Clinical session: recording and scheduling activities

In order to give a better sense of what BA might look like, we have produced a short simulated video again with Dr Hannah Whitney, playing the role of therapist and Dr Michelle Lee, playing the role of depressed patient Kate.

The therapist has already worked with Kate to explain how withdrawing might be helping to maintain her depression. Before this session had taken place, Kate had been asked to complete an activity log of what she did in the week before this session and to rate these activities in terms of achievement, closeness (to others), enjoyment and importance. The session starts with Dr Whitney reviewing with Kate one day’s worth of activities from this completed activity log. The therapist also helps Kate to identify times during the week when she withdrew or avoided activities and to think about the impact that withdrawal or avoidance may have had on her mood. Before watching the clip, please take a look at Kate’s activity log for the day being discussed in the clip below.

Figure 1: Kate’s Activity Log © University of Reading

Whilst watching the video, please think about the following questions:

• What psycho-education does the therapist provide to Kate?

• What do the following terms refer to: acting ‘inside out’ and ‘outside in’?

• How does the therapist try to help identify try to make sure that the scheduling for the upcoming week is going to be realistic?

The therapist talks in detail about an instance during the day when Kate declined to answer a phone call from her boss. She probes further and highlights the vicious cycle whereby low mood leads to withdrawal and avoidance (not picking up the call), which leads to a further reduction in mood (feeling useless) and further withdrawal (going to bed).

The therapist also refers to how Kate is acting ‘inside out’ (ie ‘doing’ (or behaving) according to how she feels) rather than acting ‘outside in’ (ie doing things even though she may not feel like it, in order to break this vicious cycle). Once again, this clip highlights the collaborative nature of CBT – where a therapist may act as a guide but seek the expertise of their patient; when helping Kate to identify which activities could be scheduled in during the upcoming week, the therapist is keen to check with Kate which of the activities from the activity log were the most important to her. She is also keen to ensure that scheduling is realistic by checking back about the amount of days that the activity (Kate cooking for her children) should be scheduled in.