The activities we engage in influence how we feel.
And yet, when depressed, clients often find themselves unable to do those things that bring enjoyment and meaning to their lives (Behavioral Activation for Depression, n.d.).
Behavioral activation is a crucial aspect of Cognitive-Behavioral Therapy, helping shed light on how the client’s behaviors influence their emotions (Beck, 2011; Farmer & Chapman, 2016).
Once understood, activities can be scheduled that improve the client’s mood and lessen their experience of emotional distress or depression.
This article explores activity scheduling as part of behavioral activation while introducing tools and worksheets for use in treatment.
Before you continue, we thought you might like to download our three Positive CBT Exercises for free. These science-based exercises will provide you with detailed insight into positive Cognitive-Behavioral Therapy (CBT) and give you the tools to apply it in your therapy or coaching.
This Article Contains:
- What Is Activity Scheduling in CBT and Therapy?
- 2 Real-Life Examples of Activity Scheduling
- Does It Work? 4 Proven Benefits
- How to Do Activity Scheduling: 6 Tips
- 6 Best Templates & Worksheets
- Are There Helpful Apps and Software?
- Useful Resources From PositivePsychology.com
- A Take-Home Message
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).
Does It Work? 4 Proven Benefits
Activity scheduling has proven effective at reducing symptoms in various mental health conditions, including anxiety and eating disorders, and is an essential element of behavioral activation commonly found in CBT treatments (Beck, 2011; Farmer & Chapman, 2016).
Its use has seen positive results elsewhere, including promoting motor functioning in Parkinson’s disease, where clients experience associated fears of falling and disease progression (Koychev & Okai, 2017).
Does it help with depression?
Activity scheduling is an effective behavioral intervention in clients with depression. A 2008 study of an inpatient depression program found that planning and performing activities associated with positive moods increased engagement in their lives and improved their chances of recovery (Iqbal & Bassett, 2008).
How to Do Activity Scheduling: 6 Tips
Participation in social and other pleasurable activities is “strongly associated with positive moods” and can be encouraged through planning, goal setting, and the use of activity schedules (Farmer & Chapman, 2016, p. 241).
The following six tips are helpful when working with clients to schedule and carry out activities. Ask the client to consider each of the following (modified from Farmer & Chapman, 2016):
- Identify the activities to participate in
Be clear on what you want and plan to do. What do you no longer do that previously you found pleasant? Create a list, including how, where, and when you will do it.
- Make a commitment
Schedule specific times during the week that are wholly dedicated to doing those activities identified as pleasurable, including social ones such as meeting up with others.
- Create a clear plan or arrangement
Are there any obstacles that might get in the way of the activities? Plan for them and seek help where needed, for example, childcare or making a reservation.
- Stick to the plan
A plan is worth nothing if it is not implemented. Following it through to the end will ensure that you gain control over your life, dictating its direction and meeting your needs.
- Reflect on the outcome
Once completed, whether entirely successful or not, reflect on the activity. Was it pleasurable? How did it impact your mood? Do you wish to schedule it again or replace it with something else?
- Increase social support
Too often we respond to emotional distress through social withdrawal. Plan activities to strengthen existing or form new relationships.
Activity scheduling is ultimately a behavioral experiment. With help from the therapist, the client learns what improves their mood and increases the frequency of pleasant activities.
6 Best Templates & Worksheets
The following templates and worksheets are helpful for working with clients in session or as homework.
Will Behavioral Activation Be Helpful?
Behavioral activation and the use of activity scheduling, in particular, can be highly effective for clients.
Use the Will Behavioral Activation Be Helpful? worksheet with your client to understand whether scheduling pleasurable activities is likely to be beneficial.
Ask the client to reflect on a series of questions, including:
- Do you typically have a sense of what is triggering the lowering of your mood or increasing your anxiety?
- Do you find yourself opting to do very little, with limited pleasure or meaning attached?
- Do you know when or why you feel better?
- Do you find yourself feeling better when you perform certain activities?
- Do you have a hard time knowing what you enjoy or find meaning in?
Answering ‘yes’ to several of the questions suggests that activity scheduling could be helpful.
Understanding Vicious Cycles
Behavioral activation research suggests that depression can create a vicious cycle of events, emotions, and behavior (Behavioral Activation for Depression, n.d.).
Use the Understanding Vicious Cycles worksheet to explore the events that trigger depression, the emotions that arise, and the client’s behavior.
Ask the client to think of some recent events that they believe may have triggered or maintained their depression.
Understanding the triggers linked to depression and the emotions that lead to specific behaviors can help create a treatment plan.
Tracking Activities and Mood
Tracking activities and accompanying moods is a valuable part of the process of behavioral activation and is often used in CBT treatments (Beck, 2011).
Use the Tracking Activities and Mood worksheet to capture the activities that the client has engaged in and how they felt over seven days.
While tracking activities will not cure the client’s depression, it can help to know what activities made them feel better (Beck, 2011).
Up and Down Activities
Having tracked at least a week’s worth of activities, it is now possible to recognize trends in what is causing the client’s moods to improve or worsen.
Use the Up and Down Activities worksheet to summarize the patterns and relationships between activities and feelings.
The ‘up’ activities should then be scheduled for the client to ensure that they form a regular part of their life, leading to a more positive sense of wellbeing.
Behavioral Activity Motivation
Even when an activity has been identified as positive in the client’s past and likely to increase their mood, they may find it difficult to initiate or maintain the behavior.
Use the Behavioral Activity Motivation worksheet to reflect on an activity the client has planned or is thinking of scheduling.
Ask the client to visualize what it might be like preparing for and taking part in the activity, and consider negative thoughts or obstacles that may get in their way.
Activity scheduling allows the client to set and commit to valuable activities they find pleasurable and that improve their mood.
Use the Activity Scheduling worksheet to plan times to perform each mood-enhancing activity. After completing each one, they can mark it as complete and capture their mood.
Are There Helpful Apps and Software?
Technology-based tools have proven highly effective for treatment engagement, particularly in CBT (Muroff & Robinson, 2022).
The following three apps are popular CBT tools for personal use.
Developed by mental health professionals, this app encourages mind-boosting activities when the user is experiencing low moods.
The app recommends ‘missions’ based on the user’s feelings and includes emotion, behavior, physical, and thought-based activities.
This helpful app assesses moods and tracks daily progress toward user-defined goals.
Over time, the user becomes more aware of what affects their moods, and the app allows users to track and try new behaviors and activities to improve symptoms.
This popular and fun app enables the user to track various aspects of their life while understanding their moods and emotions.
Each game is backed up by science and CBT interventions.
Useful Resources From PositivePsychology.com
CBT contains incredibly powerful techniques for helping clients manage negative or unhelpful thoughts.
Why not download our free CBT tool pack and try out the powerful tools contained within? Some of them include:
- Strength Spotting by Exception Finding
Help clients become aware of their strengths relative to their goals, rather than their deficiencies relative to their problems.
- Reframing Critical Talk
Reducing self-criticism can lower emotional distress and negative emotions.
Other free resources include:
- Behavioral Experiments to Test Beliefs Worksheet
This six-step approach encourages people to view negative thoughts objectively rather than as absolute truths.
- ABC Functional Analysis Worksheet
Use this worksheet to gather problematic information for the ABC approach used in CBT.
More extensive versions of the following tools are available with a subscription to the Positive Psychology Toolkit©, but they are described briefly below:
- Diary of Better Moments
Diary keeping improves feelings of competency and allows the user a more balanced perspective of a situation.
Create a thought diary of what has happened each day, answering the following questions:
What happened that was better/worse than expected?
How did this moment make you feel?
Then reflect on the better moments, looking for patterns and common threads.
- Daily Exceptions Journal
Self-monitoring of our thoughts is a classic technique in CBT and allows for a better understanding of problems and the context in which they occur.
Use the worksheet daily, asking a series of questions, including:
What has improved today, even a little bit?
What did I do differently to improve things?
When didn’t I experience the problem today?
What could I do to continue to make improvements?
- 17 Positive CBT Exercises
If you’re looking for more science-based ways to help others through CBT, check out this collection of 17 validated positive CBT tools for practitioners. Use them to help others overcome unhelpful thoughts and feelings and develop more positive behaviors.
A Take-Home Message
Our activities significantly impact the emotions we experience. Finding something enjoyable can temporarily lead to feelings of happiness and joy, alleviating negative moods.
As part of behavioral activation, activity scheduling encourages the repetition of positive activities and has particular importance in Cognitive-Behavioral Therapy (Beck, 2011).
Clients with depression often reduce or stop engaging in what they previously enjoyed. Individuals may opt out of social situations and physical activities, hiding from life and activity.
Such avoidance is harmful, encouraging a negative spiral of thinking, emotions, and behavior and leading to a reduced sense of mastery and control in their lives.
Working with a therapist, clients can identify activities they previously found enjoyable and plan and commit to performing them in the days ahead. Increasing connections with friends, family, the community, and the environment has many mood-enhancing benefits.
The worksheets and tips in this article will help therapists and clients recognize such positive activities and help schedule them for review and reflection in subsequent sessions.
We hope you enjoyed reading this article. For more information, don’t forget to download our three Positive CBT Exercises for free.
- Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond. Guilford Press.
- Behavioral Activation for Depression. (n.d.). Retrieved February 16, 2022, from https://medicine.umich.edu/sites/default/files/content/downloads/Behavioral-Activation-for-Depression.pdf
- Farmer, R. F., & Chapman, A. L. (2016). Behavioral interventions in cognitive behavior therapy: Practical guidance for putting theory into action. American Psychological Association.
- Iqbal, S., & Bassett, M. (2008). Evaluation of perceived usefulness of activity scheduling in an inpatient depression group. Journal of Psychiatric and Mental Health Nursing, 15(5), 393–398.
- Koychev, I., & Okai, D. (2017). Cognitive-behavioural therapy for non-motor symptoms of Parkinson’s disease: A clinical review. Evidence-Based Mental Health, 20(1), 15–20.
- Muroff, J., & Robinson, W. (2022). Tools of engagement: Practical considerations for utilizing technology-based tools in CBT practice. Cognitive and Behavioral Practice, 29(1), 81–96.