What Is Activity Scheduling in CBT and Therapy?
Clients with depression entering treatment may have stopped engaging in activities that previously gave them a sense of enjoyment or achievement and increased other unhelpful behaviors, such as staying in bed or watching excessive TV (Beck, 2011).
However, such inactivity reduces the opportunity to gain mastery and control over their lives or experience pleasure, increasing negative thinking and a downward spiral of triggers, negative emotions, and behavior (Beck, 2011).
Behavioral activation can help clients become more active and increase engagement in their lives through the following (Behavioral Activation for Depression, n.d.):
- Understanding the negative thinking cycles of depression
- Tracking daily activities
- Identifying and defining goals and values
- Encouraging motivation and energy through mastery and pleasure
- Purposefully scheduling enjoyable and engaging activities
- Using problem-solving to overcome obstacles to activity
- Reducing avoidance behavior
- Promoting gradual and sustained change
- Using between-session homework
The process of behavioral activation typically begins with activity monitoring. The client identifies what they are doing throughout each day and its effect on their mood. This knowledge increases their understanding of which behaviors lead to positive and negative emotions and which activities maintain or worsen their depression (Behavioral Activation for Depression, n.d.).
The client and therapist can then work together to create activity schedules for the days ahead, taking care not to overwhelm the client by creating a too-busy plan.
The therapist “builds in short periods of activity with longer periods of leisure activity or rest” and encourages them to give themselves credit every time they follow the schedule (Beck, 2011, p. 93).
At the next session, the therapist asks the client how it went. Did the activity scheduling help, or were they too tired to participate in the activities? The review process can help motivate the client to find new ways to increase engagement in pleasurable and productive activities (Beck, 2011).
2 Real-Life Examples of Activity Scheduling
Activity assessment and scheduling are vital aspects of CBT and other treatments, especially when a client is presenting with symptoms of depression and withdrawing from prior activities, such as the two real-life examples below.
Sally reviews her schedule and starts activity scheduling
Beck (2011) discusses her client Sally’s daily schedule of activities to understand what has changed for her and what she may be doing too little of.
Therapist: Sally, do you notice anything different about your daily activities from say, a year ago?
Sally: Yes, I spend more of my time in bed.
Therapist: Does staying in bed make you feel better? Do you get out feeling refreshed and ready to go?
Sally: No, I still feel sleepy and down.
Therapist: I believe you used to spend time exercising, is that right?
Sally: Yes, I used to run or swim most mornings, but I’ve felt tired and didn’t think I’d enjoy it.
Therapist: Would you like to plan some exercise, perhaps going for a short run or swim three times a week?
Sally: Yes, I could commit to that.
Therapist: You could also give yourself credit for when you do such things.
Whether written down or verbal, the client makes a commitment to take part in an activity they find enjoyable.
Diane’s level of activity is impacted by her worsening mood
Farmer and Chapman (2016) introduce Diane, a 42-year-old recently divorced woman, referred because of a progressive worsening of her mood. Following marital difficulties, her depressed mood has affected her performance at work and as a mother to her two children.
Diane completed a self-monitoring exercise where she captured her activities and associated moods. Reviewing the form, it became clear that her mood changed with the activities she performed. For example, drinking wine late at night and watching the news channel accompanied a lowered mood.
The therapist suggested that Diane may benefit from scheduling more pleasurable activities. Together, they created an activity schedule that included activities like going to the movies with her friend.
Activity scheduling can replace activities that appear to lower a client’s mood with new ones associated with pleasurable emotions. Clients can track their feelings to see whether the changes are associated with better coping and more positive feelings (Farmer & Chapman, 2016).
What our readers think
At age 71, I have always been an active, engaged individual participating in numerous artistic, hobby, and church groups as well as being self-employed. I have been on several different depression medications for 10-15 years. My primary care physician has recommended CBT since before Covid, but that just adds another activity (and homework!) to an already over-filled schedule. My days, no matter what I think I have planned, are subject to instant change depending on others’ needs. After many years of all-nighters to get things done, I’m trying to get 6-7 hours sleep a night, although I still haven’t managed to do it on a regular basis. Will CBT be of any use to me?
Hi Cynthia,
It’s wonderful to hear about your active and engaged lifestyle, and your dedication to balancing your commitments with your personal well-being. Cognitive Behavioral Therapy (CBT) is a highly flexible and evidence-based approach that has been shown to be effective for a range of issues, including depression. It focuses on changing patterns of thinking or behavior that contribute to one’s difficulties, and it can be adapted to fit into a busy schedule.
Given your active lifestyle and the challenges you face with time management and sleep, CBT could indeed be beneficial. It’s designed to provide you with practical tools and strategies that can be integrated into daily life, rather than adding to your workload. For instance, CBT for insomnia could help you improve your sleep without requiring significant time commitments outside of your existing schedule. Similarly, CBT strategies can be applied to manage stress and prioritize tasks, potentially making it easier to meet your own needs alongside those of others.
However, it’s important to communicate your concerns about time and scheduling with your therapist. They can tailor the therapy to your specific situation, ensuring that it complements rather than complicates your lifestyle. Sometimes, even brief interventions or adjustments in how you approach your daily tasks and challenges can make a significant difference.
Warm regards,
Julia | Community Manager
As a new clinician in her last semester of Grad school, the worksheets, tips, and plethora of information provided on this website has been a lifesaver. Thank you!