Table 1 Primary goals for of each session involved in behavioral activation and exposure-based therapy protocols
Session | Exposure therapy content | Behavioral activation content |
|---|---|---|
Pregroup | Brief pregroup individual check-in session: complete or review the Tulsa Life chart, provide a summary of the format and focus of exposure therapy | Brief pregroup individual check-in session: complete or review the Tulsa Life chart, provide a summary of the format and focus of behavioral activation |
1 | Session content: provide a brief overview of anxiety and depression and the rationale for exposure-based therapy Homework: initiate self-monitoring | Session content: provide a brief overview of anxiety and depression and the rationale behavioral activation Homework: Initiate self-monitoring |
2 | Session content: homework review, further discuss the role of conditioning and avoidance behavior in anxiety, begin building an exposure list Homework: continue self-monitoring and adding to exposure list | Session content: homework review, introduce concept of working from the “outside in” and discuss values as a way of identifying potential behaviors that may improve mood Homework: continue self-monitoring complete values worksheet |
3 | Session content: homework review, further develop exposure hierarchies, design and implement initial imaginal exposures Homework: continue self-monitoring, conduct repeated imaginal exposure exercises | Session content: homework review, discuss goal-dependent versus mood-dependent behavior and “acting as if,” discuss initial activity scheduling Homework: continue self-monitoring, engage in planned value-/goal-driven activities |
4 | Session content: homework review, conduct repeated imaginal exposures, discuss strategies for optimizing exposure exercises, design and complete an in vivo exposure exercise Homework: continue self-monitoring, conduct repeated imaginal and in vivo exposure exercises | Session content: homework review, introduce concept of function versus form and the tracking of antecedent, behavior, and consequences to examine function of behavior Homework: continue self-monitoring, use “ABC” sheets to examine function of behaviors, engage in planned value-/goal-driven activities |
5 | Session content: homework review, conduct repeated imaginal and/or in vivo exposure exercises, discuss strategies for optimizing exposure exercises. Homework: continue self-monitoring, conduct repeated imaginal and in vivo exposure exercises | Session content: homework review, introduce concept of avoidance as it relates to mood, values, and value-/goal-motivated behaviors. Homework: continue self-monitoring, use “ABC” or “TRAP/TRAC” worksheets to examine function of avoidance behavior, engage in planned value-/goal- driven activities |
6 | Session content: homework review, conduct repeated imaginal and/or in vivo exposure exercises, discuss strategies for optimizing exposure exercises Homework: continue self-monitoring, conduct repeated imaginal and in vivo exposure exercises | Session content: homework review, discuss how to integrate behavioral activation into their lives using “ACTION” Homework: continue self-monitoring, use “ABC” or “TRAP/TRAC” worksheets to examine function of behavior, engage in planned value-/goal-driven activities |
7 | Session content: homework review, conduct repeated imaginal and/or in vivo exposure exercises, discuss strategies for optimizing exposure exercises Homework: continue self-monitoring, conduct repeated imaginal and in vivo exposure exercises | Session content: homework review, discuss strategies to reduce the behavior of rumination, including “cueing action” and “attending to experiences” Homework: continue self-monitoring, use “ABC” or “TRAP/TRAC” worksheets to examine function of behavior, engage in planned value-/goal-driven activities, including those targeting rumination |
8 | Session content: homework review, conduct repeated imaginal and/or in vivo exposure exercises, discuss strategies for optimizing exposure exercises Homework: continue self-monitoring, conduct repeated imaginal and in vivo exposure exercises | Session content: homework review, discuss using behavioral activation to build the meaningful life that you want Homework: continue self-monitoring, use “ABC” or “TRAP/TRAC” worksheets to examine function of behavior, engage in planned value-/goal-driven activities |
9 | Session content: homework review, conduct repeated imaginal and/or in vivo exposure exercises, discuss strategies for optimizing exposure exercises Homework: continue self-monitoring, conduct repeated imaginal and in vivo exposure exercises | Session content: homework review, discuss troubleshooting techniques to counteract activation barriers Homework: continue self-monitoring, use “ABC” or “TRAP/TRAC” worksheets to examine function of behavior, engage in planned value-/goal-driven activities |
10 | Session content: homework review, conduct repeated imaginal and/or in vivo exposure exercises, repeat initial exposure exercises from session 3 to observe progress, discuss relapse prevention strategies Homework: conduct repeated imaginal and in vivo exposure exercises planned for the next 2–3 weeks and ongoing | Session content: homework review, reflect on and review previously learned techniques, discuss relapse prevention strategies Homework: continue to engage in self-monitoring as needed, engage in value-/goal-driven activities planned for the next 2–3 weeks and ongoing |
Post | Brief postgroup individual wrapup session: update Tulsa Life chart, discuss observed trajectory of self-reported behaviors and symptoms through treatment, discuss treatment referrals as needed | Brief postgroup individual wrapup session: update Tulsa Life chart, discuss observed trajectory of self-reported behaviors and symptoms through treatment, discuss treatment referrals as needed |