Getting Unstuck: How to Overcome Anxiety and Mood Problems with Behavioral Activation and Exposure

Brian_Chu-Ph.DPresenter: Brian Chu, Ph.D.

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Dr. Chu discussed Behavior Activation as a program that takes a comprehensive, and focused, approach to helping youth and families address depression and anxiety. He gave examples of how teens could use techniques to develop a more active coping approach towards life.


  1. NJCTS says:

    How does behavioral activation differ from CBT

    • Brian Chu, Ph.D. says:

      Behavioral activation (BA) is completely compatible with CBT and draws from the same behavioral principles and science. [Historically, CBT actually grew out of the behavioral principles that underlie BA]. In practice, BA focuses on the individual functional assessment principles that help us identify what triggers evoke what kind of emotional responses from each of us. And then, it leads us to look at how we respond to those emotions. Once we understand these individualized behavioral sequences, we can be more informed about how to seek out the most positive (or functional) settings and what kinds of behavioral responses get us in trouble. CBT actually encourages all of these same things. However, CBT also tends to focus on identifying and challenging negative cognitions. There is good empirical support for these interventions too, but they can sometimes be difficult to teach, and it is not clear if they are the most direct way to help us make change. We are still learning about when to recommend CBT or BA for what kinds of problems and which kinds of people.

  2. NJCTS says:

    Are you familiar with Comprehensive Behavioral Intervention for Tics? If so could you comment on how behavioral Activation differs from CBIT

    • Brian Chu, Ph.D. says:

      I am not an expert in CBIT, but my understanding is that it focuses on specific tics, and that the goal is to become more aware of premonitory urges that precede a tic behavior, before completing some kind of competing response to counter the tic. This intervention is based on the same kind of individualized functional assessment principles (behavioral sequences: antecedent – behavior – consequence) that BA is based on. The difference is that CBIT focuses on very specific behaviors (tics). However, it’s not so far off from BA. In BA, we teach clients to notice their early warning signals to threat (anxiety), to identify their typical response (avoidance of the threatening situation), and to do some kind of competing response (choose some active approach strategy). The target is the same: how can we help you do something that feels unnatural even when your body is telling you to do something else?

  3. NJCTS says:

    How do you present rewards when they are the very ones which make my daughter happy with a high score on the mood chart? Should I have her earn her happy, desirable things i.e. messaging,?

    • Brian Chu, Ph.D. says:

      This is a great question, and one that is nearly impossible to answer without knowing many more details. Anything I say here will likely sound trite. So, I’ll describe the process, instead. If this is in the context of depressed mood or a depressive episode, I would make sure that you are working with a professional who is familiar with setting up reward and contingency plans. In that context, I would imagine it would be a good idea to start with the Activity-Mood tracking first. It may seem “obvious” which triggers/events/activities are rewarding and which ones are punishing, but I am always surprised by what some concentrated observation will tell me. I would encourage both the child/teen and parent to complete one for at least 1-2 weeks.

      Then, I might discuss the TRAPs that the child is getting into and discuss the natural behaviors/rewards that seem to shift those moods in a positive direction. In that context, we might learn something different than you expected. For example, you may have thought that texting was “the only thing that makes her happy,” and removing this might seem cruel. But doing intensive tracking may reveal that texting is actually holding your daughter back. Perhaps she uses texting as an easy escape from other stressors. In some senses it is rewarding, but it also may keep your daughter stuck in an avoidant cycle – when she feels upset about a day, she removes herself to her room to text and forget about her day. But this doesn’t help solve the original problem, and it may not even be that personally gratifying. It may just be the easiest thing to do. In this case, texting may exactly be the behavior we want to reduce. And so, we might have to find something else that is naturally rewarding to lower her use of texting to cope.

      Of course, determining what is a reward and what is a TRAP depends on repeated observation and trial-and-error. This is what a professional can help you with.

  4. NJCTS says:

    How is this any different than just telling a kid, “Just do it.”

    • Brian Chu, Ph.D. says:

      Hopefully my response above indicates that the BA approach is more than simply ordering your child to “Just do it.” At some point, we do hope to help someone do things that are currently difficult. However, we get there by understanding deeply what TRAPs are holding the individual back and working with the person to figure out alternative choices that work for them specifically.