BEHAVIORAL ACTIVATION

NIRMALA DHAR, LCSW

OREGON HEALTH AUTHORITY
OLDER ADULT BH SERVICES COORDINATOR
 Describe Describe the rationale for behavioral activation

Identify Identify activities to help clients connect with their values

LEARNING
OBJECTIVES
Use Use activity structuring and scheduling to engage in
activities associated with pleasure and or mastery

Identify Identify ways to help your clients discover barriers to

engaging in activities in order to maintain and increase them
 • EVERYDAY SINCE 2011 10,000 AMRICAN (BABYBOOMERS)
HAVE BEEN TURING 65 YEARS OLD
• BY 2030 ONE IN FIVE AMERICAN AND OREGONIANS
WILL BE AGE 65 OR OLDER
• THIS DEMOGRAPHIC TRANSITION HAS HUGE
IMPLICATIONS FOR OUR SOCIETY

THE WHY • BY 2030 15 MILLION OLDER ADULTS WILL HAVE A MH

ISSUE – THIS NUMBER WILL EQUAL THE YOUNGER AGE
COHORT
AND THE • DEPRESSION AND ANXIETY ARE COMMON AMONG
WHAT •
COMMUNITY DWELLING SENIORS
RATE OF DEPRESSION IS HIGH FOR SENIORS IN LONG
TERM CARE SETTINGS
• UNTREATED OR UNDERTREATED DEPRESSION IN OLDER
ADULTS CAN HAVE A DETRIMENTAL EFFECT ON THEIR
OVER HEALTH , THEIR FUNCTIONING AND THEIR
QUALITY OF LIFE.
 • IT IS IMPORTANT TO ASSESS COGNITIVE ABILITY
AND TO EVALUATE WHETHER A PATIENT HAS
SUFFICINET MEMORY FUNCTION AND
COGNITIVE PROCESSING SKILLS TO BE ABLE TO
PARTICIPATE IN ANY KIND OF
AT THE BEGINNING PSYCHOLOGICAL THERAPY SUCH AS CBT,
INTERPERSONAL THERAPY(ITP), BEHAVIORAL
ACTIVATION (BA) PST (PROBLEM SOLVING
THERPAY)
 BEHAVIORAL ACTIVATION,
ACCEPTANCE AND COMMITMENT
THERAPY AND DBT ARE ALL
CONSIDERED THIRD WAVE
TREATMENTS FOR DEPRESSION.
THE “THIRD
WAVE” FOCUS IS ON A FUNCTIONAL
ANALYSIS OF DEPRESSION BASED
ON SKINNERIAN
PSYCHOLOGICAL MODEL OF
BEHAVIOR CHANGE REFERRED TO
AS APPLIED BEHAVIOR ANALYSIS.
 BEHAVIORAL MODEL OF DEPRESSION

DECREASED FREQUENCY OF POSITIVELY REINFORCED ACTIVITY AS THE

“COMMON DENOMINATOR “ AMONG INDIVIDUALS WITH DEPRESSION
(FERSTER 1973)

DEPRESSION IS THE RESULT OF A LOSS OR LACK OF RESPONSE

CONTINGENT POSITIVE REINFORCEMENT OFTEN
ACCOMPANIED BY STRESSFUL AVERSIVE LIFE EVENTS THAT
DISRUPT DIALY ROUTINES AND ACTIVITIES ( LEWINSOHN ET
AL)
 PUT SIMPLY……

INDIVIDUALS WITH DEPRESSION ENGAGE IN FEWER OVERT BEHAVIORS THAT

PROVIDE PLEASURE OR ENJOYMENT THAN INDIVIDUALS WHO ARE NOT
DEPRESSED

IN ADDITION INDIVIDUALS WITH DEPRESSION ENGAGE IN A HIGH FREQUENCY

OF BEHAVIORS THAT FUNCTION TO ESCAPE OR AVOID AVERSIVE STIMULI SUCH AS
STAYING IN BED ALL DAY TO AVOID ATTENDING A SOCIAL EVENT.
 CBT DEVELOPED BY DR. ARRON BECK, A PSYCHIATRIST
FROM PHILADELPHIA.

IDENTIFIED NEGATIVE COGNITIVE TRIAD - NEGATIVE

THOUGHTS ABOUT ONE’S SELF, ABOUT ONE’S EXPERIENCES
AND ABOUT THE FUTURE. BY IDENTIFYING AND
W H AT I S C O G N I T I V E CHALLENGING THESE PEOPLE CAN REDUCE THEIR
B E H AV I O R T H E R A P Y
SYMPTOMS OF DEPRESSION – THIS IS CALLED COGNITIVE
REFRAMING.

SINCE BECK’S EARLY WORK A SECOND KEY ELEMENT HAS

BEEN ADDED TO CBT – BEHAVIORAL ACTIVATION – IT
INVOLVES IDENTIFYING WHICH PARTICULAR ACTIVITIES,
SITUATIONS AND PEOPLE ARE ASSOCIATED WITH POSITIVE
MOOD AND SCHEDULING THOSE ON A DAILY BASIS
Robust effects found in reviews of behavioral activation for
depression ( see Dimidjian et al, 2011 for most recent)

A well validated treatment manual for brief form of BA is

available from Lejuez, Hopko & Hopko 2001
THE EVIDENCE
Large scale treatment studies with younger persons found BA BASE FOR BA
to be more effective than cognitive therapy and equal to
medication for treating depression. (Spates, Pagoto & Kalata,
2006; Dimidjian et al, 2006)

Research with older adults found similar results ( Gallagher-

Thompson, Hanley-Peterson & Breckenridge, 1987;
Thompson, coon et al 2001
 A successful community based program that incorporates
four evidence-based components into the ongoing delivery
of care /case management.

1.Screening and assessment

H E A LT H Y I D E A S
(IDENTIFYING DEPRESSION 2.Education about depression
E M P OW E R I N G AC T I V I T I E S
FOR SENIORS)

3.Referral and linkages

4.Behavioral Activation
 NOT ENOUGH ENVIRONMENTAL
REINFORCEMENT

TOO MUCH ENVIRONMENTAL PUNISHMENT

THEORY OF
CONTRIBUTES TO DEPRESSION
BEHAVIORAL
ACTIVATION
GOAL OF BA - INCREASE ENVIRONMENTAL
REINFORCEMENT AND REDUCE PUNISHMENT.

KEY – ACTIONS SEEN AS A CAUSE OF

EMOTIONS
 BA TARGETS INERTIA – DEPRESSION ZPAS MOTIVATION, THE BA
APPROACH IS TO WORK FROM THE OUTSIDE-IN, SCHEDULING
ACTIVITIES AND USING GRADED TASK ASSIGNMENTS TO ALLOW
THE CLIENT TO HAVE A CHANCE OF HAVING ACITIVITY
POSITIVELY REINFORCED.

CORE TARGETS BA TARGETS ESCAPE AND AVOIDANCE BEHAVIORS AS PRIMARY

FOR BA
TREATMENT

BA IS SHORT TERM
 INCREASE CLIENT’S
ENGAGEMENT IN
BEHAVE FIRST, FEEL
ACTIVITIES THAT
LATER – AN “OUTSIDE-
PROVIDE ENJOYMENT
IN” APPROACH
AND OR A SENSE OF
ACCOMPLISHMENT
WHAT IS
BEHAVIORAL
HELPS CLIENTS
ACTIVATION? PLAIN ENGLISH – ACT
CONNECT WITH THEIR
ACCORDING TO THE
VALUES AND UTILIZE
PLAN OR GOAL, NOT
STRUCTURE AND
ON FEELING OR HOW
ACITIVITIES TO LIVE A
YOU ARE FEELING
VALUED LIFE
 • BEHAVE FIRST, FEEL LATER
• EMPHASIZE MOTTO “ DON’T
JUST TALK, DO!”
GUIDING
PRINCIPLES • ROLE OF PROVIDER AS COACH
• TROUBLESHOOT POSSIBLE
AND ACTUAL BARRIERS TO
ACTIVATION
 STEP 1. RATIONALE – EXPLAIN THAT WHEN WE FEEL DOWN, WE
SOMETIMES STOP DOING MANY ACTIVITIES THAT WE USED TO LIKE
TO DO – PSYCHOEDUCATION IS IMPORTANT.

STEP 2. SELECT ACTIVITIES THAT INCREASE PLEASURE/ENJOYMENT

AND OR SENSE OF MASTERY – ASK THE CLIENT ABOUT ACTIVITIES
BEHAVIORAL THEY USED TO ENJOY AND ANY ACITIVTY THEY ALREADY DO AND
ACTIVATION WOULD LIKE TO DO MORE OFTEN ( TALKING WITH FRIENDS). YOU
MAY ASK IF THERE IS SOMETHING THAT THEY NEED TO DO THAT
STEPS THEY HAVE BEEN UNABLE TO DO OR ARE AVOIDING.

STEP 3. IN FOLLOW UP VISITS THE CLINICIAN REVIEWS PROGRESS

ON GOALS REINFORCES POSITIVE BEHAVIOR AND RESETS GOALS AS
NEEDED.
 • EXPLAIN BEHAVIORAL ACTIVATION TO YOUR
CLIENT
• THIS APPROACH IS BEHAVIORAL AND
ENVIRONMENTAL IN NATURE WHICH MEANS IT
TARGETS CHANGES IN YOUR ENVIRONMENT
AND PERSONAL BEHAVIOR AS A METHOD FOR
IMPROVING YOUR THOUGHTS, MOOD AND
RATIONALE FOR B A OVER ALL QUALITY OF LIFE
IN DEPRESSION • ALTHOUGH THE FOCUS IS ON BEHAVIOR WE
TREATMENT ARE NOT IGNORING THOGUHTS AND
FEELINGS.
• INFACT WE SUGGEST THAT NEGATIVE
THOUGHTS AND FEELINGS WILL CHANGE
ONLY AFTER POSITIVE EVENTS AND
CONSEQUENCES ARE EXPERIENCED MORE
FREQUENTLY
 THE LESS WE DO THE
MORE DEPRESSED WE
BECOME

WHY WE GET THE MORE DEPRESSED

WE ARE THE LESS WE DO
STUCK

LACK OF INTEREST/
PLEASURE = INACTIVITY/
ISOLATION
 NEGATIVE BEHAVIOR – SLEEP
UNTIL NOON EVERY DAY TO
AVOID STRESS AND NEGATIVE
FEELINGS

IMMEDIATE CONSEQUENCE – MISS

EXAMPLE BREAKFAST, NO TIME FOR EXERCISE,
NO TIME FOR DAILY CHORES

RESPONSE – INCREASED STRESS DUE

TO UNADDRESSED RESPONSIBILITIES,
GUILT ABOUT WORSENING HEALTH
DUE TO LITTLE ACTIVITY, REDUCED
ENERGY DUE TO POOR DIET
 • ACCURATE ASSESSMENT OF OUR DAILY
SCHEDULE OF ACTIVITIES
• CREATING AN ENVIRONMENT THAT
SUPPORTS HEALTHY BEHAVIORS - ASK
FAMILY AND FRIENDS TO HELP YOU BY
NOT FOCUSING ON YOUR DEPRESSIVE
SYMPTOMS BUT ON YOUR EFFORTS TO
ENGAGE IN HEALTHY BEHAVIORS. KEEP
PREPARING FOR YOUR DEPRESSION FROM BEING THE
TREATMENT FOCUS OF YOUR SOCIAL INTERACTIONS
EG. YOU MAY ASK YOUR FRIENDS NOT TO
ALLOW YOU TO SPEND MORE THAN 25%
OF YOUR TIME TOGETHER TALKING
ABOUT WHAT IS GOING WRONG IN YOUR
LIFE TO ALLOW MORE TIME TO DEVELOP
AND DISCUSS POSITIVE EXPERIENCES.
• CREATE A FORMALIZED BEHAVIOR
CONTRACT
 • VALUES ARE HOW YOU WANT TO LIVE
YOUR LIFE
• THEY ARE STATEMENTS ABOUT WHAT IS
REALLY IMPORTANT TO YOU
IDENTIFY • VALUES SHOULD BE DETERMINED FOR
ALL AREAS OF YOUR LIFE - FAMILY,
VALUES SOCIAL ROMANTIC, EDUCATION,
HOBBIES ,VOLUNTEER WORK, SPIRITUAL,
PHYSICAL,
PSYCHOLOGICAL/EMOTIONAL
 IT IS DIFFICULT TO FEEL
DEPRESSED AND HAVE
LOW SELF ESTEEM IF YOU
ARE RUGULARLY
ENGAGING IN ACTIVITIES
THAT BRING YOU A
SENSE OF PLEASURE AND
OR ACCOMPLISHMENT

RATIONALE IN
PLAIN ENGLISH
INCREASED HEALTHY
BEHAVIORS +
DECREASED DEPRESSED
BHAVIORS= POSITIVE
EXPERIENCES =
IMPROVED THOUGHTS
AND MOOD
 • TYPICALLY WE THINK OF ACTING FROM THE
INSIDE OUT
• WE WAIT TO FEEL MOTIVATED BEFORE
COMPLETING TASKS, OR WE RESPOND TO OUR
AN OUTSIDE-IN ITNERNAL STATES SUCH AS SITTING IN FRONT
OF THE TV WHEN BORED
APPROACH
• IN BA, WE ASK PEOPLE TO ACT ACCORDING TO
A PLAN OR GOAL RATHER THAN A FEELING
• “DON’T JUST TALK, DO”
 INCREASE ACTIVITY FROM THE OUTSIDE

1 2 3 4
FOLLOW A WRITTEN MONITOR PROGRESS HIGHLIGHT EXPRESS YOUR
PLAN ( AN ACTIVITY CONSEQUENCES OF INTENTION TO
SCHEDULE) INCREASED ACTIVITY ANOTHER PERSON.
PUBLIC SUPPORT CAN
HELP GET THE JOB
DONE.
 • NAME A PERSON WHO CAN HELP YOU DO
ENJOYABLE/IMPORTANT
ACITIVITIES______________________
• WHAT IS AN ACTIVITY YOU WOULD LIKE THIS
PERSON TO HELP YOU
WITH:__________________________________
RECRUIT SOCIAL _________
SUPPORT • WHAT ARE THE WAYS THIS PERSON CAN HELP
YOU WITH THIS ACTIVITY:
• 1.____________________________
• 2._______________________________
• 3.___________________________________
 IDENTIFY POTENTIAL ACTIVITIES

ACTIVITIES SHOULD BE OBSERVABLE AND

MEASURABLE – THEREFORE A GOAL LIKE “THINKING
MORE POSITIVE” IS NOT APPROPRIATE

CREATE AN ACTIVITY HIERARCHY - RANK THEM FOR

GETTING EASE AND REWARD
STARTED
“WHAT ACTIVITIES DID YOU PREVIOUSLY ENJOY THAT YOU
WOULD LIKE TO START PARTICIPATING IN AGAIN”?

“LIST ACITIVITES THAT YOU NEED TO DO TO BETTER YOUR

CURRENT SITUATION”?
 ROLE PLAY/REHEARSE USE
TASK VISUALIZATION/IMAGERY

ASSIGN “HOMEWORK”
IMPLEMENTING THAT IS ENGAGING AND
SET TIME FRAME FOR
ACTION
SATISFYING
THE BA PLAN

HELP IDENTIFY POSSIBLE

TEACH SKILLS TO HELP
PEOPLE WHO MIGHT
REACH GOALS –
HELP WITH OBTAINING
PROBLEM SOLVING,
THE GOAL – LOOK FOR
RELAXATION
WAYS OTHERS CAN HELP
 WHEN A PERSON IS PLEASANT ACTIVITES ARE
DEPRESSED IT’S HARD DOUBLY BENEFICIAL TO
FOR THEM TO REMEMBER THE CLIENT AS THEY
ANY ACTIVITIES THAT INCREASE ACTIVITY AND
HAVE BEEN PLEASANT FEELINGS OF PLEASURE

PLEASANT
ACTIVITES
ASK THEM WHAT IS IT
START SLOW TO ALLOW
THAT THEY USED TO
FOR EARLY SUCCESS
ENJOY?
 BASED ON FUNCTIONAL
ANALYSIS AND GOALS

ASSIGN INCREASINGLY MORE

DIFFICULT TASKS TO MOVE
TOWARDS FULL PARTICIPATION
GRADED TASK
ASSIGNMENT
HELP BREAK DOWN TASKS INTO
MANAGEABLE COMPONENTS

ENGAGE IN MENTAL REHEARSAL

– TROUBLESHOOT BY
ANTICIPATING OBSTACLES.
 AVOIDANCE AND ESCAPE
BEHAVIORS IN DEPRESSION

• DEPRESSED INDIVIDUALS TEND TO SUBSTITUTE

BEHAVIORS THAT PROVIDE IMMEDIATE RELIEF FOR
BEHAVIORS THAT MIGHT CAUSE SHORT-TERM
DISCOMFORT BUT ARE NOT HELPFUL IN THE
LONGER TERM
• EXAMPLE:AVOIDING CONTACT WITH THE SOCIAL
COMMUNITY BY STAYING IN BED ALL DAY CAN
FUNCTION TO AVOID EXPOSURE TO SITUATIONS
This Photo by Unknown Author is licensed under CC BY-SA THAT ELICIT AVERSIVE THOUGHTS AND FEELINGS IN
THE INDIVIDUAL
 • UNDERSTAND THE DISCOMFORT IN A
PARTICULAR SITUATION THAT IS
FOLLOWED BY SOME ACTION BY THE
CLIENT TO MITIGATE OR EXTINGUISH
THE AVERSIVE EXPERIENCE.
• AVOIDANCE SERVES AN ADPATIVE
AVOIDANCE FUNCTION IN THE SHORT TERM BUT IS A
MODIFIC ATION PROBLEM IN THE LONG TERM
• ASSIST THE PERSON IN IDENTIFYING THE
FUNCTIONS OF VARIOUS AVOIDANCE
BEHAVIORS AND HELP CHOOSE
ALTERNATIVE COPING
 TRAP AND TRAC

TRAP TRAC

• TRIGGER • TRIGGER
• RESPONSE • RESPONSE
• AVOIDANCE PATTERN • ALTERNATIVE COPING
 TRAP & TRAC

TRAP TRAC

• TRIGGER – DEMANDS AT WORK • TRIGGER – DEMANDS AT WORK

• RESPONSE – DEPRESSED • RESPONSE – DEPRESSED
MOOD/HOPELESS MOOD/HOPELESS
• AVOIDANCE- STAY IN BED/DON’T • ALTERNATIVE COPING – APPROACH
ANSWER PHONE BEHAVIOR USING GRADED TASKS.
 • HELP CLIENT DEVELOP AND FOLLOW A
REGULAR ROUTINE FOR BASIC LIFE ACTIVITIES –
EATING, SLEEPING, WORKING , CHORES, FAMILY
ROUTINE TIME
REGULATION IS • EVALUATE NEW BEHAVIORS AFTER SOME TIME –
ESSENTIAL MAKE THEM ROUTINE BEFORE EVALUATING
• USE ACTIVITY LOGS AND ACTION PLANS
 CHOOSE - ACTIVATING
ASSESS – HOW WILL MY MYSELF WILL INCREASE MY
BEHAVIOR AFFECT MY CHANCE OF IMPROVING MY
DEPRESSION? AM I LIFE SITUATION AND MOOD.
AVOIDING/WHAT ARE MY CHOOSING NOT TO SELF
GOALS IN THIS SITUATION? ACTIVATE COULD BE A
PROBLEM

ACTION TRY THE BEHAVIOR I HAVE INTEGRATE NEW ACTIVITY

STRATEGY CHOSEN INTO MY DAILY ROUTINE

OBSERVE THE RESULTS – DO I

FEEL BETTER OR WORSE? DID
NEVER GIVE UP!
THE ACTION IMPROVE MY
SITUATION?
 RUMINATION REFERES TO THE
WAY CERTAIN ANIMALS SUCH
DEPRESSED PEOPLE OFTEN
AS COWS EAT STORING THEIR
THINK ABOUT THE MISERY OF
FOOD PARTIALLY DIGESTED IN
LIFE MULL OVER EVENTS AND
A SPECIAL STOMACH CALLED A
DO NOT PROBLEM SOLVE
RUMEN TO BE BROUGHT BACK
UP LATER AND CHEWED

THE CONSTANT REHASING OF RUMINATION LEADS TO

MEMORIES SERVES TO FEED WITHDRAWAL, INACTIVITY
RUMINATION AND PROLONG DEPRESSION AND MORE RUMINATION

BA TREATS RUMINATION AS A
BEHAVIOR RATHER THAN
FUNCTION MAY BE ESCAPE OR
ENGAGING OR CHALLENGING
AVOIDANCE
THE CONTENT OF THEIR
RUMINATIVE THOUGHT
 LIKELY TO FOCUS ON
THE NEGATIVE BOTH IN
THE RECALL OF THEIR
PAST AND PERCEPTION
RUMINATION IMPACTS
OF CURRENT EVENTS
YOUR SOCIAL SUPPORT
AND ENVISION THE
NETWORK
FUTURE IN A NEGATIVE
WAY. THESE NEGATIVE
THOUGHTS MAKE US
FEEL MORE DEPRESSED
RUMI NAT I ON AND
D E P R E SSION –
DANG E R OF
DW E L LING
RUMINATION IMPAIRS
ABILITY TO PROBLEM
SOLVE. EVEN IF YOU
COME UP WITH A
SOLUTION
RUMINATION CREATES
SELF DOUBT THAT
PREVENT US FROM
CARRYING OUT THE
PLAN
 RUMINATION AS BEHAVIOR

FOCUS ON CONTEXT (BA)

FOCUS ON CONTENT
(COGNITIVE)
• I WAS DEPRESSED ALL DAY YESTERDAY • I WAS DEPRESSED ALL DAY YESTERDAY
BECAUSE I WAS THINKING HOW MY SISTER BECAUSE I WAS THINKING HOW MY SISTER
DOES NOT LOVE ME DOES NOT LOVE ME
• WHAT IS THE EVIDENCE THAT THIS • WHEN DID YOU START THINKING THIS WAY?
THOUGHT IS ACCURATE?
• HOW LONG DID IT LAST?
• WHAT WOULD IT MEAN IF IT WAS TRUE?
• WHAT CONSEQUENCES DID IT HAVE?WHAT
• CAN YOU THINK OF ANOTHER WAY TO MIGHT BE THE FUNCTION?
INTERPRET WHAT YOUR SISTER SAID?
• WHAT ELSE COULD YOU HAVE DONE
• WHY MUST EVERYONE LOVE YOU? DURING THIS TIME?
 TARGETING RUMINATION

• LEARN TO BLOCK AVOIDANCE FUNCTION

OF RUMINATION BY MIDNFULNESS
EXERCISE ( NOTICE COLORS, SMELLS,
NOISES, SIGHTS)
• RUMINATION AS A CUE TO GET ACTIVE -
RCA
 AT THE BEGINNING OF EVERY SESSION THERAPIST SHOULD
CHECK HOW PLAN IS GOING TO HIGHLIGHT IT’S
IMPORTANCE

SUCCESSES SHOULD BE MET WITH PRAISE

FOLLOW UP
FAILURES SHOULD BE ADDRESSED WITH PROBLEM SOLVING
– PERHAPS THE ACITIVITY WAS TOO DIFFICULT?

WHEN MOTIVATION AND MOOD IMPROVE, TRANSITION TO

MORE CHALLENGING POSITIVE ACTIVITIES
 IN CONCLUSION

• BA HELPS CLIENTS REESTABLISH

ROUTINES OF ENGAGING IN ACITIVITIES
THEY WERE AVOIDING
• THROUGH ENGAGING IN THESE
ACTIVITIES AND INTERESTS YOUR CLIENT
WILL EXPERIENCE INCREASED PLEASURE,
DIMINISHED DEPRESSED MOOD AND
OVER TIME INCREASED MOTIVATION TO This Photo by Unknown Author is licensed under CC BY

ENGAGE IN VAULED ACTIVITIES

• BA CREATES AN UPWARD SPIRAL
 • A BREIF BEHAVIORAL ACTIVATION TREATMENT
FOR DEPRESSION – C.W.LEJUEZ;DEREK HOPKO;
SANDRA HOPKO – Beh Mod,Vol.25 no.2, April 2001
255-286
• THE PSYCHOLOGY OF DEPRESSION, NEW YORK,
NY WILEY 1974 – A beh approach to Depression,
P.M. Lewinsohn
• PLEASANT ACTIVITIES AND DEPRESSION – P.M.
REFERENCES LWEINSOHN. Journ of Consult Psych 1973: 41:261-
268
• PLEASANT ACTIVITIES, ACITIVITY SCHDULES
AND DEPRESSION, P.M. LEWINSOHN – Journ of Ab
Psych 1972: 79:291-295
• THE ORIGINS AND CURRENT STATUS OF BEH
ACT TREATMENT OF DEPRESSION , S. DIMIDJIAN
ET AL – Annual Review of Clin Psych 2011; 7:1-38
 • BEHAVIORAL ACTIVATION FOR DEPRESSION IN
OLDER ADULTS: THEORETICAL AND PRACTICAL
REFERENCES CONSIDERATIONS – POLENICK, C, FLORA,
STEPHEN – The Behavior Analyst 2013, 36, 35-55,
No.1, (Spring)
 THANK YOU

• NIRMALA.DHAR@STATE.OR.
US
• 503 945 9715