Behavioural activation

Figures checked September 2026

Behavioural activation works on what you do rather than on what you think. You and your therapist look at what a week actually contains, then plan specific things back into it. Those things start far smaller than seems worth doing. You do them at the time you planned, whatever you feel like when it comes around. The planning comes first and the motivation is expected to follow.

How it works

When you feel flat, doing less makes sense. Everything costs more than it used to, and dropping something gives you back a bit of room straight away.

The cost turns up later. Each thing you drop takes with it whatever it might have given you — some interest, some contact with another person, the sense of having done something. The day gets emptier, and an empty day gives you less to get up for.

Behavioural activation runs that cycle in the other direction, and it doesn’t wait until you feel like it. The reasoning behind the Approach (modality) The kind of therapy someone uses, such as CBT or psychodynamic therapy. You'll also see it called a modality. More in the jargon decoder is that motivation tends to follow action rather than lead it, so the activity goes into the week before the wanting turns up.

What happens in a session

Working out where the week goes. A few days of noting what you did and how you felt, so you and your therapist have something real to work from rather than an impression.
Two kinds of activity. Things that give you a sense of having got something done, and things that give you some pleasure or put you near other people. Being pushed entirely towards the first kind is a common way the approach goes off course.
Specific things at specific times, worked out in advance rather than on the day.
Steps sized down until they’re possible. If getting round the block didn’t happen on Tuesday, your therapist might suggest that Wednesday’s plan is standing at the front door for a couple of minutes. Steps that small are how the approach is built to work.
Where the time goes instead. What you do when you pull back from something, and what that tells the two of you about the obstacles.
What stopped a plan happening. A plan that didn’t come off is worth bringing to the session, because it shows you both what the next plan has to account for.

A course of behavioural activation is structured, and shorter than open-ended therapy.

Who it tends to suit

This tends to suit you if you can explain exactly why you should get up and do the thing, and still don’t. If you’ve spent time in therapy examining your thoughts and the heaviness didn’t move with them, this works on a different part of the problem.

It also suits you if you want something to start doing rather than something to understand first. When nothing feels like anything covers the experience it’s most often used for.

Behavioural activation suits you less if the question you actually have is why you’re like this. Psychodynamic therapy A therapy that looks at the parts of your life you can't quite see from the inside. Its core idea is that a lot of what shapes how you feel and act sits outside your awareness, and was laid down early. More in the jargon decoder and Schema therapy A longer-term talking therapy that works on deep, long-standing patterns. A schema is a deep belief about yourself and other people, formed early, that shapes how you read situations. More in the jargon decoder are the approaches that take that question on. Cognitive behavioural therapy (CBT) is the nearest neighbour. Behavioural activation came out of it, and plenty of therapists use the two together. Acceptance and commitment therapy is the other structured option.

What the evidence says

Most of what’s known about behavioural activation comes from trials treating depression. One review pooled 22 of them, covering 819 people. Those who did behavioural activation were doing considerably better at the end than people who got nothing or waited (Cuijpers and colleagues, 2023).

The researchers who pooled those trials call behavioural activation relatively simple to apply compared with other therapies. That is about what it asks of the therapist. What it asks of you is to do things at the point when doing things is hardest. That difficulty is part of what you’re there to treat.

The same researchers then looked only at the nine best-conducted trials. There the gap between the two groups was about half the size, and much less certain. Results varied a lot from one trial to the next. The weaker trials made the result look larger than it is, and the careful trials still found people doing better.

That 22-trial review compared behavioural activation against no treatment and against waiting lists. It says nothing about how behavioural activation compares with other therapies. A broader overview of the depression research found that the well-studied talking therapies brought symptoms down by about the same amount (Cuijpers and colleagues, 2023, on treatments for depression). Behavioural activation is one of those therapies.

Both comparisons are between groups of people in trials. Neither one predicts how much better you in particular will feel. Coming out level on average doesn’t make the choice between therapies unimportant either. What suits you is not what the averages measure. The trials were treatment for depression. None of it carries over automatically to flatness after a loss, after something frightening, or alongside a physical illness.

So the question becomes which approach you can actually get to, and who you’d be doing it with.

Getting it in Australia

Psychologist Someone trained to assess mental health problems and treat them with therapy. It takes at least six years of study and supervised practice, and they're registered with Ahpra, the national regulator. Psychologists can't prescribe medication. More in the jargon decoder provide behavioural activation, and so do Mental health social worker A social worker with an extra mental health accreditation. They're trained in therapy, and in the practical things around it, such as housing, money, family services and the systems people get stuck in. More in the jargon decoder and Mental health occupational therapist An occupational therapist with a mental health endorsement. Their focus is on daily life, such as getting back to work, study and routine, alongside the therapy itself. More in the jargon decoder . Counsellor Someone trained to help people talk through and work on difficulties. The title isn't protected in Australia, so it's worth checking a counsellor's training and registration. Medicare doesn't give a rebate for counsellors. More in the jargon decoder and Psychotherapist Someone trained in therapy, often for longer-standing patterns. Like counsellor, the title isn't protected in Australia, and Medicare doesn't give a rebate for psychotherapists. More in the jargon decoder also use it, though Medicare Australia's public health insurance scheme. For mental health, it gives rebates on sessions with psychologists and some other professionals, usually through a Mental Health Treatment Plan. More in the jargon decoder doesn’t Rebate The amount Medicare pays back towards a session. It comes back to you after you've paid, so what you pay yourself is the fee minus the rebate. More in the jargon decoder them. Almost nobody advertises it by name. Most therapists use it as part of Cognitive behavioural therapy (CBT) A structured, practical form of talking therapy. It's built on a simple idea: what you think affects how you feel, and both affect what you do. More in the jargon decoder rather than as a therapy in its own right. When you’re ringing around, ask whether they work on activity and avoidance. That gets you further than asking for behavioural activation.

What Medicare rebates. A Mental Health Treatment Plan from your GP (general practitioner) For most people, where getting help starts. A GP can write a Mental Health Treatment Plan, prescribe medication and refer you on, and some are trained to deliver a small number of structured therapy sessions themselves. More in the jargon decoder gives you a Medicare rebate on up to ten individual sessions a calendar year. You can use them with a psychologist, mental health social worker or mental health occupational therapist. Your first Referral A letter from a GP, psychiatrist or paediatrician that you need for the Medicare rebate. You can see a psychologist without one if you pay the full fee. More in the jargon decoder is for six of them. You then go back to your GP for a review before the last four. The rebate is $149.05 a session with a Clinical psychologist A psychologist with an extra endorsement, which usually means two more years of training aimed at more complex problems. More in the jargon decoder and $101.55 with a Registered For psychologists, psychiatrists and occupational therapists, registration with Ahpra is required, and using the title without it is an offence. Counsellors and psychotherapists can register with their national associations, which is voluntary. More in the jargon decoder psychologist. Fees vary, so what you pay on top varies too.

Cognitive behavioural therapy is on Medicare’s list of approaches that can be delivered under a plan. Behavioural activation is its behavioural half, so the rebate already applies.

Behavioural activation works over video as well as in a room. A session is mostly going over how the week went and planning the next one.

If things are difficult right now, Lifeline is on 13 11 14, the Suicide Call Back Service is on 1300 659 467, and Kids Helpline is on 1800 55 1800 for anyone aged 5 to 25. In an emergency, call 000. Crisis and emergency support has the full list.

Where next

Which approach you land on matters less than whether you can work with the person delivering it. Why who you see matters more than what they do covers why the relationship does more of the work than the method.

If you haven’t got that far yet, what therapy actually is covers the basics. Would I benefit from therapy? starts from what you’d want to be different, rather than from whether things are bad enough.