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English — Official English version of behavioral-activation.

Behavioral Activation (English)

Activity planning, mood-activity diary, and values-based activity selection: Counteracting the vicious cycle of inactivity and low mood

See: ETHICS.md

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Context

Behavioral Activation (BA) is an evidence-based intervention from behavioral therapy for treating depression. It is based on the insight that depression leads to withdrawal and inactivity, which further worsens mood (vicious cycle). Through targeted building of positive activities, this cycle is broken.

Evidence: Behavioral activation is effective as a standalone therapy and is equivalent to cognitive therapy (Dimidjian et al. 2006, Richards et al. 2016 COBRA study). Recommended as first-line intervention for mild to moderate depression (NICE Guidelines).

Note: This is support, not a substitute for professional therapy. For severe depression or suicidal thoughts, ALWAYS recommend professional help. Never implement: EMDR, Prolonged Exposure (PE), Narrative Exposure Therapy (NET)

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1. The Behavioral Activation Model of Depression

The Vicious Cycle

Triggering situation (loss, stress, change)
        |
        v
Low mood, lack of energy
        |
        v
Withdrawal, avoidance, inactivity
        |
        v
Fewer positive experiences, isolation
        |
        v
Even deeper low mood
        |
        v
Even more withdrawal ... (downward spiral)

The Counter-Principle

Targeted activity (even with low motivation)
        |
        v
Positive experience / sense of accomplishment / connection
        |
        v
Slight mood improvement
        |
        v
Somewhat more energy and motivation
        |
        v
Further activity ... (upward spiral)

Core principle: Don't wait for motivation to come — action creates motivation. "Act first, feel second." (Not: "Feel first, then act.")

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2. Mood-Activity Diary

Goal

Make connections between activities and mood visible. Recognize which activities improve mood and which worsen it.

Diary Format

MOOD-ACTIVITY DIARY

Date: [...]

| Time  | Activity | Mood (0-10) | Enjoyment (0-10) | Importance (0-10) |
|-------|----------|-------------|-------------------|---------------------|
| 07:00 | Got up, had breakfast | 3 | 2 | 5 |
| 08:00 | Work: emails | 4 | 1 | 6 |
| 10:00 | Walk | 6 | 5 | 4 |
| 12:00 | Lunch with colleague | 7 | 6 | 7 |
| 14:00 | Work: project | 5 | 3 | 7 |
| 18:00 | Watching TV (alone) | 3 | 2 | 1 |
| 20:00 | Phone call with friend | 6 | 5 | 8 |

Daily mood average: [...]
Best activity today: [...]
Insight: [...]

Weekly Review

Guiding questions:

• Which activities regularly lift my mood?
• Which activities lower my mood?
• Are there times that are particularly difficult?
• How much time do I spend on pleasant vs. unpleasant activities?
• Which activities have I been avoiding?

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3. Activity Planning

Step 1: Create Activity List

Collect three categories of activities:

A) Pleasant Activities (joy, enjoyment)

• Nature: Walk, park, forest
• Social: Meet friends, phone calls, cook together
• Creative: Music, painting, writing, crafting
• Physical: Sports, yoga, dancing, swimming
• Enjoyment: Cook favorite meal, read a book, listen to music
• Relaxation: Take a bath, meditation, breathing exercise

B) Necessary Activities (structure, self-care)

• Household: Tidying up, cooking, shopping
• Personal care: Showering, getting dressed, brushing teeth
• Administration: Bills, appointments, paperwork
• Health: Doctor's appointments, medication, nutrition

C) Values-Based Activities (meaning, significance)

• See section 4 below

Step 2: Create Weekly Plan

WEEKLY PLAN

| Day | Morning | Midday | Afternoon | Evening |
|-----|---------|--------|-----------|---------|
| Mon | [...]   | [...]  | [...]     | [...]   |
| Tue | [...]   | [...]  | [...]     | [...]   |
| Wed | [...]   | [...]  | [...]     | [...]   |
| Thu | [...]   | [...]  | [...]     | [...]   |
| Fri | [...]   | [...]  | [...]     | [...]   |
| Sat | [...]   | [...]  | [...]     | [...]   |
| Sun | [...]   | [...]  | [...]     | [...]   |

Planning Rules

1. Start small: Don't plan the whole day, but 1-2 activities per day
2. Mix: Pleasant + necessary + values-based
3. Specific: "Tuesday 3:00 PM walk in the park" instead of "Move more"
4. Realistic: Achievable even with low energy
5. Flexible: Plan is guidance, not obligation
6. Graduated: For very low energy: mini-steps (5 minutes is enough)

Dealing with Obstacles

Obstacle	Strategy
"I have no energy"	Reduce activity to 5 minutes
"I don't feel like it"	Reminder: motivation comes through action
"It won't help anyway"	Experiment: try it and measure mood afterward
"I can't do it alone"	Involve someone (appointment = commitment)
"I don't have time"	Build in small activities (take stairs, 5 min break outside)

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4. Values-Based Activity Selection

Principle

Activities that align with personal values create sustainable well-being — as opposed to mere pleasure, which fades quickly.

Life Domains and Values

VALUES COMPASS

Relationships:     What kind of partner/friend/family member do I want to be?
Work/Education:    What is important to me about my work?
Leisure:           How do I want to spend my free time?
Health:            How do I want to treat my body?
Community:         What contribution do I want to make?
Personal:          What kind of person do I want to be?

Values-Activity Mapping

Example:

Value	Activity	Frequency
Connection	Call a friend	2x per week
Health	20 min walk	Daily
Creativity	Play guitar	1x per week
Helpfulness	Help neighbor with shopping	1x per week
Learning	15 min reading non-fiction	3x per week

Values vs. Goals

• Value: A direction you want to move toward (e.g., "being a loving partner")
• Goal: An achievable endpoint (e.g., "plan anniversary celebration")
• Values can never be "checked off" — they provide ongoing orientation

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5. Measuring Progress

Weekly Review

WEEKLY REVIEW

Week: [Date]
Planned activities: [Number]
Completed activities: [Number]
Average mood: [0-10]

What went well: [...]
What was difficult: [...]
Insight of the week: [...]
Plan for next week: [...]

Long-Term Tracking

• Observe mood trends over weeks
• Recognize the connection between activity level and mood
• Make successes visible (even small ones)

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Ethics and Boundaries

An AI assistant may:

• Guide through the diary and activity planning
• Suggest activities (never prescribe)
• Document mood data and reflect back patterns
• Accompany values reflection
• Acknowledge small progress

An AI assistant must NOT:

• Be the sole support for severe depression
• Make medication-related recommendations
• Assess suicidality
• Make diagnoses
• Guarantee that behavioral activation is sufficient

Important: For severe depression (persistent lack of drive, suicidal thoughts, inability to manage daily life), professional help is essential. Behavioral activation is a complement, not a substitute.

In case of acute crisis, ALWAYS refer to:

• 988 Suicide & Crisis Lifeline (US): 988
• Crisis Text Line (US): Text HOME to 741741
• Samaritans (UK): 116 123
• Telefonseelsorge (DE): 0800 111 0 111 / 0800 111 0 222
• Emergency services: 911 (US) / 112 (EU)

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Ported from BACH v3.8.0 | Standalone Version Sources: Martell et al. (2010), Dimidjian et al. (2006), Richards et al. (2016) — Not professional therapy