Behavioral Activation Therapy (BAT) vs. Cognitive Behavioral Therapy (CBT) for Therapists

  Wednesday, September 29, 2021

As a mental health professional, it is an unspoken part of your job to look out for new research better helps your patients. The field of psychology, like any other, is continuously evolving as we learn more about the toils and turns of the human mind. Psychologists have worked on a lot of methods that have their basis on cognitive and behavioral practices. Cognitive Behavioral Therapy (CBT) is an amalgam of treatments that focus on both cognition and behavior. CBT is used to treat multiple mental health disorders, including anxiety, depression, PTSD, etc. You may be familiar with CBT, considering there is extensive research to corroborate its popularity. 

However, another psychotherapy is slowly paving its way to the frontlines, known as Behavioral Activation Therapy (BAT). Behavioral Activation (BA) finds its basis in behavioral changes. These changes work on engaging towards positive outcomes as opposed to negative ones. 

Some psychologists consider BA as a branch of CBT and prefer the former over the latter. BA is known to treat patients with depression.

The purpose of this article is to shed light on both practices. It is to help you weigh the advantages and disadvantages of both against each other for your practice. Only when you have all the knowledge can you make an informed decision - the best decision for your patients and your practice. 

Behaviorism vs. Cognitive Psychology

Before we get into the methodologies, it is essential to understand the underlying theories of both methods. BA comes from Behaviorism, a branch of psychology that focuses on people's actions and behaviors influenced by external, environmental factors. These external factors include the consequences of these actions in the form of reward and punishment. They can be simulated in a controlled environment to condition a person's behavior. For example, imagine that you are dealing with a patient suffering from an anxiety disorder. They need to surround themselves with an environment that brings out positive consequences when faced with their anxieties. These positive outcomes will fuel their desire to change their behavior. Of course, to the change that orients them with that outcome. Behaviorists are interested in seeing a behavior change, and so focus on the stimulus and response. All of the above is also a part of Behavior Learning Theory. 

On the other hand, Cognitive Psychology finds its basis in mental processes, motivation, logical reasoning, positive and negative thoughts, etc. Unlike behaviorism, it focuses on internal processes and changing one's thoughts before actions come into play. Cognitive psychotherapy methods are effective in treating anxiety, depression, PTSD, personality disorders, etc. Your patient suffering from an anxiety disorder can wholly benefit from cognition-based therapies. Essentially you would work with the patient in developing techniques to control their thoughts and feelings. They would practice mindfulness and learn to deal with emotions as they come. Cognitive specialists believe the biggest weapon one has in their arsenal is their attitude. A positive attitude influences emotions, actions, and of course, behavioral patterns.

How Does Behavioral Activation Work?

The concept behind BAT is to enforce activities that promote pleasurable and favorable outcomes and decrease activities that induce negative thoughts and behaviors. Essentially, BA is more of an analysis of what your patient does and requires closely tracking the progress to move further on with therapy. BA is an iterative process that starts with interviewing the patient. It is essential to understand your patient's values and capabilities and tailor the treatment accordingly. As their therapist, ask about their depression journey and what it's been like for them. That leads to the next step, which is creating a Behavioral Model. 

A behavior model is a personalized view of the actions and behavioral patterns of the patient. As a therapist, you can conceptualize and interpret a person's iterative actions that lead them to develop depression or any other disorder. Through that model, a therapist can identify which behaviors to promote and which ones to eliminate. It is crucial to keep track of a patient's progress. They can keep track of their progress as well through journaling. An online daily journal will give them an introspective look at the treatment, and they can gauge how much harder they need to work. 

Techniques used in BA are: 

  • Activity and mood self-monitoring
  • Scheduling activities
  • Problem-solving
  • Training in social skills
  • Ranking how easy certain activities are to accomplish
  • Training healthy behaviors
  • Risk and Reward Measurement
  • Examining different aspects of your life

How does Cognitive Behavioral Therapy Work? 

The foundation of CBT is an understanding of how certain ways of thinking can lead to negative ideas that can affect a person's behavior. It is not as intrusive as its predecessors, but softer. CBT is a talking treatment that is based on the therapist and patient's mutual trust. CBT carries very little danger, yet it may be uncomfortable for your patients as they confront their negative sentiments. This is why going at a slower pace and sticking to a plan will help them heal faster. To improve the efficacy of CBT, you must follow particular steps:

  1. Encourage your patients to recognize troublesome situations in their lives. Assist them in recognizing the patterns of behavior that emerge in such situations.
  2. Once you've identified the triggers, ask your patients how they feel about the emotions and ideas that go along with them. They'll need to keep track of their thoughts, which can be done easily with the help of a daily online journal.
  3. Encourage your patients to be aware of any negative retaliations or behaviors that may arise as a result of being provoked. They must be able to identify damaging activities and categorize them as negative.
  4. Encourage your patients to look at their issues objectively and come up with strategies for changing their negative beliefs.

The final step is difficult, but with practice and comprehensive information, you can teach your patients good thought patterns and actions that can help them break free from stress spirals or overthinking, which can lead to anxiety attacks.

Comparison of Both Techniques

There's no doubt that both of these psychotherapies have their merits, and either one has been proven to be successful in treating different mental disorders. However, for the sake of your practice, it is good to know the pros and cons of both of them. This way, you can recommend your patient the best therapy treatment possible. 

Some psychotherapists prefer BAT over CBT for the following reasons: 

  • Behaviors are easier to predict and therefore control when compared to thoughts and feelings
  • It is less costly
  • The theories supporting behaviorism are simpler and therefore easily understood by patients
  • Some therapists believe that the reason CBT is so effective is that it encompasses aspects of behaviorism

On the other hand, CBT also has its benefits. Others prefer CBT because:

  • There is extensive research to back up the treatment
  • There are many techniques developed in CBT. With BA, you may feel the list is currently insufficient in terms of variety
  • CBT is also widely known amongst the mental health community. Hence it is easier to teach and compare notes on
  • With BA, a therapist may unknowingly project or try to influence a patient's behaviors based on their own.

Even though CBT is older, BA has recently shined in front of the mental health community with promising results. It is up to you as a therapist to weigh the pros and cons of each and decide what is best for your patient at that moment. Extensive research on the matter will help. You can even get certified to apply some of these techniques. 

There is also an option of offering your patient a mixture of both BA and CBT. Remember with both, it'll be good for your patient to be journaling on line to keep track of their progress. This is a good way for them to be on top of their recovery. With both techniques, remember that it needs to be centered on your patient and their personality. If someone is quickly responding to one treatment, it does not mean that it will work for everyone else. This is a good time to listen to your instincts. 

Lastly, here is a general outlook on the topic of BA. Positive reinforcement is an important feature of Behavioural Activation, especially in social circumstances. This means that how we respond to those who are depressed around us can have a significant impact on their mood in the near term as well as their long-term health.

While we all have a lot on our minds at any given time, we should also consider how we react to the healthy and harmful actions of those we care about. Reinforcing a friend's healthy habits could be the key to their recovery from mental illnesses like depression.

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