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The research

What is behavioural activation?

Behavioural activation means doing something small and worthwhile before you feel like it. The idea is that your mood can follow. It's the method underneath every Inzention app.

It's spelled behavioral activation in the US. Psychologists often shorten it to BA.

Why waiting can keep you stuck

When you feel low, tired or stuck, it's natural to wait until you feel better before doing anything. The trouble is that waiting can keep you there. Behavioural activation describes it as a loop:9, 10

  1. You feel flat, so you do less.
  2. Doing less means fewer good moments, because you get less done, see fewer people and have less fun.
  3. With fewer good moments, you can feel flatter. And round it goes.

Behavioural activation works on the loop from the doing end. You don't have to fix how you feel first. You only have to do something small.

How it works in practice

With a psychologist, behavioural activation usually looks like this:

  • Plan small activities. Choose ones that give you a sense of getting something done, being close to people, or enjoying yourself.
  • Do them whether or not you feel like it. The idea is that you start first, and motivation can follow.
  • Notice how you feel afterwards. Over time you look for the activities that lift you, and do more of those.
  • Start small and build. Opening the curtains counts. So does a two-minute walk.

Need ideas? Here are 142 small activities, grouped by area and by how long they take. To do it on paper, print the free worksheet, and see how activity scheduling works.

What the research says

Behavioural activation for depression has been tested in many trials. Here is what the main reviews and one large trial found.

  • In the short term, it did about as well as CBT.

    A 2020 Cochrane review brought together 53 studies of behavioural activation for depression in adults, with about 5,500 people. Five of those studies, with 601 people, compared it with CBT. The review found no clear difference between the two in the short term, up to six months after treatment, and rated that evidence as moderate certainty.1

    Two earlier reviews, from 2007 and 2008, also found no clear difference between behavioural activation and cognitive therapies.3, 4

  • It doesn't need a senior therapist. A large UK trial followed 440 adults. Junior mental health workers ran behavioural activation. Experienced therapists ran CBT. A year later, behavioural activation had done as well as CBT.2
  • It also improved wellbeing. A review of 20 trials found it improved wellbeing in people without depression, mostly university students, and in people with symptoms of depression.5

Behavioural activation is a recommended psychological approach for depression (RANZCP 2020; NICE NG222).

These studies tested behavioural activation, mostly with a therapist or trained mental health worker. They didn't test our apps, and the apps aren't therapy. What the apps take from the research is the method: small activities, done first, so mood can follow.

How our apps use it

Bloom is the method without a story around it. Bloom picks small activities for today, one, three or five as you choose, and asks one question after each: how do you feel now? Turn on the program for before-and-after ratings, and a PDF summary you can take to an appointment.

The worlds wrap the same method in a story. In each one:

  • Five small habits arrive each morning. The app does the planning, so there's no blank page to face.
  • One is enough. A day with one habit done is a day that counts.
  • Your rank never drops. A study of 96 people building a daily habit found that missing one day made no real difference to forming it.6 Other studies found that seeing a broken streak made people less likely to keep going.7 So a missed day pauses your progress instead of erasing it.
  • Choose a world you'd like to spend time in. A review of 16 trials found game elements helped people move more, and a smaller effect remained about 14 weeks after the programs ended.8

When to get more help

Has low mood lasted more than two weeks? Is it getting in the way of your life? Then talk to your GP. In Australia, your GP can refer you to a psychologist under a Mental Health Treatment Plan. The apps can sit alongside that work.

If you're not safe right now, call 000 in Australia or 911 in the US. Lifeline is on 13 11 14, and in the US you can call or text 988. In Australia you can also call Beyond Blue on 1300 22 4636. Anywhere else, see findahelpline.com.

Sources

  1. Uphoff E and others (2020). Behavioural activation therapy for depression in adults. Cochrane Database of Systematic Reviews. doi.org/10.1002/14651858.CD013305.pub2
  2. Richards DA and others (2016). Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA). The Lancet 388: 871–880. doi.org/10.1016/S0140-6736(16)31140-0
  3. Cuijpers P, van Straten A, Warmerdam L (2007). Behavioral activation treatments of depression: a meta-analysis. Clinical Psychology Review 27: 318–326. doi.org/10.1016/j.cpr.2006.11.001
  4. Ekers D, Richards D, Gilbody S (2008). A meta-analysis of randomized trials of behavioural treatment of depression. Psychological Medicine 38: 611–623. doi.org/10.1017/S0033291707001614
  5. Mazzucchelli TG, Kane RT, Rees CS (2010). Behavioral activation interventions for well-being: a meta-analysis. Journal of Positive Psychology 5: 105–121. doi.org/10.1080/17439760903569154
  6. Lally P, van Jaarsveld CHM, Potts HWW, Wardle J (2010). How are habits formed: modelling habit formation in the real world. European Journal of Social Psychology 40: 998–1009. doi.org/10.1002/ejsp.674
  7. Silverman J, Barasch A (2023). On or off track: how (broken) streaks affect consumer decisions. Journal of Consumer Research 49: 1095–1117. doi.org/10.1093/jcr/ucac029
  8. Mazeas A and others (2022). Evaluating the effectiveness of gamification on physical activity: systematic review and meta-analysis. Journal of Medical Internet Research 24: e26779. doi.org/10.2196/26779
  9. Kanter JW and others (2010). What is behavioral activation? Clinical Psychology Review 30: 608–620. doi.org/10.1016/j.cpr.2010.04.001
  10. Lewinsohn PM, Libet J (1972). Pleasant events, activity schedules, and depressions. Journal of Abnormal Psychology 79: 291–295. doi.org/10.1037/h0033207
  11. NICE (2022). Depression in adults: treatment and management (NG222). www.nice.org.uk/guidance/ng222
  12. Malhi GS and others (2021). The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Australian and New Zealand Journal of Psychiatry 55: 7–117. www.ranzcp.org/getmedia/a8c79505-c0b5-46b4-9f27-67f79e047674/RANZCP-mood-disorders-clinical-practice-guideline-2020.pdf