symptom that seemed to prevent him from feeling the kind of energy and engagement for his life that had previously allowed him to pursue things like exercise or even hobbies like paddle boarding and hiking. Instead, he spent time binging on Netflix and social media, avoiding exposing himself to activities that just felt too hard or to relationships that were challenging in any way. Timothy was stuck. He was drowning in this lack of motivation and energy and the less he engaged life, the worse he felt.


The treatment plan Timothy and I created was traditional in some ways. I referred him to our psychiatrist for a round of anti-depressants and he agreed to meet with me once a week for cognitive behavioral therapy. But it was clear for me as I developed a plan for Timothy‘s care that we needed to directly address his depression and anxiety in a holistic manner. Not only did we need to get a medication online that would balance out his serotonin levels and pursue therapy that could help him realign his thought life with a sincere hope for the future, we needed to get him re-engaged physically, emotionally, and spiritually.


The good news is that Timothy got better. We enrolled him in our integrative health program and he participated in therapeutic activities like yoga, mindfulness training, nutrition counseling, massage, and what we call behavioral activation. In 10 weeks, Timothy was back at work every day, consistently engaging in enjoyable activities and exercise. And he was no longer avoiding things that felt too hard or overwhelming.


Timothy’s story is incredibly relevant at this moment in time. The prevalence of depression and anxiety have been on the rise for decades. In 2017, 8% of adults were diagnosed with a depressive disorder and 19% were diagnosed with an anxiety disorder. Since the pandemic, the incidence of anxiety and depression has completely exploded. It has been difficult for us to even treat the amount of patients that are calling for services at Florida Counseling Centers since the first COVID-19 lockdown. If you or someone you know is struggling with anxiety or depression that is draining energy and stealing the ability to engage life, it’s important that you recognize there is hope. Just like Timothy, you can find a path forward out of the feelings of being overwhelmed, disengaged, and stuck.


This path out of anxiety and depression starts with behavioral activation. Behavioral activation is a therapeutic model that is based on the idea that individuals experiencing symptoms of depression and anxiety have developed patterns in their life that yield low levels of positive reinforcement. In other words, trauma, loss, or just the daily grind of life puts some people in a position where they are no longer engaging activities that actually produce positive emotion. It makes sense on an intuitive level because it’s actually quite natural for a person that feels sad to quit engaging in pleasurable activities and to attempt to cope by withdrawing socially and shutting down emotionally. Sound familiar? That’s where Timothy was and that’s where many of us have been in the wake of the COVID-19 lockdowns. When this emotional shut down happens, many people turn to unhealthy coping mechanisms to ease the pain of life. Think addiction, pornography, binge eating, and social media addiction just to name a few. The issue here is clear: these kinds of coping mechanisms don’t alleviate depression, they make it worse. While it’s true that the unhealthy coping mechanisms, like addiction, work short-term to release some dopamine, in the end all they do is make us feel more shame, guilt, and hopelessness.


Behavioral activation targets inertia, meaning the whole idea is to get your body moving toward behaviors that encourage you to approach life and people rather than avoid them. That means to get alleviation from the symptoms of anxiety and depression, you have to start from the “outside-in” by literally scheduling activities that will give you a chance of experiencing some positive reinforcement. Behavioral activation says “go for a walk” when depression says “sit on the couch and watch TV.” Behavioral activation says “make yourself go to Starbucks and have coffee with a friend” when anxiety says “play a video game and go to bed early.” I can’t tell you how many times I have encouraged my patients in the clinical office to “do it anxious” or “ do the opposite of what depression tells you to do.” And guess what? When patients who feel paralyzed by depression and anxiety set goals that help them approach life rather than avoid life, they tend to get better much faster. Why? Because they start to get the positive reinforcement of engaging in healthy behaviors.


As I alluded earlier, we have been using behavioral activation effectively at Florida Counseling Centers for years. I asked Dave Jones, a social worker who is our behavioral activation specialist, why he thought we were having such success treating anxiety and depression by integrating behavioral activation into more traditional therapies. His response was fascinating, “Movement is a great first step toward recovering from anxiety and depression. Intentional walks, swims, or bike rides are like magical neurochemical, physiological, psychological, relational, and even spiritual reboot buttons. They can be like the tiny spark that is ultimately responsible for starting the fire of hope. The results of behavioral activation can be astounding.”


It’s important that you recognize that my goal is not to oversimplify depression and anxiety. I’m not suggesting that the entire treatment comes down to platitudes like “take and walk and you will feel better.” Long-term recovery requires a dual process. On one hand, you have to engage. You have to get your body moving and you have to allow yourself to pursue activities that allow you to approach positive people and experiences rather than avoid them. On the other hand, it’s important to work simultaneously from the “inside-out,” meaning at some point you need to understand the cognitive and emotional issues that are underlying anxiety and depression. But what we have found over the last several years in our clinic is that long-term recovery really does require intervening on both fronts. My encouragement to you, if you are struggling with feeling stuck in depression and anxiety, just like Timothy, is that you will take steps today to work from the outside in and from the inside out to get healthy. Always remember that if you’d like to speak with someone that can help you create a path forward into a happier life the professionals at Florida Counseling Centers are always available.


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