Behavioral activation

Behavioral activation is a therapeutic technique aimed at increasing an individual's engagement in adapted activities, most often with a strong positive impact allowing its reinforcement.

We find among patients, particularly those suffering from anxio-depressive disorders, a high level of avoidance. The symptoms of the disorders often lead to a reduction in activities through avoidance of the associated unpleasant emotions. Frustration, fear, fatigue, sadness are among the anticipated consequences and it becomes preferable for patients to reduce their activities and actions rather than risk being exposed to these consequences.

Coming from cognitive-behavioral therapies, the goal of behavioral activation will be to reintroduce adapted behavioral habits into the patient's life, reduce avoidance, and bring back positive emotions associated with different activities.

More simply, we will use the pleasure associated with the practice of sport, leisure activities, positive social interactions, as well as the feelings of self-reward felt after completing chores or difficult tasks to reinforce these behaviors and get out of inactivity.

Behavioral activation is mainly used in the treatment of depressive symptoms. The fatigue generated by the illness, as well as thought patterns focused on the negative, expectations of the worst, all of this will lead to an avoidance of many situations and actions. Individuals suffering from depression, by using avoidance as a strategy to manage potential unpleasant situations, will reduce the frequency and intensity of their active behaviors, which will lead to a worsening of depressive symptoms.

This same pattern of avoidance is found in anxiety disorders, including social phobias and generalized anxiety disorder.

It can therefore be used in the treatment of these two families of disorders, as well as with any patient whose avoidance leads to a sharp reduction in activity and overall functioning.

Behavioral activation will help reduce avoidance behaviors. These short-term coping (management of emotions) strategies prove effective in avoiding confronting potential unpleasant emotions, but lead to the appearance and maintenance of a vicious circle which maintains anxiety and depressive symptoms. Behavioral activation trains the patient to recognize their avoidance behaviors and to replace them with active behaviors by focusing on the reward and positive emotions associated with carrying out these actions.

Indeed, behavioral activation makes it possible to reintroduce sensations of pleasure or mastery, which are mostly absent in people suffering from anhedonia and prone to avoidance. These pleasant sensations will contribute to the reinforcement of active behaviors and to the increase in their frequency and their positive impact on the mental health of patients.

The first step will be to teach the patient to recognize their symptoms and to understand the mechanisms of avoidance and reinforcement, in order to better identify which situations are most sensitive to them. We can work in mindfulness to facilitate the recognition of these processes which may have become automatic over time.

After having learned to know and recognize his illness, we define with the patient what his values are, which will serve as a compass during therapy and will make it possible to facilitate the perception of rewards and pleasant emotions during activities.

Once the psychoeducation is completed, the active part of the therapy will consist of identifying the traps that lead to avoidance in order to face them, and thus take action, by reintroducing activities gradually. The goal is to go at the patient's pace, depending on their abilities. The difficulty should not be too high so as not to set the patient up for failure while allowing rewards to be found in the effort accomplished.

After working on these aspects, the objective will be to consolidate this mode of operation in the long term, and to transform it into a complete and functional way of life. We will ensure that the rest of the patient's living environment is compatible with good mental health and we will make the necessary changes (stopping substance use, healthy sleep, etc.)

Recent studies on the use of virtual reality in behavioral activation, particularly on the practice ofphysical activities in virtual reality (walking, cycling, etc.) showed that thanks to its playful and motivating aspect, benefits on mood and motivation were greater than during simple physical activity.

In addition to offering well-being and cognitive and behavioral therapy tools, virtual reality can also be considered in the case of behavioral activation support for the treatment of anxiety and depression.