Behavioral Activation for Depression: A Clinician's Guide

The guide Behavioral Activation for Depression sets out with a formidable task: to teach new-found recruits as well as the seasoned professional to provide behavioral therapy comfortably and effectively in whatever field they choose to practice. In this vein, the authors succeed, and given the caliber of the professionals behind the work, this is hardly surprising. Dr. Martell is a distinguished practitioner in both clinical psychology and behavioral psychology through the American Board of Professional Psychology and is a founding fellow of the Academy of Cognitive Therapy. Dr. Dimidjian has researched extensively in the treatment and prevention of depression among pregnant women as well as in the postpartum period. She is a leading expert in cognitive and behavioral approaches to depression and is widely published in the area of behavioral activation. Dr. Herman-Dunn is in private practice and has been a research therapist on several large randomized clinical trials for behavioral therapy.

To the outsider, behavioral therapy seems almost intuitive. Its basic principle, which is reiterated throughout the book, is “just do it.” The idea is simple; if you get up, get active, and do the things you're avoiding, you'll feel better. However, people with ties to the patient have probably already given this advice, so how does a therapist help facilitate this change? Most practitioners have recommended, for example, that patients exercise or reconnect with old friends—with little result. The answer, it seems, is to help the patient formally schedule activities and then work together to overcome obstacles. It is important as well to assign homework, as is done in cognitive-behavioral therapy, because the patient can frequently get off track if he or she is not closely monitored. This approach is in the trend of the research in the field, and this book is certainly a useful addition to the field of knowledge.

This work is clearly a labor of love, and its strengths shine through. Multiple patient scenarios are explored, including one theoretical patient present from start to finish, who works through resistance and finally achieves success. Step-by-step instructions are provided as well as detailed examples of possible homework assignments and how a patient might complete them, with mood-monitoring exercises and tips to overcome obstacles. Helpful hints are provided to help the therapist derail ruminations and maintain activation. The style of the book is short and succinct, and each chapter provides helpful summaries. At fewer than 250 pages, it is easily digestible, even for the busiest of practitioners.

The book overall is very good, but a few suggestions are noted here for future editions. Some of the patient interactions are unrealistic and unbelievable, eliciting the occasional raised eyebrow from the reader. The example homework assignment sheets are printed in an appendix in the back in type that is too small. This arrangement does not allow the sheets to be easily photocopied for use, even though the book grants permission for a purchaser to do so. With a scanner, worksheets can be blown up to usable size, but this is cumbersome and frustrating for the less technically savvy. Overall, however, the book is an excellent tool for those who wish to practice behavioral activation. I find myself doing many of the recommended exercises myself when I can't sleep or when the anxieties of work become overwhelming, and my patients have benefited from these exercises as well. Behavioral Activation for Depression is well written and easy to read, and it would be a helpful addition to the library of most therapists. It could easily be used as a teaching tool in therapy classes for psychologists and psychiatrists alike. I highly recommend giving it a read.