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Behavioral Activation: Treatment of Adolescent Depression


>> KATHRYN DELONGA: Hi, my name is Dr. Kathryn DeLonga. I am a licensed clinical psychologist and director of the psychological treatment program with the Mood Brain and Development Unit. Our lab is located within the Emotion and Development Branch of the National Institute of Mental Health at the National Institutes of Health in Bethesda, Maryland.

I have nothing to disclose. All the opinions I am presenting are my own. And all this work is supported by the National Institute of Mental Health Intramural Research Program. This is a picture of the NIH Clinical Center here at our Bethesda location.

The Mood, Brain and Development Unit is led by psychiatrist Dr. Argyris Stringaris.

And we have a research and clinical team and together we work to improve understanding and treatment of adolescent depression.
In this short webinar, I’ll be talking a little bit about psychological, or “talk therapy” treatment for clinical depression in adolescents—specifically, I’ll be sharing information about a type of talk therapy called Behavioral Activation, that we offer in our outpatient clinic to teenagers enrolled in our studies.

Depression is an illness of brain circuitry and chemistry that causes and is caused by changes in mood, thinking, motivation and behavior. When you review the scientific research on most effective treatments for depression in adolescents, what comes up again and again is that the behaviors we engage in make a difference and can help us feel better or can lead to feeling worse.

Take, for example, Sally, a hypothetical 15-year-old girl who had a fight with a friend. She’s failing in school while her parents are separating.  These are some of the stressful events and the daily hassles that she’s been dealing with.  She gets into this negative mood spiral because she feels sad, worthless, overwhelmed and angry. She copes with these big feelings in a pretty natural way. She skips classes because she is overwhelmed by school and she avoids her friends so not to be as anxious. She starts spending a lot of time alone in her room listening to sad music.  So the ways that she is coping actually has some negative consequences as well. So her friends stop calling, she gets further behind in school, her parents are upset and get on her case. So these negative consequences led back to some of these stressful daily hassles. She feels lousy and it starts this negative mood spiral.  

Behavioral Activation is a type of talk therapy that helps teens get unstuck from negative mood spirals. With your clinician you work to reverse the negative spiral by noticing the connection between what you do and how you feel, and gradually adding more small and enjoyable actions back into your life. Behavioral Activation is an evidence-based treatment that helps teens engage in mood-and confidence-boosting activities. With the goal of decreasing avoidance, bolstering peer connection, and improving engagement in rewarding activities and incorporates parent involvement so parents gain tools for supporting their adolescent.

So instead of the negative spiral when feeling depressed and following unhelpful actions – avoiding, withdrawing and then having those negative consequences and things get worse. Through behavioral activation you could work with your counselor to start looking at helpful actions that could help boost your mood. For Sally, at the start of her treatment her goal was to get out of her pajamas and to shower every morning. She noticed that she actually felt a little bit better, more like herself, just by taking that step. Then, with her parents support she reached out to her counselor to get excused from some of the homework she had missed and to get extra support catching up in subjects where she had fallen behind. She started spending more time outside her room and reduced the number of hours she spent on her phone and signed up for a rec basketball league through which she ended up making some new friends. Through the treatment her parents also worked with her therapist to learn new ways to encourage, praise and support Sally for her efforts and progress. Overall, Sally learned that through taking small, incremental steps, she could do things that would lead to feeling better, more resilient, more like herself, and that she again felt hopeful about the future.

So in Behavioral Activation instead of mood directed behavior where you might feel bad and you don’t do anything much because you feel so lousy and then you feel even worse, we focus on goal directed action.  We focus on goal directed behavior. Even though you might be feeling bad you will do something fun and you do something because you set the goal to do it. For Sally, she got up and showered because she had set that goal even though she didn’t feel like showering. Then she noticed she felt a little better after that.  So the heart of Behavioral Activation is that action can help you feel more motivated. So rather than waiting to feel better, do things that align with your values that will lead to feeling better.

Parents receive coaching and what’s helpful to know is that depression makes teens irritable, angry, oppositional. As the depression is treated, and with the right kind of support, your child will again feel interest, joy, motivation and connection. You can learn skills and ways to support your child to prevent future bouts of depression. So next steps could be to seek professional assessment for your child and encourage adherence, work with your child’s treatment team to learn new skills, seek emotional support or treatment yourself, remove guns from the home and keep medicines or other lethal means in a safe manner, set appropriate limits on social media, on electronics, on sleep, support sleep hygiene, and to stay positive and supportive.

Here are 8 things to do to support your teen in general but in particular for those with depression. Listen, show your concern and that you are trying to understand your child’s perspective, acknowledge all positive or healthy choices you see, praise steps in the right direction, express confidence in your teen, model healthy problem-solving, facilitate/support your child’s engagement with healthy activities and a positive peer community, and allow your teen to have autonomy and independence, while also monitoring and setting appropriate limits.

For more information on talk therapy, what to consider when looking for a therapist, online resources, federal resources, and a listing of professional organizations with clinician directories, please visit:

And for more information about The Mood, Brain and Development Unit’s teen depression study, please feel free to call 301-827-1350. Find us on the website. And if you have a child or teen who may be depressed and may be interested in participating in our study or interested in the inpatient or outpatient treatment program, please get in touch.

Thank you.