Behavioral Activation and Healthy vs. Unhealthy Coping Strategies

I’ve had an especially hard past 3 days, so I’ve been reviewing some materials on Behavioral Activation which I want to share here. I also have a worksheet that I will complete as an example, but provide to you too so you can also fill it out if you think it will be helpful.

Just like medication, EMDR, cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), etc., behavioral activation is a treatment for depression that has been found to be equally as effective as other treatments. While CBT focuses on our thoughts and feelings (because one thought creates a feeling which leads to a behavior and just repeats), behavioral activation focuses on the environment and the actions of a person. Why, you might ask?

Traumatic life events, which can involve grief, genetic predisposition, daily life stressors, and legitimate trauma affect us negatively, which can lead to depression which can then cause a person to have too little positive reinforcement and unhealthy behaviors. In an attempt to avoid the negative feelings and thoughts that come from our traumatic environments, we tend to engage in unhealthy ways to cope. Drugs, alcohol, not showering, spending all day in bed, social withdrawal, binge eating or not eating, overworking, aggression, impulsive spending, risky behavior, smoking, pathological procrastination, etc. are just some of the maladaptive behaviors we engage in to make us feel better in the moment. While they do tend to help in the short-term, they ultimately lead to more problems which just leads to more depression. It’s a vicious cycle.

For example, a problem I am currently dealing with is my intense worry and stress over financial stability in the coming months and years. I could write a whole post on this, but let’s just suffice to say that I’m in a bad place right now and it’s scaring the shit out of me. What are my unhealthy coping strategies? I tend to isolate myself from other people because I think I will just depress them too; I often don’t eat, because it’s one thing I can control in my life; I have spent money impulsively in the past; and I do everything I can to avoid my thoughts, problems, and feelings. Isolation keeps me from maintaining healthy relationships and losing support that I would otherwise have had. Not eating affects my energy levels and ability to think and reason, as well as just makes me weaker to fight all my other conditions. Spending money unnecessarily just makes me feel guilty. And avoiding thinking about trauma and allowing myself to feel grief only prevents me from processing through these things and increases my depression, anxiety, and tendency to dissociate. The immediate relief of these coping strategies helps me to cope in the moment, but the long-term consequences only cause me more distress, guilt, and reduced energy to cope with trauma and stress.

Behavioral activation focuses on developing positive behaviors to replace the negative ones. In order for this to work, positive replacements should be just as easy and rewarding as the negative behaviors. What would be a list of 10 things that could be positive versus negative? How could you rank them 1-10 in categories of ease and reward? Here’s my list:

1. Lying with a weighted blanket
2. Squeezing a squishie (my term for a squishmallow)
3. Playing with my cats (or snuggling with them)
4. Soaking in a bathtub
5. Buying some flowers
6. Eating and drinking comfort foods and drinks…like gluten free mac and cheese and a glass of wine
7. Talking to a loved one
8. Journaling
9. Going for a walk
10. Traveling somewhere new/different

What is really important with positive replacement behaviors is changing our internal dialogue. Try using a gracious tone instead of an ungracious one towards yourself. Be more matter-of-fact than judgmental. Also, be specific about implementing these new behaviors. Set certain times and days that you are going to do them. Involve someone else for accountability – social support is a huge motivator. Finally, make a list of barriers to using you healthy coping strategies as well as expected outcomes. Tweak your list if you find that one of your healthy behaviors is not as easy or rewarding as you thought it would be.

Expected Outcomes to my List

1. Weighted blankets are very comforting in the moment and make me feel safe
2. Squeezing squishies is comforting because it makes me feel like I am hugging someone and they are hugging me back
3. Interacting with my cats makes me smile and feel unconditionally loved.
4. Soaking in a bathtub is very relaxing and often eases the pain I’m in which helps me to have a better perspective all around.
5. Buying some flowers and putting them in places I see often makes me happy and grateful to see beautiful things.
6. Eating and drinking comfort foods (in moderation!) gives me the nutrients I need for energy and a sense of well-being.
7. Talking to a loved one usually cheers me up but also helps me to refocus on someone else rather than myself.
8. Journaling allows me to get all my negative feelings and thoughts out in a safe way. It calms the angst in my heart. It also provides a way for me to process my grief and stress and trauma.
9. Going for a walk is always calming so long as I’m around trees and birds. It also gets my blood moving which is helpful for feeling better mentally and physically.
10. Traveling gives me motivation to keep on living. It makes me feel alive and like myself.

Barriers to my List – Having a plan in place

1. Not having a weighted blanket on hand or nearby – buying a weighted blanket and keeping it close or finding something else that is comforting
2. Not having a squishie around to squeeze or not being a place where that would be appropriate – buying a squishie and keeping it on hand or finding something else that is comforting
3. My cats might not be around or they just may be ornery and not want to interact – maybe look at cat videos, memes, or pictures; see if there is someone else’s pet you can play with
4. I might not have time to soak in a bath – schedule it like an appointment
5. I might not have the money for flowers – see if I can pick some in my yard or ask a neighbor if I can pick some of theirs
6. I might not have the energy to cook or open a bottle of wine – maybe get some takeout or go out to eat instead
7. Maybe no one is available to talk – see if texting is possible or schedule a time to talk
8. I might not have a pen or my journal nearby or I just don’t have the energy to write – make sure I always keep a journal and pen in my house and purse. If I don’t have energy, schedule another time to do it.
9. I may be in too much pain to walk or the weather might not be conducive to walking – see if I can do something else active like yoga or pilates or housework. If the pain is too bad, maybe just open some windows. Don’t berate yourself for not being able to do this particular thing – find something else that is comforting or meaningful.
10. I might not have the money or the time to travel – this is one we really have to plan ahead for. There are budget friendly travel options and sometimes you just have to make the time when there is seemingly none.

Finally, here are some free resources that will hopefully help you understand behavioral activation and coping strategies better!