If you’re feeing tired, getting back in to activities can help

behavioural activationBehavioural activation is a relatively simple treatment that aims to help people understand the relationship between what they do and how they feel. The aim is for people to identify behaviours that help them feel good and more energetic and then look at changing what they do on a day-to-day basis, incorporating more of those activities. Small gradual steps to put them back in touch with the things in their world that are healthy and subsequently they change how they feel.

What is behavioural activation?

People with conditions that cause a lack of energy or motivation such as depression, pain, chronic medical conditions or fatigue syndromes, often stop doing a range of activities such as exercise or catching up with friends. These activities are an important part of feeling good about themselves, and stopping them because of a lack of motivation or energy, can start a vicious cycle of feeling even more tired or depressed. There is good research showing behavioural activation is an effective treatment for depression, and it has also been used in fatigue syndromes such as chronic fatigue syndrome.

In a practical sense, behavioural activation encourages increased engagement in life’s activities.  The treatment aims to help people identify obstacles to daytime activities and discusses how to overcome these obstacles.  Behavioural activation can easily be integrated into other psychological treatments such as cognitive behavioural therapy (CBT) when depression or fatigue are associated with significant reduction in activities.  Used in such situations, behavioural activation can help break the vicious circle connecting low level of activity to physical deconditioning, which further reduces activity level.

  • Exercise is a specific form of behavioural activation that has shown efficacy for pain management and reduction of daytime fatigue.  Moderate exercise (55% to 75% of heart rate maximum) is safe and well tolerated by many patients with medical comorbidities.  It effectively reduces fatigue during and after various forms of medical treatment.  In the context of pain, paced behavioural activation and moderate exercise are often included for pain management.
  • behavioural activationOther nurturing activities such as catching up with friends, or going out are also forms of behavioural activation. These are activities that could be considered nurturing, or energy giving, that people often stop doing if they aren’t feeling well. Even though some of these activities may temporarily cause more tiredness or disrupt sleep patterns, there can be a significant benefit for people in re-engaging with normal life activities.

What is behavioural activation used for?

Behavioural activation has been used for a range of conditions that cause people to withdraw from many of life’s activities either because of a lack of energy, perceived inability to do the activity or lack of motivation. These conditions include:

  • Depression: a recent paper in The Lancet showed that behavioural activation can be an effective treatment for depression, with similar effectiveness to cognitive behavioural therapy (CBT).
  • Fatigue: is very common in people undergoing cancer treatment or post-cancer treatment. A meta-analysis of 22 studies, showed increased vigour post-treatment and improved physical fitness with behavioural activation. Fatigue due to syndromes such as chronic fatigue syndrome (CFS) can be improved with behavioural activation, as in this study, but because of the large variation in symptoms and functional capacity in CFS, behavioural activation should be under-taken cautiously under the supervision of a team used to working with people with CFS.
  • Pain: A meta-analysis of  25 studies in adults with pain showed that behavioural activation improved pain and coping mechanisms. A Cochrane review looked at the impact of behavioural activation with physical activity on pain and fatigue symptoms in people with fibromyalgia, and showed improvements in quality of life and pain and reduction of other symptoms of fibromyalgia.

Although very little research on behavioural activation for sleep disorders has been done, people with sleep disorders can have tiredness and fatigue as well as alterations in mood. So it makes sense that behavioural activation should help people with sleep disorders to reduce the impact of tiredness and fatigue symptoms as well as help to improve mood. For this reason, behavioural activation is a technique I will often incorporate in to treatment for sleep disorders such as insomnia and hypersomnias.

How can I go about behavioural activation?

If you are interested in using behavioural activation, it would be good to discuss it with your health professional. They will be familiar with other aspects of your health and ensure what you plan to do fits in with your overall health and abilities. It’s also helpful to have someone who knows you and your health to help coach you along the way and troubleshoot any difficulties you may have.

Once you have your health professional on board you can:

  1. Identify activities that you could plan to put back in to place as part of your behavioural activation program using this worksheet. The aim of this step is to develop a working list of activities to pick from that you will aim to build in to your schedule.
  2. Plan activities using this task planner. Following the example on the last page of the task planner, choose some activities from your activity selection worksheet to build in to your weekly schedule. Don’t put too many activities in all at once, and start with activities that you think are achievable rather than those you rank as the hardest to achieve. You can build up to those.

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