Behavioural activation — structured clinical viva

Opening (definition and model)

BA is a structured, collaborative psychotherapy that increases contact with response-contingent positive reinforcement and reduces avoidance that maintains depression.[8][14][15] Outside-in: do not wait for motivation. Ferster functional analysis plus Lewinsohn reinforcement loss is the theoretical backbone.[8][14]

TRAP/TRAC for this case

• TRAP: Trigger = evening alone after school → Response = emptiness/hopelessness → Avoidance Pattern = bed, phone scrolling, cancelled plans.
• TRAC: same trigger/response → Alternative Coping = pre-scheduled 10-minute walk or shower, then one valued micro-task (prepare tomorrow's materials).

Session structure and early homework

Agenda, PHQ-9, homework review, new graded plan, summary. Session 1 sets monitoring; early tasks must be small enough for a bad day. Mastery/pleasure ratings guide shaping.[15]

Contrasts

BA vs full CT: CT adds cognitive restructuring; Jacobson dismantling supports activation sufficiency for many patients.[3] BATD is a brief manualised activation family (life areas, contracts).[14][15]

Evidence bundle

• Dimidjian 2006: BA competitive with CT and ADM acutely.[1]
• Dobson 2008: BA/CT durable after response vs medication withdrawal framing.[2]
• COBRA: BA non-inferior to CBT; junior workforce/cost advantages.[5]
• Ekers meta / Cochrane: effectiveness support with certainty caveats.[6][12]

When BA is not enough alone

Acute high suicide risk, mania, medical emergency, severe self-neglect, need for trauma-focused work, or preference/indication for medication/ECT pathways — BA may still be adjunctive for routine rebuilding.[12][14]

Examiner pushbacks