Behavioral activation

Faced with depression and its negative symptoms, behavioral activation is today a first-line treatment whose effects continue to be highlighted in the scientific literature. Theorized in the 1950s, developed in the 1970s and popularized in the 1990s, behavioral activation shows equivalent effects to antidepressants and cognitive therapy, while simplifying the patient’s therapeutic path. Spotlight on this technique still too little known.

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1. WHAT IS BEHAVIORAL ACTIVATION ?

Behavioral activation is a therapeutic technique aimed at increasing an individual’s engagement in adapted activities, most often with a strong positive impact allowing for reinforcement.

Patients, especially those with anxiety-depressive disorders, have a high level of avoidance. The symptoms of the disorders often lead to a decrease in activities by avoiding the associated unpleasant emotions. Frustration, fear, fatigue, sadness are among the anticipated consequences and it becomes preferable for patients to reduce their activities and actions rather than risk being exposed to these consequences.

Derived from cognitive-behavioral therapies, the goal of behavioral activation is to reintroduce appropriate behavioral habits into the patient’s life, reduce avoidance, and bring back positive emotions associated with different activities. 

More simply, we will use the pleasure associated with the practice of sports, hobbies, positive social interactions, as well as the feelings of self-reward felt after completing chores or difficult tasks to reinforce these behaviors and get out of inactivity.

2. WHEN SHOULD BEHAVIORAL ACTIVATION BE USED ?

Behavioral activation is primarily used in the treatment of depressive symptomatology. Fatigue generated by the illness, as well as negative-focused thinking patterns and expectations of the worst, will lead to avoidance of many situations and actions. Individuals suffering from depression, by using avoidance as a coping strategy for potential unpleasant situations, will reduce the frequency and intensity of their active behaviors, which will lead to a worsening of depressive symptoms.

This same pattern of avoidance is found in anxiety disorders, including social phobias and generalized anxiety disorder.

It can therefore be used in the treatment of these two families of disorders, as well as with any patient whose avoidance leads to a strong decrease in activity and global functioning.

3. WHAT ARE THE EFFECTS ?

Behavioral activation will reduce avoidance behaviors. These short-term coping strategies (management of emotions) are effective in avoiding potential unpleasant emotions, but lead to the appearance and maintenance of a vicious circle that sustains anxiety and depressive symptoms. Behavioral activation allows the patient to recognize his or her avoidance behaviors and to replace them with active behaviors by focusing on the reward and positive emotions associated with the realization of these actions.

Indeed, behavioral activation allows the reintroduction of sensations of pleasure or control, which are mostly absent in people suffering from anhedonia and subject to avoidance. These pleasurable sensations will participate in the reinforcement of active behaviors and increase their frequency and their positive impact on the mental health of patients.

4. WHAT ARE THE STAGES OF BEHAVIORAL ACTIVATION ?

The first step will be to teach the patient to recognize his or her symptomatology and to understand the mechanisms of avoidance and reinforcement, in order to better identify which situations are the most sensitive to them. We can work in mindfulness to facilitate the recognition of these processes that may have become automatic over time. 

After learning about and recognizing the disease, values are defined with the patient, which will serve as a compass during therapy and will facilitate the perception of rewards and pleasant emotions during activities.

Once the psychoeducation is completed, the active part of the therapy will consist of identifying the traps that lead to avoidance in order to face them, and then to take action, by reintroducing activities progressively. The goal is to go at the patient’s pace, according to his or her abilities, and the difficulty should not be too high so as not to set the patient up for failure, while allowing him or her to find rewards in the effort made.

After working on these aspects, the goal will be to consolidate this mode of functioning over the long term, and to transform it into a complete and functional lifestyle. We will make sure that the rest of the patient’s life environment is compatible with good mental health and we will make the necessary changes (stopping substance use, healthy sleep, etc.)

5. BEHAVIORAL ACTIVATION AND VIRTUAL REALITY

Recent studies on the use of virtual reality in behavioral activation, in particular on the practice of physical activities in virtual reality (walking, cycling, etc…) have shown that thanks to its playful and motivating aspect, the benefits on mood and motivation were greater than during a simple physical activity. In addition to offering tools for well-being and cognitive and behavioral therapy, virtual reality can therefore also be considered in the case of behavioral activation for the treatment of anxiety and depression.

Do you need further information or have any specific questions ?

FAQ

Virtual reality (VR) is an innovative technology that enables patients to be exposed to immersive and controlled environments, facilitating the management of numerous psychological and psychiatric disorders. Its use in mental health offers several advantages:
  • Gradual and Controlled Exposure: VR allows patients to confront anxiety-inducing situations in a secure environment, gradually adjusting the intensity of stimuli to promote habituation and emotional regulation.
  • Realistic and Reproducible Environments: Unlike traditional techniques, VR provides immersive scenarios that can be consistently reproduced, ensuring a coherent and effective approach.
  • Increased Patient Engagement: The interactive and immersive nature of VR enhances treatment adherence and motivates patients to continue their therapy.
  • Personalized Treatment: Virtual environments can be adapted to meet the specific needs of each patient.
  • Versatile Applications: VR is used to treat anxiety disorders (phobias, post-traumatic stress disorder, obsessive-compulsive disorders), addictions, mood disorders, and even cognitive remediation.
The use of virtual reality in healthcare is not new! It has been studied and utilized for over 30 years in the medical and psychological fields. As early as the 1990s, researchers began exploring its potential for treating anxiety disorders, particularly phobias and post-traumatic stress disorder. Since then, numerous scientific studies have confirmed its effectiveness in addressing various psychiatric, neurological, and cognitive disorders.
Today, VR is widely integrated into therapeutic and medical practices, with clinically validated protocols. It is used in hospitals, clinics, and psychologists' offices worldwide to provide patients with innovative, effective, and safe treatments.
To use virtual reality, one must immerse themselves in a virtual environment. There are several ways to achieve this.
In the past, the CAVE system (Cave Automatic Virtual Environment), a 3D setup consisting of multiple screen walls, was the primary method used. This system allowed users to be fully immersed in the virtual world, with their movements detected in real-time. However, this technology was expensive and not widely accessible.
Since around 2016, with the introduction of virtual reality headsets like the Oculus Rift and HTC Vive, VR has become much more accessible. These headsets immerse users in virtual reality through an enclosed screen that projects digital images. The user's head movements are tracked, enabling them to look around and interact with the environment as they would in the real world.
Today, VR headsets are wireless and standalone, providing maximum comfort and ease of use without requiring external sensors or cables.
A virtual environment is an immersive digital simulation created through virtual reality. It allows users to navigate in a 3D space that accurately replicates everyday situations or specific contexts.
In mental health, these environments are designed to help individuals gradually face certain situations, manage their emotions, or enhance cognitive skills. By interacting with these virtual spaces, patients can engage in meaningful experiences tailored to their needs.
You need to equip yourself with a virtual reality headset. Our software is compatible with Meta Quest 2, 3, and 3S. 
You will then only need an internet connection. 
Numerous studies confirm that virtual reality is safe to use. However, some restrictions are in place to protect users from potential adverse effects.
For instance, individuals with epilepsy and pregnant women should avoid this type of therapy.
As with any immersive technology, prolonged use may cause visual fatigue or mild discomfort, particularly for those sensitive to motion sickness. Therefore, it is recommended to take regular breaks and adjust session durations according to individual needs.
Virtual environments are designed to be gradual and controlled, minimizing the risk of excessive anxiety. Most users quickly adapt to immersion and experience the benefits of this innovative approach from the first sessions.
Anxiety disorders and phobias can be effectively treated using virtual reality. Patients are gradually and progressively exposed to anxiety-inducing situations in various environments while remaining in a safe space. This process helps develop a sense of habituation, ultimately reducing or even eliminating anxiety over time.
Behavioral and substance addictions can also be addressed through virtual reality. By incorporating synthetic stimuli into the environments that trigger craving responses, patients struggling with addiction can work on their cravings to diminish the urge to consume.
Additionally, multiple environments—such as bars, casinos, and social settings—enable cognitive work on dysfunctional beliefs associated with specific temptation scenarios.
Regarding eating disorders, virtual reality software helps target key etiological factors, such as body dysmorphia, allocentric lock (a tendency to focus on others rather than oneself), and food cravings.
Currently, our TERV (Virtual Reality Exposure Therapy) solutions include multiple software programs designed to address critical psychiatric, psychological, and neuropsychological determinants such as relaxation, cognitive stimulation, behavioral activation, and social skills training.
Reminiscence therapy is also a major therapeutic tool in treating depression. By allowing patients to relive sensations linked to past pleasurable activities (such as sports, driving, or traveling), virtual reality stimulates hypoactive brain areas, enhancing therapeutic success. VR serves as an excellent mediator for reigniting engagement in enjoyable activities.
Moreover, cognitive stimulation for elderly individuals is another area where virtual reality proves beneficial. By leveraging technology to make stimulation activities more engaging and accessible, patients and nursing home residents can improve executive functions and memory through specially designed applications.
Today, virtual reality in mental health care is advancing rapidly. Researchers, clinicians, and developers continue to explore new therapeutic targets to offer innovative and effective treatment solutions in the near future.
VR can be used by all healthcare professionals assisting patients with anxiety, phobias, post-traumatic stress disorders, addictions, or other psychological challenges.
It is particularly beneficial for psychologists, psychiatrists, neuropsychologists, specialized nurses, as well as psychomotor therapists, physiotherapists, dietitians, sophrologists, and hypnotherapists. With a wide range of immersive environments, VR enhances therapeutic approaches and provides innovative tools to improve patient care.
Healthcare providers incorporating virtual reality exposure therapy (VRET) expand their range of treatment options. VRET is a well-established therapeutic technique with scientific validation from cognitive-behavioral therapy research.
  • Professional Differentiation: Integrating VR into practice allows therapists to stand out from traditional treatment options.
  • Scientific Validation: VRET is backed by extensive research, reinforcing its credibility as an effective treatment method.
  • Improved Patient Engagement: The interactive nature of VR fosters greater patient involvement in therapy.
  • Time-Saving: VR provides direct access to various exposure environments without needing external logistics.

One of the considerable advantages of virtual reality is that it is effective on a wide spectrum of populations. Existing data from the literature on the subject shows us that it is entirely possible to expose a wide age group to virtual reality, with real therapeutic benefits.

The studies attest, in fact, to excellent feasibility and significant results; particularly in adults, in the treatment of anxiety disorders (including school phobia), autism, addictions, eating disorders, neuropsychological disorders, psychotic disorders and mood disorders.

The results are identical for adolescents with a significant added value concerning therapeutic engagement where virtual reality promotes adolescents' interest in their therapy.

Among elderly subjects, study results encourage the use of virtual reality with the aim of working on cognitive stimulation, on behavioral disorders but also on anxiety.

One of the major advantages of virtual reality is its effectiveness across a broad spectrum of the population. Existing literature on the subject shows that virtual reality can be used with individuals of various age groups, providing significant therapeutic benefits.
Studies confirm excellent feasibility and significant results, particularly among adults in the treatment of anxiety disorders (including school phobia), autism, addictions, eating disorders, neuropsychological disorders, psychotic disorders, and mood disorders.
The results are equally promising for adolescents, with a notable advantage in terms of therapeutic engagement, as virtual reality enhances their interest and participation in treatment.
For older adults, research supports the use of virtual reality to improve cognitive stimulation, behavioral disorders, and anxiety management.
However, people with epilepsy and pregnant individuals are not advised to undergo this type of therapy.
Yes, all our environments are grouped within a single application.
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