Behavioral activation flips the script on depression: you do things in order to feel better instead of waiting for motivation that never comes. The heart of it is practicing setting small goals and meeting them, shrinking the goals when they are missed, and it ranks with exercise, light and psychotherapy among the most important treatments for depression.
What it is
Depressed patients wait to get motivated and the motivation never comes. Behavioral activation flips the script: you do things in order to start feeling better, not the other way around.
“Essentially, they wait to get motivated and the motivation never comes. And what I try to teach patients is I want to almost flip the script. I want you to say, I'm going to engage in this activity so that I feel better”
43:21What Patients Should Know When Diagnosed With DepressionSep 2026 Also said in 1 more episode
“behavioral activation is trying to tell you that you're not going to it's not that you wait to feel better before you do things. It's you have to do things to start feeling better. So it's really flipping the script in that”
10:24Beyond Medications: The Best Lifestyle Treatments for Mental HealthFeb 2025 Act like a non-depressed person as much as you can handle, even if it feels bad and you do not enjoy it, on top of medication, to speed recovery. That is the core of behavioral activation, or fake it till you make it.
“you have to essentially act like a non-depressed person, even if it feels bad, even if you don't enjoy it, to the extent that you can handle it, on top of the medications to really speed the recovery from a depressive episode”
43:26Handling Difficult Situations in Psychiatry: ADHD Evaluations, Benzo Requests, Disability Claims, and Involuntary AdmissionsOct 2025 Also said in 1 more episode
“these are kind of the core principles of behavioral activation or, said in a quote, fake it till you make it”
43:40Handling Difficult Situations in Psychiatry: ADHD Evaluations, Benzo Requests, Disability Claims, and Involuntary AdmissionsOct 2025 The most important part is the practice of setting goals and then achieving them. It sounds silly, but that alone can be encouraging.
“I think the most important part of behavioral activation is the practice of setting up goals and then achieving them. OK, I know it sounds silly, but even doing that can be an encouraging process”
8:12Beyond Medications: The Best Lifestyle Treatments for Mental HealthFeb 2025 Behavioral activation, exercise, light exposure and psychotherapy are the most important 'medications' for depression.
“the most important, quote, medications for depression are behavioral activation, exercise, light exposure, and psychotherapy”
43:39Treating Depression: Practical Tips & Pearls for Anti-Depressant MedicationsJan 2025
How we use it
To find goals, ask what they used to enjoy before they felt this way, and if there is no good answer, what they would like to be doing.
“I'll ask questions like, what did you used to enjoy before you felt this way in the past? And if there's no good answer there, what would you like to enjoy? What would you like to be doing”
13:22Beyond Medications: The Best Lifestyle Treatments for Mental HealthFeb 2025 Another approach is to skip the expectation of enjoyment entirely. Hope they enjoy it, but base the goal on what they are willing to do.
“I don't want to set people up to expect to enjoy things at all. I hope they enjoy it. But I want them to act without the expectation of enjoyment. So I just I just base it off. What are you willing to do”
15:28Beyond Medications: The Best Lifestyle Treatments for Mental HealthFeb 2025 Pair it with morning light: ask patients to make a goal of getting out every morning and walking around in daylight.
“I do this to combine light exposure with behavioral activation, something that we know to be effective for depression. And I simply ask patients to make a point, make a goal to get out every morning and walk around in the daylight”
20:48The Deficit Model in Psychiatry & Difficult to Treat Depression with Dr. Chris Aiken | Episode 18Mar 2025 Build sleep into it. The aim is not just more sleep but a habit of sleeping at night and being active during the day, and being well rested enough to do it.
“I don't just want them sleeping more. I want them starting to get into a habit of sleeping at night and being active during the day. I try to build that into the behavioral activation component and making sure that they're well-rested”
42:33Insomnia and Sleep Medications in PsychiatryDec 2024
Talking to patients
The point is to set goals, however small, and accomplish them. If they are not being met, make the goals even smaller, so the plan does not add more stress.
“The real point of this is to set goals however small and accomplish them. And if you find that you're not accomplishing them, make the goals even smaller because we don't want to produce even more stress over not setting goals”
44:38What Patients Should Know When Diagnosed With DepressionSep 2026 Plan goals expecting that you may not follow through, and that is OK. Simply putting the goal down is the first step.
“i also encourage patients to act anticipating failure. I want you to plan these goals with the understanding that you may not follow through with them, and that's okay. Simply putting the goal down is the first step”
11:38Beyond Medications: The Best Lifestyle Treatments for Mental HealthFeb 2025
It also comes up on
- Circadian rhythmLight exposure is accessible, low harm and low cost, and it weaves into sleep regulation, behavioral activation and exercise at once.
- Light therapyIt is accessible, low harm and low cost, and it weaves into sleep regulation, behavioral activation and exercise at once.
- MindfulnessReach for it, think about it and counsel on it the way you would CBT-I or behavioral activation. Your options are not just medication prescriptions.
From these episodes
- What Patients Should Know When Diagnosed With DepressionSep 2026 · 2 points
- Handling Difficult Situations in Psychiatry: ADHD Evaluations, Benzo Requests, Disability Claims, and Involuntary AdmissionsOct 2025 · 2 points
- The Deficit Model in Psychiatry & Difficult to Treat Depression with Dr. Chris Aiken | Episode 18Mar 2025 · 1 point
- Beyond Medications: The Best Lifestyle Treatments for Mental HealthFeb 2025 · 5 points
- Treating Depression: Practical Tips & Pearls for Anti-Depressant MedicationsJan 2025 · 1 point
- Insomnia and Sleep Medications in PsychiatryDec 2024 · 1 point
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.