Behavioral Activation Group Therapy Therapist Manual


Assessment of In-session Behavior



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Assessment of In-session Behavior

Purpose: To observe first-hand both the depressive behaviors, as well as the healthy behaviors, that the patient engages in during the therapy session. These observations can be brought up as they are made or at a later time. This is an effective way of demonstrating the functional relationships between environment, behavior and its consequences.


Method: Observe the patient’s behavior in terms of the typical symptoms of depression as well as in terms of generally unhealthy behavior. Observe the patient’s behavior in terms of healthy and productive behavior. Examine what is happening when problem behaviors or healthy behaviors occur and what the results of the behaviors are.
Example:

A patient is talking during the session and is interrupted by another group member. The patient who was interrupted begins pouting and crying during the session. The therapist notes to her/himself what occurred and how the patient reacted. This information can be used at a later time to demonstrate the functional relationships between the environment, behavior, and its consequences.


NOTES:

Intervention Techniques


Assigning Activities to Increase Sense of Mastery or Pleasure
Purpose: To activate the patient in such a way that s/he feels more effective in her/his environment and consequently receives more pleasure from activities.
A) Activities that are likely to improve negative aspects of the environment or ones that were previously (prior to the onset of the depression) reinforcing.

Example: The patient used to enjoy playing the piano but since being depressed, has stopped playing. The therapist might contract with the patient to play again and discuss possible obstacles to playing that may hinder performance. Such obstacles might be decreased skills due to not playing for a long time or due to the depression. The patient might also have more difficulty than usual concentrating for a prolonged period. It is important to communicate that these obstacles are to be expected and that they are normal due to the current depressed condition.

B) High probability activities: activities that are likely to occur, initially solitary activities that are within the patient’s control. It is important to set the patient up for success, not failure.

Example: The patient contracts to take a 15-minute walk each day before the next session. Or the client agrees to bake herself a favorite meal for dinner Thursday night.

Activities that involve the cooperation and participation of others should be used cautiously at first, as they present a greater risk for failure due to their dependence on another person(s).

C) Activities from lists of pleasurable events, either ones currently pleasurable or ones that at least at one time have been pleasurable. This information can be obtained from having the patient complete a Pleasant Events Schedule (possible homework assignment).

NOTES:




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