Behavioral Activation Treatment for PTSD

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Researchers found that behavioral activation can be useful in reducing avoidance among people with PTSD, reducing symptoms, decreasing depression, and improving quality of life.

Behavioral Activation

As the name implies, behavioral activation is behavioral treatment. It focuses on changing behaviors to address problems people might be experiencing.

Behavioral activation was originally developed to treat depression. It's based on the theory that people with depression are less likely to come into contact with positive or rewarding aspects of their environment.

For example, a person with depression might feel so bad that they decide not to get out of bed one day. However, by staying in bed, the depressed person does not have potentially rewarding contact with friends and family, making the depression linger or worsen.

How Behavioral Activation Works

In behavioral activation, the main goals are to increase activity levels (and prevent avoidance behaviors) and help the patient take part in positive and rewarding activities that can improve mood.

The patient and therapist come up with a list of activities that the patient values and finds rewarding, such as reconnecting with friends or exercising. The therapist and patient also look at any obstacles that might get in the way of completing these goals.

Each week the patient is asked to set goals for how many activities he or she wants to complete outside of the session. Throughout the week, the patient then tracks his progress in achieving these goals.

Behavioral Activation for PTSD

Individuals with PTSD may avoid things that remind them of their traumatic event, leading them to withdraw from others and also not allowing them to learn that they can cope with their anxiety.

Researchers provided 11 veterans with PTSD 16 weeks of individual behavioral activation therapy. The veterans worked with the therapists to identify current avoidance behaviors, as well as rewarding and positive goals and activities that they would like to pursue.

The veterans tracked their progress in completing these goals and activities throughout the treatment. The researchers looked at differences in the veterans' PTSD symptoms, depression, and quality of life from the beginning to the end of treatment.

By the end of the 16 weeks, they found that:

  • More than half of the veterans showed a reduction in PTSD symptoms.
  • Four veterans had their depression reduce.
  • Four veterans reported that their quality of life had improved.

Although this study was small, the findings were promising and show that behavioral activation may be a useful way to treat PTSD, especially in regard to its avoidance symptoms. 

2 Sources
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  1. Etherton JL, Farley R. Behavioral activation for PTSD: A meta-analysis. Psychological Trauma: Theory, Research, Practice, and Policy. March 12, 2020. doi:10.1017/S1352465810000081

  2. Jakupcak M, Roberts LJ, Martell C, et al. A pilot study of behavioral activation for veterans with posttraumatic stress disorderJ Traum Stress. 2006;19(3):387-391. doi:10.1002/jts.20125

By Matthew Tull, PhD
Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder.