Intervention Spotlight: Behavioral Activation

By Christine Larsen, MS, LBS, Behavioral Health Manager

As this colder-than-average winter comes to a close, how many times have you had the thought “I’ll [fill in the blank] once it gets warmer”? Putting things off until we feel like doing them doesn’t always yield the best outcomes.  Behavioral Activation is a facet of Cognitive Behavior Therapy that’s used for Depression. Individuals with intellectual disabilities and Autism are more likely to experience mental health symptoms than the general population. They may also struggle with rigidity, making it even harder to break out of a depressive rut—but sometimes changing our behavior is the first step towards improving our mood!

When people procrastinate on going to the gym; making plans with friends; or getting that mountain of laundry done, they’re using avoidance and withdrawal as an immediate negative reinforcer, which will only provide temporary relief for their Depression. It’s easy to say “I’ll wait until I’m in a better mood”, but sometimes it takes engaging in the very actions we’re avoiding in order to start feeling better long-term. Inaction begets inaction, but fortunately, doing things usually results in doing more things!

Here are some tips for using Behavioral Activation with individuals who have ID or Autism:

Resources: ‍‍

PCHC Health Fair Activities Guide

Weekly Schedule for Behavioral Activation

Feelings cards; naming feelings‍‍

• Start small.  Big changes can be overwhelming! Setting a goal to attend a day program for one hour once a week is better than not going at all. New goals can be set after thecurrent one is achieved. Once a person notices that they feel better getting out every day, being social, and engaging in fun activities, the task will become less daunting and just a regular part of their routine.
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• Use pairing.  Individuals with ID and/or Autism might have trouble seeing “the big picture”. Therefore, they would likely benefit from a little motivational nudge in the form of pairing a new or intimidating routine or habit with something familiar and highly preferred (for example, “Let’s take a walk in the park, then for lunch we can go to your favorite restaurant”). Over time, they will be used to getting up and going out, and won’t need extra motivators.  
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• Track mood.  Use concise words or pictures to help individuals identify and label their moods several times a day. Help them make connections between positivemoods and their activities so they can see for themselves how changing your behavior can change your mood. You can also offer encouraging reminders, such as “I know you’re feeling tired, but you usually love going to your friend’s house and feel so happy and energized afterwards”.