Behaviours – Changing Actions to Support Positive Change

In Cognitive Behavioural Therapy (CBT), changing unhelpful behaviours is a core component of achieving positive, lasting change. While addressing negative thoughts is important, our behaviours can also maintain or reinforce cycles of anxiety, depression, and low motivation. By adjusting behaviours, we disrupt these cycles and create new pathways that foster well-being.

Behavioural changes in CBT are especially effective for conditions like depression, where low energy and motivation often lead to withdrawal, or for anxiety, where avoidance of feared situations prevents growth. This chapter explores techniques such as behavioural activation, exposure therapy, and activity scheduling, each aimed at transforming behaviours to break free from negative cycles.

1. Behavioural Activation for Depression
   Behavioural activation is a powerful technique used to counteract the withdrawal and low motivation common in depression. When we feel low, we tend to withdraw from activities that might otherwise provide joy, support, or stimulation. Behavioural activation involves intentionally engaging in small, enjoyable or meaningful activities, even when motivation is low, to lift mood and increase positive experiences.

   • Example: If feeling down, start with a small action like taking a walk or calling a friend. This action, although simple, can break the cycle of inaction and improve mood.

   • Application: This technique works well for individuals experiencing depression, as it encourages engagement in activities that can boost mood and shift negative thought patterns over time.

2. Exposure Therapy for Anxiety
   Anxiety often leads to avoidance, a behaviour that reinforces fear and increases anxiety over time. Exposure therapy is a systematic approach that involves gradually facing feared situations or stimuli in a controlled manner. By experiencing these situations without catastrophic consequences, the individual gradually learns that they can handle the discomfort.

   • Example: For someone with social anxiety, start by speaking to a familiar person in a small group, then gradually move on to larger, less familiar settings. This incremental approach reduces anxiety and builds confidence over time.

   • Application: Exposure therapy is especially effective for specific phobias, social anxiety, and panic disorder, helping individuals reduce avoidance and gain a sense of mastery over their fears.

3. Activity Scheduling for Structure and Motivation
   Inactivity and a lack of structure often reinforce low mood and anxiety. Activity scheduling involves planning out small, achievable tasks each day to create a sense of control, progress, and accomplishment. By filling time with meaningful or satisfying activities, we create positive experiences and build a sense of routine, which can be particularly helpful during periods of low motivation.

   • Example: Schedule simple tasks, such as preparing a meal or reading a chapter of a book. These small actions build a sense of progress and achievement.

   • Application: This technique benefits individuals dealing with depression, low motivation, or anxiety, as it encourages engagement and can reduce the feelings of overwhelm that often accompany these states.

• Managing Depression through Behavioural Activation
  Depression often causes individuals to avoid activities that they previously enjoyed, leading to isolation and reinforcing feelings of worthlessness or hopelessness. Behavioural activation provides a structure to gradually re-engage with activities that bring fulfilment or joy, helping to shift the depressive cycle.

  • Steps:

    • Identify activities that once brought enjoyment or meaning (e.g., listening to music, spending time in nature).

    • Start with low-effort, enjoyable tasks, such as sitting outside or calling a friend.

    • Gradually increase engagement over time, building up to activities that require more effort or social interaction.

• Reducing Social Anxiety through Exposure Therapy
  Social anxiety can lead to avoidance of social interactions, creating a cycle where the fear of social situations grows stronger. Exposure therapy can help reduce this avoidance by introducing social interactions in small, manageable steps.

  • Steps:

    • Begin with safe, low-pressure social interactions, such as talking to a familiar person in a small group.

    • Gradually increase the challenge by moving to less familiar groups or larger settings.

    • Record experiences after each exposure, noting any successes or unexpected positive outcomes.

• Increasing Motivation through Activity Scheduling
  When motivation is low, as it often is in both anxiety and depression, inactivity can take over, leading to feelings of aimlessness or frustration. Activity scheduling creates structure and provides a roadmap for engaging in activities that bring satisfaction or fulfilment, promoting positive mood changes over time.

  • Steps:

    • Plan small, achievable tasks each day, even if motivation feels low.

    • Begin with simple actions, like tidying a small area or preparing a favourite meal.

    • Over time, expand the schedule to include more activities that contribute to a sense of progress or connection.

Reflecting on these questions can help you understand how your behaviours impact your mood and motivate you to make positive changes:

1. What behaviours might reinforce your current thought patterns or feelings?
   Think about any avoidance, withdrawal, or inactivity that might be strengthening negative cycles. Are there specific actions (or lack thereof) that contribute to low mood or anxiety?

2. When feeling low or anxious, what small action might provide a sense of control?
   Consider one action that could break the cycle of inaction, such as calling a friend, taking a walk, or engaging in a creative activity. How might this small step help shift your mood or mindset?

These exercises are designed to help you apply CBT’s behavioural techniques to break unhelpful patterns and reinforce positive change.

1. Behavioural Activation Exercise
   For this exercise, make a list of three small, enjoyable activities that are easy to accomplish. Commit to doing one each day for the next week, regardless of how you feel. Track your experiences and any changes in mood or energy after each activity.

   • Steps:

     • Write down three small activities you enjoy or find fulfilling, such as reading a chapter of a book, listening to a favourite song, or taking a short walk.

     • Schedule one activity each day, making it a priority regardless of motivation level.

     • After completing each activity, reflect on how it made you feel, noting any shifts in energy, mood, or motivation.

   Example Entry:

   • Activity: Took a 10-minute walk in the park.

   • Mood Before: Low energy, unmotivated.

   • Mood After: Slightly refreshed, a bit more positive.

   Reflect at the end of the week on how engaging in small activities impacted your overall mood. Did you notice any benefits from doing enjoyable activities, even when motivation was low?

2. Exposure Practice
   For individuals dealing with social anxiety, avoidance behaviours can reinforce fear and reduce confidence. This exercise involves taking a gradual step toward a feared situation, starting with low-stakes scenarios. The goal is to build confidence in facing anxiety-provoking situations over time.

   • Steps:

     • Identify a feared situation, such as talking to strangers, making phone calls, or speaking up in groups.

     • Break down this situation into smaller steps, beginning with the least intimidating scenario.

     • Choose a small, manageable step to complete this week, like talking briefly with a familiar person or making a quick phone call to a friend.

     • After completing the step, reflect on how the experience felt and note any successes or positive surprises.

   Example:

   • Feared Situation: Making phone calls.

   • Step 1: Practice calling a friend or family member to talk briefly.

   • Reflection: Felt nervous but accomplished the call. Realised it was less intimidating than expected.

   Repeat this process, gradually working up to more challenging situations, such as making a call to an unfamiliar person or speaking up in a larger group. Note any changes in anxiety levels over time as you gain exposure.

3. Activity Scheduling Exercise
   Activity scheduling helps create structure, especially during periods of low motivation or high anxiety. Start by planning simple, achievable tasks for each day of the week, focusing on activities that contribute to a sense of progress, control, or enjoyment.

   • Steps:

     • Choose one small task each day that provides a sense of control or fulfilment. These tasks could include tidying up a space, preparing a meal, or engaging in a hobby.

     • Schedule a specific time for each activity, treating it as a non-negotiable commitment.

     • At the end of each day, reflect on how completing the activity impacted your mood or sense of accomplishment.

   Example Schedule:

   • Monday: Prepare a healthy breakfast.

   • Tuesday: Call a friend for a brief catch-up.

   • Wednesday: Read a chapter of a book.

   • Thursday: Go for a 10-minute walk outside.

   • Friday: Watch a favourite movie or listen to relaxing music.

   Review your activity log at the end of the week to observe any patterns in mood or motivation. Did planning out daily activities help create structure? Did you feel more positive or accomplished?

In this chapter, you learned about the importance of changing behaviours to break negative cycles in CBT. Techniques such as behavioural activation, exposure therapy, and activity scheduling provide practical tools for improving mood, reducing anxiety, and increasing motivation. By incorporating these behavioural changes into your routine, you can create positive feedback loops that build resilience and reinforce a sense of control. Each small step reinforces the idea that behaviours, even when they feel challenging, can significantly impact well-being