How to use a behavioral activation worksheet with clients

How you use a behavioral activation worksheet with your clients ultimately depends on the clients’ needs and preferences, and your therapeutic style. Some therapists incorporate CBT principles in a regimented way, while others take a more organic approach. If you’re familiar enough with the framework of behavioral activation, you can easily incorporate the principle in and out of session, and with or without worksheets.

Help clients identify their values

At the core of behavioral activation, Tague says, is aligning one’s life with their values. In session, start by helping clients list out what’s most important to them so they can eventually parse out how to incorporate those values into their lives. For example, if health and nature are priorities, then you might encourage your client to schedule a short outdoor walk a few times a week. A value-based worksheet can be helpful here, or you can use a whiteboard or simply have a conversation in session.

Rank values and activities

Once the client identifies what’s most pleasurable or meaningful to them, ask them to rank these things based on how important it is and how much enjoyment they expect to get out of it. You can use a dedicated worksheet to rank, or simply have your client write their valued activities in a journal.

Because small changes are often more effective than huge overhauls, it may help to incorporate the most valued activities first. The list should also incorporate things that are fairly easy to do, especially if something like depression or anxiety is showing up in the client. So, going for a 10-minute walk versus running a 5k may feel both rewarding and more doable on a very difficult day.

Set goals and schedule activities 

Next, Tague says, you can use goal-setting and scheduling worksheets to help set up your client for success in their valued activity. Encourage them to start small at first.

“If they have such an ambitious goal that they won’t realistically achieve it, they might think they failed,” she says. “Talk them down from five days at the gym to one day a week, and if they happen to go more, then they’ll gain confidence.”

Monitor mood changes 

You can also use behavioral activation worksheets to help clients track their progress and mood changes as they engage in their chosen activities. Tague says it’s helpful to have them write down how they felt before and after the activity, along with reflecting on barriers to engaging in it. In therapy, you can work through how to overcome those challenges together for more future success.

Stack activities 

If it’s difficult for your clients to stick with a routine, get strategic. Mike Arevalo, PsyD, a private practice therapist and Headway’s clinical product lead, says he often has clients pair new activities with ones they’re already doing.

For example, if your client wants to socialize more, going to the grocery store with a friend may feel more doable than setting up a separate coffee date. Over time, as the client gains self-efficacy and confidence, they’ll grow more motivated to keep growing — and hopefully, their unwanted mental health symptoms will become more manageable in the process.