Depression Protocol – Module 2

Module 2: Behavioral Activation

In the second phase of treatment, you will begin addressing the behavioral causes of depression by deliberately trying to “activate” yourself through vision casting, goal setting and monitoring behavior.

You begin by analyzing the weekly monitoring worksheets assigned for homework in the first phase of therapy.  These monitoring sheets ask you to record what a typical day/week looks like and to rate your mood throughout the day.  It is also useful to record your subjective experience of “pleasure” and “mastery” on a scale from 1-10.  Monitoring behavior is a potent tool for promoting self-awareness  but it also gives your therapist data that can help draw connections between certain behaviors/situations and moods.  This data can be useful when helping you set goals which is the next task of behavioral activation.

After introducing monitoring and collecting data, an examination of core values is often helpful to set the stage for setting meaningful life goals.  The research confirms that setting goals concordant with your values leads to a range of positive outcomes.  For example, see the following study which suggests self-concordant goals leads to better academic outcomes:

https://www.ncbi.nlm.nih.gov/pubmed/11195887

However, self-awareness appears to be relatively rare in the population and especially rare in those suffering with mental health disorders.  There is often a large disconnect between what clients say they value and how they are behaving.  Many depressed clients have given up on pursuing a life they would value as they do not believe it can be achieved and settle for unrewarding lives.  It is important to determine your top values before setting goals in order to ensure those goals are line with who you want to be. You can use a list of common values and go through that list to identify which ones stand out if you are unsure.

After determining what you value, some variation of the “miracle question” is helpful to allow you to begin dreaming of a life that excites you.  Ask: “If a miracle happened today and you had the life that you desired what would that look like?”  It can be difficult thinking about what your relationships/career/hobbies/family/spirituality/achievements/health would look like but keep persisting. It is important that you do not hold back out of fear but that you are honest about your deepest hopes and desires.  In the business world, Jim Collins calls this process of vision casting setting your “Big Hairy Audacious Goal” or BHAG.  It is a crucial process for engaging in a life of pleasure and meaning.

If you are struggling to visualize the future or to determine what would excite you then try asking yourself the following questions:  “Before you were depressed, what did you like to do?” What do friends/neighbors like to do?” Can I suggest some things and see if any of them sound good?”  “Consult a pleasurable activities list and see which ones stand out to me.”

After determining core values and setting your “BHAGs” you are now ready to begin breaking down what you need to do in order to make this dream a reality.  Set SMART goals that can be accomplished and measured each week.  In order to avoid overwhelming yourself, begin by only setting 2-3 goals a week and then as you build a record of success continue adding onto those goals.

For the rest of therapy, the therapist will check in with you each session concerning goal monitoring and progress.  For many clients, being “reactivated” is often enough to drastically reduce symptoms of depression but for others they need to address deeply ingrained core beliefs.

The main goals for phase 2 include:  

  • Collecting and analyzing data from monitoring worksheets.
  • Determining your core values and setting self-concordant goals.
  • Setting Big Hairy Audacious Goals by answering the miracle question.
  • Homework: Setting and following up on weekly goals that lead to accomplishing the dream.
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