Activity Record

The activity record in CBT and behavioral activation

6 minute read

The activity record comes from cognitive behavioral therapy, and it is part of almost every version of behavioral activation, a treatment for depression that focuses on changing what people do, day to day. This article covers where the record came from, where it sits in that treatment, and what the trials of behavioral activation found.

The record in cognitive therapy

Aaron Beck's cognitive therapy for depression, published in 1979 and one of the founding forms of CBT, included a set of behavioral techniques alongside its work on thoughts. Patients kept a weekly activity chart and used it in two separate ways: to record what they did, rating their activities for mastery and pleasure, and to plan activities ahead of time. A 2010 review by Jonathan Kanter and colleagues notes that simple weekly activity charts like this first appeared in Beck's manual, and that later versions of behavioral activation adopted them.

Activity and mood

The record's focus on activity and mood rests on a simple observation. In 1973 the behaviorist Charles Ferster proposed that depression is partly a problem of lost reward. People do less of what used to be rewarding, and more of what they do goes to escaping or avoiding things that feel bad. The same year, Peter Lewinsohn and Michael Graf reported that mood rose and fell with the number of pleasant activities people took part in. If lower activity and lower mood feed each other, then a record that shows both on the same page is a good place to start, and changing activity is a way in.

Where the record fits in behavioral activation

Behavioral activation is made of several distinct techniques. That same review identified eight, including activity monitoring, assessment of values, activity scheduling, skills training, and work on avoidance. Monitoring and scheduling were the two that appeared in essentially every version.

Activity monitoring is keeping an hour by hour record of what you do and how you feel. The review describes it as a way of gathering information rather than a technique for changing behavior, with two main jobs. It gives a baseline of activity and mood that the rest of the work can build on, and it lets people see in their own record that what they do and how they feel are connected. Therapists also use it to find the hours that go better, to spot avoidance, and, when it is kept going, to compare later weeks with earlier ones.

Activity scheduling is different work. It plans specific activities into the coming week, usually in small steps. Other techniques, such as working on avoidance directly or testing predictions with behavioral experiments, may come in too. Behavioral Experiment, a separate tool of ours, is built for the last of these. The record often informs these steps and is often kept alongside them, but each has its own methods and is usually worked out with a therapist or a structured program.

The Activity Record app, the online worksheet, and the printable sheets are for activity monitoring. They record what happened. They do not schedule activities or run experiments, and keeping a record does not require doing either.

How behavioral activation became its own treatment

In 1996 Neil Jacobson and colleagues ran what they called a component analysis. They randomly assigned 150 people with major depression to one of three treatments. One was the behavioral activation part of cognitive therapy on its own. One added work on automatic thoughts, the quick negative thoughts that pop up in the moment. The third was the full cognitive therapy. The full treatment did no better than its behavioral part, either at the end of treatment or six months later. The behavioral treatment on its own also changed negative thinking about as much as the others did.

That result led Christopher Martell, Michael Addis and Jacobson to develop behavioral activation as a treatment in its own right, set out in their 2001 book Depression in Context. Their version pays close attention to avoidance, the things people do to escape a bad feeling in the short term and what those escapes cost later. They describe the pattern as a TRAP, a Trigger, the Response it brings, and an Avoidance Pattern, and the treatment works toward a TRAC, where Alternative Coping takes the place of the avoidance. Carl Lejuez, Derek Hopko and colleagues developed a briefer version built around life areas, values, and planned activities. They revised it in 2011.

What the trials found

In a 2006 trial of 241 adults with major depression, Sona Dimidjian and colleagues compared behavioral activation, cognitive therapy, antidepressant medication, and a pill placebo. Among the more severely depressed participants, behavioral activation did as well as medication, and both did better than cognitive therapy.

Reviews that pool many trials have come to similar conclusions. Cuijpers, van Straten and Warmerdam in 2007 pooled 16 trials of activity scheduling treatments, their name for behavioral activation, and Mazzucchelli, Kane and Rees in 2009 pooled 34. Both found it worked much better than comparison conditions such as waiting lists or usual care, and no better or worse than cognitive therapy. Since cognitive therapy also includes behavioral steps, that comparison asks whether a treatment built around what people do works as well as one built mainly around changing thoughts. Ekers and colleagues updated the evidence in 2014 with 26 randomized trials and again found behavioral activation effective against comparison conditions, while noting that study quality was low in most of the trials and follow-up was short.

The largest single test came in 2016. The COBRA trial randomized 440 adults with depression in England to behavioral activation delivered by junior mental health workers or to CBT delivered by trained therapists. After a year, behavioral activation was no less effective, and it cost less to provide. In 2022 the UK's National Institute for Health and Care Excellence included behavioral activation, one to one or in a group, among the treatments it recommends for depression in adults.

What this does not show

The research is mostly about depression, and mostly about behavioral activation delivered or guided by a professional. None of it tested this app or this website. The trials tested whole treatments, monitoring together with scheduling and other techniques. Monitoring on its own has also been studied, often as the comparison condition in trials, and the fuller treatments have generally done better. Keeping a record is one part of the method, with its own purposes, not the whole of it. On your own or with a therapist covers what is known about self-guided use, and the research page gathers every reference in one place.

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Helpful links

Educational content, not medical advice or a substitute for professional care. Ready to try it? Open the free worksheet, print a sheet, or get the app for iPhone and iPad or Android.