Cognitive Behavioral Therapy (CBT): How To Perform Behavioural Interventions?

Rather than targeting thoughts directly, the behavioural side of CBT works on changing behaviours in order to have a positive impact on thoughts and feelings. Mental illness can often bring about behaviour changes that in turn feed into and reinforce the illness, and this is a major target for CBT. A good example of this is compulsive behaviours in OCD. 

The most appropriate behavioural interventions will depend a lot on the specific illness and illness-related behaviours. However, this section gives an overview of some of the behavioural strategies that are used in CBT. 

Observation and Self-Monitoring 

In order to tease apart what’s happening with thoughts, feelings, physiological reactions, and behaviours, we have to be aware of what’s actually happening so that we can start to figure out what our patterns are. A bullet journal or mood tracking app can be a great way of keeping track of all of these pieces. 

When you’re doing the self-monitoring, try to separate out thoughts and feelings. We often use the words “I feel” when we’re actually referring to thoughts. As an example, “I feel like something bad is going to happen to me today” is a thought, which is likely accompanied by a feeling like anxiety or foreboding. A quick way to differentiate thoughts and feelings is how many words are required to describe them. Feelings are described by single words (e.g. happy, angry, anxious), while thoughts require a string of several words to express. Being able to distinguish between thoughts and emotions is important for you to be able to work on unlinking the two. 

Behavioural Activation 

Behavioural activation is a major part of CBT for depression. This activation refers both to increasing physical activity and increasing other daily activities, and it can be done within the home or outside of the home. Before and after participating activities, you’re supposed to rate your mood and how you perceive your ability to do the activity (mastery). 

Physical activity should be done at a level that’s appropriate for how you’re currently feeling, which may be a far lesser level of exertion than you would normally aim for. 

It’s also important to fit in activities that are pleasurable (or at least they would be pleasurable if you were feeling better). This includes acts of kindness towards both yourself and others. If these activities just aren’t happening on their own, try scheduling them in your calendar for specific days and times. 

Another recommendation is setting goals and identifying activities that can help you in the direction of achieving your goal(s). When goals for certain tasks seem overwhelming, it’s useful to break it down into individual steps. This functions as a staircase to help you make your way up toward your goal. 

The basic premise of behavioural activation in CBT is that it’s easier to focus on changing behaviour compared to changing thinking, and motivation follows activation. 

Personally, I’ve got mixed feelings about the whole idea of behavioural activation. For some people, behavioural activation works really well; for others, not so much. I’m one of those not so much people. 

If I’ve lost all interest in doing something, doing it over and over again anyway is just going to leave me annoyed. I’ve tried pushing physical exercise for months because I knew that’s what you’re “supposed” to do, and it just remained consistently unpleasant, even though it was a form of exercise I used to enjoy. 

At the same time, giving in to the depressive urges not to get out of bed isn’t helpful either. I try to focus on basic functional activities and self-care activities and not worry as much about trying to push myself in other areas. 

I also believe that with behavioural activation it’s better to aim low and feel like you’ve accomplished something than it is to aim high, not be able to do it, and beat yourself up. Keep in mind that the targets you set for yourself should be calibrated to your current level of functional ability, not the way you function when you’re at your best. If you’re really low, taking a shower is a huge behavioural activation gold star.


Pritam Chakraborty

As I was moving through life, I occasionally saw brief glimpses of beauty.

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