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Behavioural activation

Behavioural activation vs CBT

Behavioural activation and cognitive behavioural therapy (CBT) are both talking therapies for depression, and you'll often see them named together. This page sets out how they differ and what studies found when they were compared.

Is behavioural activation part of CBT?

It started as one part of it. Behavioural activation was the behavioural side of CBT: planning activities and noticing how they affect your mood. Since the 1990s it has also been used as a therapy of its own, without the work on thoughts that CBT adds.

Where behavioural activation came from

In a 1996 study, Neil Jacobson and colleagues split cognitive therapy for depression into its parts. 150 adults with depression had the behavioural part alone, the behavioural part plus work on negative thoughts, or the full therapy. The three groups did about as well as each other at the end of treatment and six months later.

What each one works on

Behavioural activation works on what you do. You plan activities that give you a sense of achievement, closeness or enjoyment, do them at set times, and notice how you feel afterwards. It doesn't ask you to change your thoughts first.

CBT works on what you do and on how you think. As well as planning activities, you learn to spot unhelpful thoughts, check them against the evidence and find more balanced ones.

What the research found

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.

A large UK trial in 2016, called COBRA, compared the two with 440 adults with depression. Junior mental health workers delivered behavioural activation, and experienced therapists delivered CBT. A year after people joined, behavioural activation was no less effective than CBT, and it cost less to deliver in the UK.

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

These studies tested behavioural activation with a therapist or trained mental health worker. They didn't test Bloom, and Bloom isn't therapy.

Behavioural activation, activity scheduling and behaviour therapy

You may see these names used for overlapping ideas. Activity scheduling, planning activities for set times, is one part of behavioural activation. Behaviour therapy is an older and wider name. Beyond Blue describes it as focusing on "encouraging activities that are rewarding, pleasant or satisfying", which is the idea behind behavioural activation too. The activity scheduling guide shows how to plan a week.

Which one to ask about

Psychologists offer both. Ask your GP or psychologist which suits you. If you'd like to try the behavioural side on your own, start with behavioural activation step by step and the list of 142 activities, such as the connection ideas.

When to get more help

Has it lasted more than two weeks? Is it getting in the way of work, study or the people around you? Then talk to your GP. In Australia, your GP can refer you to a psychologist under a Mental Health Treatment Plan.

Beyond Blue is on 1300 22 4636 in Australia. If you're not safe, 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. Anywhere else, see findahelpline.com.

Bloom does this with you

Bloom uses the behavioural activation method: it picks small activities for each day and asks how you feel after each one.

Coming soon to the App StoreMore about Bloom

Sources

  1. Jacobson NS and others (1996). A component analysis of cognitive-behavioral treatment for depression. Journal of Consulting and Clinical Psychology 64: 295–304. doi.org/10.1037/0022-006X.64.2.295
  2. Uphoff E and others (2020). Behavioural activation therapy for depression in adults. Cochrane Database of Systematic Reviews. doi.org/10.1002/14651858.CD013305.pub2
  3. 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
  4. Kanter JW and others (2010). What is behavioral activation? Clinical Psychology Review 30: 608–620. doi.org/10.1016/j.cpr.2010.04.001
  5. Beyond Blue. Treatments for depression. Accessed 22 October 2026. www.beyondblue.org.au/mental-health/depression/treatments-for-depression
  6. NICE (2022). Depression in adults: treatment and management (NG222). www.nice.org.uk/guidance/ng222
  7. 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