What Behavioral Activation Actually Looks Like in a Therapy Session
When you're depressed, "do more things you enjoy" can sound almost insulting. If you could do things, you would. That's kind of the whole problem.
So when a therapist says the plan is to schedule activities and do them whether or not you feel like it, I understand the skepticism. When I sat down with Jill Hasso, LPC, to talk about behavioral activation, I told her honestly that it can sound too simple to work.
She agreed that it's simple. "That's kind of one of the things I like about behavioral activation," she said. "It's really simple to follow. And it's really just very routine and structured."
The simple part is the idea. The part that makes it work is how it's done in session, week after week. We've already written about what behavioral activation is and why it works. This post is about what it actually looks like when you're sitting in the room with a therapist.
Do you really schedule activities during the counseling session?
Yes. This is one of the biggest differences between behavioral activation in therapy and trying it on your own.
Jill doesn't send people home with a vague goal like "try to get out more." She sits down with them and fills out a schedule for the week, together, before they leave.
She uses a simple worksheet. For each activity, you write down:
The day and time
What you're actually doing
How long it will last
Who you're doing it with
Your mood before and after, on a scale of 0 to 10
Whether you completed it
The goal is at least one activity every day. Not ten. One.
Together, you and your therapist might decide for each day what activity you’ll do, what time you’ll do it and when you’ll do that. For example, you may decide that on Monday from7:30-8am you’re going to make a cup of coffee with a fun new creamer in it and sit down to slowly drink it. Then on Tuesday from 6-7pm you’ll watch an episode of your favorite show with your spouse. And on Wednesday at 3-3:30pm you’ll meet a friend at Frost Coffee House.
That level of detail matters. "It's not just go home and do your homework," Jill said. "It's like, okay, so we're gonna do this activity at this specific time."
When you're depressed, deciding is half the battle. Your energy is low, and every choice feels heavy. Making the decisions in session, while someone is right there with you, takes a lot of that weight off the moment itself. When Monday at 1:00 comes, you don't have to figure anything out. You just have to start.
If you're also working on other skills in therapy, those can go on the schedule too. Jill sometimes schedules a Cognitive Processing Therapy worksheet the same way, so practice has a real place in your week instead of floating around as something you'll get to eventually.
How do you decide what goes on the schedule?
This is where behavioral activation gets more personal than "just do stuff."
Jill looks for activities that connect to what you care about, not activities for the sake of being busy. "If you don't find fulfillment in it, then I wanna know that," she said.
What counts is different for everyone. For one person, buying a new shirt might be a real lift. For someone else, it does nothing, but a half hour of reading or a walk with their kids does.
Sometimes the meaning comes from someone else's enjoyment. Jill's husband collects baseball cards, and she enjoys going with him to a card shop even though cards aren't really her thing. "I enjoy the fact that he enjoys it," she said. That counts. If one of your values is time with the people you love, that can absolutely go on the schedule.
A few other things Jill pays attention to:
Start small. You don't start with the hardest thing on your list. Jill compares it to working with a personal trainer. "They're not starting you with the heaviest weight, or you're gonna get hurt." Extra weight gets added as you build strength.
Make it a little out of the ordinary. If you already make coffee every morning, that's not new. Trying a new flavor might be. Meeting a friend for coffee is further up the ladder.
It doesn't have to be big, and it doesn't have to be out of the house. Fifteen minutes with a cup of coffee, just for you, is a real activity.
At least one thing a day should be just for you. When you're depressed, Jill noticed, "your priorities are kind of everywhere else except yourself." Work, kids, and responsibilities come first. One small thing that's yours starts to change that.
Why rate your mood before and after?
Jill has clients rate their mood right before an activity and again right after. There are a couple of good reasons for this.
First, it shows you where you started. Maybe it was a hard day and you were at a 3 or 4 before you began. If you finish at a 6, that's real movement, even if 6 isn't great.
Second, it shows which activities actually help. As Jill put it, the bigger the jump, the more that activity lines up with your values and the things you care about. Over a few weeks, you start to see a pattern. Some activities lift your mood a lot. Some barely move it. That tells you and your therapist where to put your energy.
It also does something quieter. Depression is very good at predicting that nothing will help. The numbers give you something to check that prediction against. You don't have to believe the activity will help before you do it. You just do it and see what happens.
That's the core idea Jill kept coming back to. "We're not waiting for motivation and energy to show up first," she said. "We're just taking action and seeing what happens."
What happens at the next session?
You bring the schedule back, and you go through it together.
"I can look at each and every activity that you did for the entire week," Jill said. For each one, she asks a few questions. Did you do it? If not, what got in the way? How did it shift your mood?
Then you build next week's schedule, using what you learned. Activities that helped stay. Activities that didn't get swapped out. If something was too big a step, you make it smaller. If something was easy, you might add a little more.
This is where having a therapist matters. A lot of people come in already exhausted from pushing through on their own. Jill hears that often. "I don't wanna push through anymore. I'm here because I'm exhausted."
Trying to do this alone is a lot like white-knuckling it. In therapy, someone is watching the pattern with you, adjusting the plan, and noticing when something else might be getting in the way.
What if I don't do the activities?
It happens. Life gets busy, or the week goes sideways, or depression wins a few rounds.
Jill doesn't treat a missed activity as a failure. "That can be seen not as, like, you did something wrong," she said, "but these are the barriers you're encountering here. And what can we do to fix that?"
She also pointed out that even when a specific plan falls apart, the goal is still to do something that day. If your calendar gets flipped upside down, you can still pick one small thing.
What if I do the activity and still don't feel better?
This is one of the most common, and most discouraging, moments in behavioral activation. You did the thing. And you felt nothing.
That's useful information, not proof that it doesn't work for you. Sometimes it just wasn't the right activity, and you try something else. Sometimes it takes a few repetitions before your mood starts to respond.
And sometimes something deeper is getting in the way. Thoughts tied to past trauma can drain the meaning out of almost anything. When Jill sees that, she may shift to Cognitive Processing Therapy for a while. Once those thoughts don't hold the same power, she brings behavioral activation back in, and the activities often start working in a way they couldn't before.
"A lot of times people don't come in just with depression," Jill said. "They come in with anxiety. They come in with trauma." Behavioral activation can be powerful on its own. It can also be one piece of a bigger plan.
Does behavioral activation actually work?
The research is pretty clear that it does. One large review of 26 randomized trials found behavioral activation to be an effective treatment for depression, with clearly better results than control conditions.
We also see it in our own practice. At Aspire, clients fill out the PHQ-9, a widely used depression questionnaire, throughout therapy. Scores of 10 to 14 usually mean moderate depression, 15 to 19 moderately severe, and 5 to 9 mild.
Here's what we've seen with Jill's clients who started therapy with a PHQ-9 score of 10 or higher. This includes 40 clients and 360 completed questionnaires:
Start of therapy the PHQ9 score is an average of 16.5 showing significant depression (some clients have a lower or higher score of course, this is an average for Jill’s clients who had at least moderate depression symptoms when they started.
8 weeks the average drops to 10.8
12 weeks the average PHQ9 score drops to 7.3
20 weeks it drops to 6.7
On average, scores dropped by about 5.6 points by week 8, 9.2 points by week 12, and 9.7 points by week 20. That's a move from the moderately severe range into the mild range. This doesn’t mean “depression is gone” at 8 weeks. Rather, even by 8 weeks her clients are startring to re-engage with things, might have a little more energy and are staritng to find daily life more manageable. The depression is still there. It’s still present. They might not have noticed a huge difference themselves yet, but a 5.5 point improvement on the PHQ9 absolutely means that things are starting to move.
By 12 or 20 weeks, there’s been substantial change. The depression is now mild and not dominating nearly as much of that client’s life. They may be participating mor ein relationships, activities, work or routines. They’re experiencing depression symptoms less often or less intently. They’re starting to really re-engage with life in a meaningful way.
A few honest caveats. These are real-world results from clients in our practice, not a controlled research study. Jill uses behavioral activation alongside other approaches when they fit, like Cognitive Processing Therapy, so these numbers reflect her work overall. Forty clients is a meaningful group for one therapist, but it's still small, and averages hide a lot of variation. Some people improve faster, and some take longer. And these numbers include clients who kept coming and filled out the questionnaire, which can make results look a little better than they would for everyone who ever started.
So this isn't a promise of what will happen for you. Everyone is different. But it does line up with what the research shows: when people keep showing up and keep doing the small, scheduled things, depression often gets lighter. Certainly, it doesn't happen overnight.
Behavioral Activation for Depression in Lee's Summit and Online Across Missouri
Jill Hasso, LPC, offers behavioral activation for depression at our Lee's Summit office and online anywhere in Missouri. She also offers Cognitive Processing Therapy for trauma and CBT-I for insomnia, which matters, because depression rarely shows up alone.
If you've been trying to push through on your own and you're tired of it, this is a different kind of help. It's structured, it's practical, and you won't be figuring out the next step by yourself.
Every new client starts with a free consultation, so you can ask questions and see whether it feels like a good fit. Call us at (816) 287-1116 (Lee's Summit) or 573-328-2288 (Columbia). Both numbers reach the same client care team or you can reach out to our client care team online.
You don't have to feel motivated to start counseling for depression. You just have to start.
About the Author
Jessica Oliver, MSW, LCSW, is the founder and clinical director of Aspire Counseling. She has more than 15 years of experience treating anxiety, trauma, and depression. She built Aspire around measurement-based care, which means clients track their symptoms throughout therapy so progress is something you can actually see, not just hope for. This post draws on an interview with Jill Hasso, LPC, who provides behavioral activation, Cognitive Processing Therapy, and CBT-I at Aspire's Lee's Summit office and online across Missouri.
