Does behavioral activation really work as well as therapy for low mood?

In Ekers and colleagues' 2014 review of 26 trials, behavioral activation clearly beat doing nothing and was about as effective as antidepressant medication. An earlier meta-analysis by Cuijpers and colleagues (2007), pooling 16 studies, found it held its own against cognitive therapy too. It is simple, but it is not slight.

How is this different from therapy homework on a hard week?

Homework is practice your therapist assigns to carry a specific skill forward. Behavioral activation is broader: deliberately adding meaningful or rewarding activity back into a low day to keep mood from sinking further. On a bad day the two overlap, and one small planned action serves both.

What if I only manage one tiny thing?

That counts. The research rewards getting an activity started, not a full productive day. One reachable action, done, is closer to what these studies measured than a long list you cannot face. Shrink the step until it fits the day you are actually having.

The Wait

What helps on a bad day when my next session is far away?

Last updated November 2, 2026

Short answer

On a bad day between sessions, do one small activity on purpose, even when you do not feel like it. Research on behavioral activation finds that gently scheduling simple, meaningful actions eases low mood, and it works about as well as fuller therapy. Start with one reachable thing, not a whole day.

The research

Ekers, D., Webster, L., Van Straten, A., Cuijpers, P., Richards, D., and Gilbody, S. (2014). Behavioural Activation for Depression; An Update of Meta-Analysis of Effectiveness and Sub Group Analysis. PLoS ONE, volume 9, issue 6, article e100100.

Sample 26 randomized controlled trials, 1,524 people

Published 2014

Journal PLoS ONE

David Ekers and colleagues updated a review of behavioral activation for depression, a plain approach that helps people plan and do simple, meaningful, or rewarding activities instead of withdrawing when mood drops. They pooled 26 randomized controlled trials covering 1,524 people. Against control conditions, behavioral activation lowered depression symptoms with a standardized mean difference of -0.74 (95% CI -0.91 to -0.56), a moderate to large effect, across 25 comparisons and 1,088 people. In the four trials that compared it with antidepressant medication, it was about as effective. The authors call the result encouraging, but note the evidence is uneven: only 7 of the 26 trials met three or more common standards for a well-run trial.

Read the paper

What does this mean for you?

A bad day between sessions is not a sign the work is failing, and it is not a day you have to white-knuckle alone. Behavioral activation is one of the most studied answers to low mood, and its logic is simple. Low mood pulls you to withdraw, withdrawing removes the small rewards that lift mood, and mood sinks further. The way out is to add one small action back in, on purpose, before you feel like it.

Be honest about what the research shows. The effect against doing nothing was moderate to large, which is a strong signal for such a plain idea. But the trials were mixed in quality, only a handful were tightly run, and these studies tested full courses of therapy, not a single hard afternoon. So treat this as a reason to try one small step, not a promise that one walk fixes a heavy day.

What still translates to your week is the shape of the action. The activities that helped were specific, reachable, and tied to something you value or enjoy, not grand plans. A short walk, a text to one person, ten minutes on a task you have been avoiding, a meal eaten at the table. The point is to act first and let a little of the mood follow, rather than waiting to feel ready.

The takeaway

Pick one small activity and do it on purpose, before you feel motivated. Motivation often arrives after the first step, not before it.
Make it reachable on a bad day. A five-minute version that you finish beats an ambitious plan you abandon.
Choose something that matters to you or used to feel good, and tell your care team at your next session what helped and what did not.

Terms in this page

Between-session support Grounding Mental readiness

This is the work Asendar™ was built for: holding a light thread to your care on the days between sessions, so one small step is easy to find when a day turns heavy. If you want a simple read on where you are today, take your Mental Readiness Score.

Start free: get your Mental Readiness Score

Your Mental Readiness Score is a short daily check-in on how steady you feel today. Free, web app, no download.

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