Lesson 2 of 6 · Why it holds itself in place
The inversion, in one sentence
Here is the whole of the next lesson compressed into a line, and it is worth reading twice.
You are waiting to feel like doing something before you do it. In depression the feeling arrives after the action, not before it.
That is not a motivational slogan. It is a description of the order things happen in when reward has been stripped out. Waiting for motivation in a depressive episode is waiting for a bus on a road the buses no longer run down.
The claim has a name and a trial record. It is the core of behavioural activation, and when activation was tested on its own, with none of the work on thoughts attached, it did as well as the full package it had been carved out of.
Al-Ghazali makes the same structural point in the Ihya, and it is worth having beside the trials. Fine traits are acquired by training, he says, by forcing yourself at the outset into the acts that issue from them so that at the end they become your nature, because influence runs both ways between the heart and the limbs. He is writing about character rather than about mood, and about months rather than about a Wednesday, so he is not describing this treatment. What he is not doing is waiting for the feeling first.
What the research says
When cognitive behavioural therapy was taken apart and the activation component run on its own, activation alone matched the full treatment including all the work on thoughts. That is the specific reason this course teaches doing rather than thinking.
The trial that took cognitive behavioural therapy apart and ran the activation component on its own. Activation alone matched the full treatment including the work on thoughts. The precise claim it supports is that acting first produces improvement without needing the thought changed first, which is narrower than saying motivation always follows action.
Jacobson NS, Dobson KS, Truax PA, Addis ME, Koerner K, Gollan JK, Gortner E, Prince SE (1996). A component analysis of cognitive-behavioral treatment for depression. Journal of Consulting and Clinical Psychology, 64(2), 295 to 304 doi
Behavioural activation matched antidepressant medication and outperformed cognitive therapy among the more severely depressed people in this trial. It is one trial, and one trial does not settle a question, so hold it as encouraging rather than decisive.
Behavioural activation was comparable to antidepressant medication and did better than cognitive therapy among the more severely depressed people in the trial. This is one trial, and one trial does not settle which treatment suits which person.
Dimidjian S, Hollon SD, Dobson KS, Schmaling KB, Kohlenberg RJ, Addis ME, and others (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74(4), 658 to 670 doi