In yesterday's post "Targeting behavioural activation better both for decreasing depression and increasing wellbeing (first post)", I suggested that there are at least three (and probably many more) interesting ways that could make behavioural activation (BA) both more targeted and potentially more effective.  I wrote about aiming BA particularly to "problem solve" triggering factors (especially interpersonal ones) that seemed to have contributed to deterioration in a subject's psychological state.  I also mentioned the recent Mazzuchelli et al paper "Behavioral activation interventions for well-being: a meta-analysis"  showing how helpful BA can also be at building wellbeing as well as treating depression.

Today I want to mention a couple of other overlapping ways that BA can be made a bit more targeted and potentially a more effective.  2.) So a further possible way to target BA better is to look at the kinds of activity - both quantitatively and qualitatively - that are associated with poorer mood.  It does seem that, in simple quantitative terms, low mood is associated with a general decrease in rewarding activities - see, for example, Hopko et al's 2003 paper "The use of daily diaries to assess the relations among mood state, overt behavior, and reward value of activities."  In qualitative terms, Hopko & Mullane - in their more recent 2008 paper "Exploring the relation of depression and overt behavior with daily diaries" - wrote that " ... this study utilized a ... behavioral coding system to directly assess whether qualitative aspects (or types) of human behavior differed as a function of depression level. Relative to non-depressed individuals, mildly depressed participants engaged less frequently in social, physical, and educational behaviors and more frequently in employment-related activities."  As I was taught "All work and no play makes Jack a dull boy"!  A good way to work this approach of increasing social, physical, and educational behaviours more methodically is to use the "Pittsburgh enjoyable activities test (PEAT)". This useful 10 item questionnaire looks broadly at both individual and social forms of enjoyable activity.  It has been shown to correlate with a whole series of both physical and psychological positive measures.  Good both for broadening one's mind about the variety of enjoyable activities to consider and for producing a score showing how the frequency of one's involvement with such activities compares with a general population.  An earlier blog post on this website - "Assessing and encouraging enjoyable activities" - gives more detail.

3.)  The other way that BA might be better targeted and more effective, that I'd like to mention today, is more specifically in the area of promoting wellbeing.  Earlier this year Sheldon and colleagues published the paper "Persistent pursuit of need-satisfying goals leads to increased happiness: A 6-month experimental longitudinal study."   The study's abstract reads "University-based community members (N=181) participated in a four-wave, 6-month longitudinal experiment designed to increase treatment participants' happiness levels. Participants were randomly assigned to set goals either to improve their life circumstances (comparison condition) or to increase their feelings of autonomy, competence, or relatedness in life (treatment conditions). We hypothesized that sustained gains in happiness would be observed only in the three treatment conditions, and that even these gains would last only when there was continuing goal engagement. Results supported these predictions and the sustainable happiness model on which they were based (Lyubomirsky et al. in Rev Gen Psychol 9:111-131, 2005). Furthermore, participants with initial positive attitudes regarding happiness change obtained larger benefits. We conclude that maintained happiness gains are possible, but that they require both "a will and a proper way" (Lyubomirsky et al. in Becoming happier takes both a will and a proper way: two experimental longitudinal interventions to boost well-being, 2009)."  This way of "aiming" behavioural activation derives both from Self-Determination Theory and also research on happiness - see, for example, this website's page "Wellbeing, time management & self-determination" and also Sonja Lyubomirsky's publications.

Note too that the blog post a little earlier this month - "Recent research: six studies on mindfulness, values & meaning" - is also relevant to thoughts about making behavioural activation more effective.