Blog: Behavioral Activation: Principles and Protocols
Here is an example of flexible clinical decision-making (from MODULE 3, Behavioral Coping Section).
Principles of Behavioral Activation: Life structure is a necessary component for healthy functioning. People often make emotionally driven decisions, and people suffering from depression, anxiety, PTSD, personality disorders are susceptible to waiting to feel better before doing things. The idea is to make plans to structure time in advance. This reduces the likelihood of emotionally driven decisions.
Protocols for Behavioral activation: Activities planning for the following areas: mastery activities (work, obligatory things like laundry, errands, etc.); pleasurable activities; self-care; and, interpersonal. The typical protocol involves a written sheet with a daily /weekly schedule, and filling it up with activities from all areas.
Flexible decision-making using principles: Patient feels overwhelmed just completing the activities plan. He knows it is important to structure his time, but is stuck. Or, we complete the plan in session and next session he reports he didn’t do anything. Now what? I go back to the principle: create structure and disentangle the negative emotion from the activity. Patient is depressed and anxious and a full activities plan is too challenging.
>>Clinical Decision: scale back activities plan to do one thing. Don’t worry about covering all four areas. Talk with your patient how to increase the likelihood of doing that one thing even if feeling anxious or stuck. In effect, I adjusted the protocol to meet the needs of my patient to get some momentum going towards positive change. Once we get some traction, then we can use the more extensive protocol for activities planning.
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Posted by Ed on Dec 22, 2010