![A hillside allotment with one bed freshly planted and the rest still overgrown](https://viacara.com/img/content/approaches-behavioural-therapy-feature-light.webp)

# Behavioural Therapy and Behavioural Activation

Learn how behavioural therapy works, why NICE lists behavioural activation for depression and how gradual exposure helps with fears and phobias.

## What is behavioural therapy?

Behavioural therapy works on what you do, more than on what you think. You and your therapist plan small changes, try them out and look at what happens.

It is one of the two roots of [cognitive behavioural therapy](https://viacara.com/approaches/cbt/), which adds work on thoughts. This page covers three behavioural methods: behavioural activation, exposure and habit reversal.

Exposure and response prevention, used for obsessive-compulsive disorder, has [its own page](https://viacara.com/approaches/erp/).

## How it *works*

What you do and how you feel shape each other. Behavioural therapy looks for the patterns that keep a problem going. Then it changes them, one planned step at a time.

Avoidance is often part of the pattern. The NHS says avoiding a fear can bring relief in the short term, but it can make the fear grow.

Source: [NHS: facing your fears](https://viacara.com/approaches/behavioural-therapy/#ref-7)

## Behavioural *activation*

Behavioural activation (BA) is a talking therapy for depression. It focuses on the links between what you do and your mood, rather than on thoughts and feelings.

NICE describes it as helping you spot patterns and plan practical changes that reduce avoidance. The plan leans on activities linked to a better mood. The work is structured, with clear goals, and deals with problems you face now.

Linking *activity and mood*

1. **Notice patterns** The therapist and client explore links between activity and mood.
2. **Plan a change** They plan small changes to what the client does each day.
3. **Try and review** The client tries the plan between sessions. They review what happened together.

The work focuses on activity and mood. It does not depend on challenging the wording of each thought.

NICE lists BA among the treatments to discuss for a new episode of depression. It can be one to one or, for less severe depression, in a group.

NICE says a course usually runs to eight sessions for less severe depression. For more severe depression, it is usually twelve to sixteen. NHS Talking Therapies offers BA at both its lower and higher intensity levels.

8

sessions for less severe depression

usual course [NICE NG222](https://viacara.com/approaches/behavioural-therapy/#ref-2)

12-16

sessions for more severe depression

usual course [NICE NG222](https://viacara.com/approaches/behavioural-therapy/#ref-2)

Sources: [NHS: depression treatment](https://viacara.com/approaches/behavioural-therapy/#ref-1), [NICE NG222](https://viacara.com/approaches/behavioural-therapy/#ref-2), [NHS England: talking therapies manual](https://viacara.com/approaches/behavioural-therapy/#ref-3)

![The same allotment weeks later, several beds green and the fork moved on](https://viacara.com/img/content/approaches-behavioural-therapy-mid-light.webp)

Behavioural activation starts with one small, planned step, before your mood has lifted.

## Exposure for *fears* and phobias

Exposure means facing something you fear on purpose, in small steps and with support. NHS inform says treating simple phobias involves gradually becoming exposed to what causes your fear. This is also called desensitisation.

You list the situations you fear, from the least to the most difficult. Then you face them one at a time, starting with the easiest. Your therapist helps you plan each step and stay with it.

How *exposure* is planned

1. **Map the fear** The client describes what they fear. They work with the therapist to rank these fears.
2. **Start small** They plan a first step that feels less hard.
3. **Build from there** They review what happened before they plan the next step.

The therapist helps plan the pace. The work addresses fear. It does not ask clients to face real danger.

For obsessive-compulsive disorder, exposure is paired with holding back the compulsion. That is [exposure and response prevention](https://viacara.com/approaches/erp/).

Sources: [NHS inform: phobias](https://viacara.com/approaches/behavioural-therapy/#ref-8), [NHS: facing your fears](https://viacara.com/approaches/behavioural-therapy/#ref-7)

## Habit *reversal*

Habit reversal is a behavioural method for tics and hair pulling. The NHS names habit reversal therapy as one of the main therapies for tics. It says trichotillomania, or hair pulling, is commonly treated with habit reversal training.

The NHS calls that training a type of CBT. Behavioural methods and CBT overlap, and many therapists use both.

You learn to notice when the urge comes, and to respond in a new way. For a shoulder shrug, that might mean stretching your arms until the urge passes. Our [Tourette's page](https://viacara.com/support/neurodivergence/tourettes/) covers tics in more depth.

What habit *reversal* involves

1. **Notice the pattern** The client learns to spot an urge and what tends to bring it on.
2. **Learn a new response** The therapist helps the client practise a different action.
3. **Build support** The client practises between sessions, with support.

For hair pulling, this means noticing the urge and trying a different action. The response depends on the habit.

Activation works with activity and mood. Exposure works with avoidance, while habit reversal develops another response to an urge.

Sources: [NHS: tics treatment](https://viacara.com/approaches/behavioural-therapy/#ref-10), [NHS: trichotillomania](https://viacara.com/approaches/behavioural-therapy/#ref-11), [NHS: depression treatment](https://viacara.com/approaches/behavioural-therapy/#ref-1), [NHS: facing your fears](https://viacara.com/approaches/behavioural-therapy/#ref-7)

## Who is it best *suited* to?

NICE says BA may be helpful when depression has led to pulling away from people, doing fewer things or inactivity. It says the same when depression followed a change in circumstances or routine.

Behavioural therapy can be a good fit if you:

- Have stopped doing things you used to enjoy, and the days have gone flat
- Avoid a place, an object or a situation because of fear
- Prefer practical steps to talking about the past
- Want to see progress in what you do from week to week

NICE also notes that BA asks you to be willing to do homework between sessions.

Source: [NICE NG222](https://viacara.com/approaches/behavioural-therapy/#ref-2)

## Behavioural therapy or *CBT*?

CBT joins behavioural methods to work on thoughts. A 1996 trial compared full CBT for depression with its behavioural activation part alone. It found no sign that the full treatment did better.

Many CBT therapists use behavioural methods, and some specialise in them. If that matters to you, ask a therapist how much of their work is behavioural.

Source: [Jacobson et al. 1996](https://viacara.com/approaches/behavioural-therapy/#ref-6)

## The *evidence*

Most of this research is about BA for depression. In the COBRA trial, 440 adults with depression in Devon, Durham and Leeds had either BA or CBT. Junior mental health workers gave the BA, and psychological therapists gave the CBT.

BA did no worse than CBT, and it was more cost-effective. The authors concluded that workers with less costly training can deliver BA with no loss of effect.

440

adults with depression had BA or CBT, and BA did no worse

COBRA trial, Devon, Durham and Leeds [Richards et al. 2016](https://viacara.com/approaches/behavioural-therapy/#ref-4)

A 2014 review pooled 26 trials of BA for depression. It found BA did better than the control groups in those trials.

For fears, a 2008 review of 33 trials looked at specific phobias. Exposure did much better than no treatment. It also did better than placebo and than other talking therapies.

Sources: [Richards et al. 2016](https://viacara.com/approaches/behavioural-therapy/#ref-4), [Ekers et al. 2014](https://viacara.com/approaches/behavioural-therapy/#ref-5), [Wolitzky-Taylor et al. 2008](https://viacara.com/approaches/behavioural-therapy/#ref-9)

## Where the evidence *stops*

The trials above studied depression and specific phobias. They do not test BA for other problems, such as anxiety or long-term illness.

For depression, our [low mood and depression page](https://viacara.com/support/depression/) covers the other options NICE names.

On this page

[What is behavioural therapy?](https://viacara.com/approaches/behavioural-therapy/#what-is-behavioural-therapy) [How it works](https://viacara.com/approaches/behavioural-therapy/#how-it-works) [Behavioural activation](https://viacara.com/approaches/behavioural-therapy/#behavioural-activation) [Exposure for fears and phobias](https://viacara.com/approaches/behavioural-therapy/#exposure) [Habit reversal](https://viacara.com/approaches/behavioural-therapy/#habit-reversal) [Who is it best suited to?](https://viacara.com/approaches/behavioural-therapy/#who-is-it-best-suited-to) [Behavioural therapy or CBT?](https://viacara.com/approaches/behavioural-therapy/#behavioural-therapy-or-cbt) [The evidence](https://viacara.com/approaches/behavioural-therapy/#the-evidence) [Where the evidence stops](https://viacara.com/approaches/behavioural-therapy/#where-the-evidence-stops)

Related

[Cognitive Behavioural Therapy (CBT)](https://viacara.com/approaches/cbt/) [Exposure and Response Prevention (ERP)](https://viacara.com/approaches/erp/) [Acceptance and Commitment Therapy (ACT)](https://viacara.com/approaches/acceptance-and-commitment-therapy/) [Low Mood and Depression](https://viacara.com/support/depression/) [Understanding Anxiety](https://viacara.com/support/anxiety/) [Understanding Different Approaches](https://viacara.com/guides/understanding-approaches/) [Behavioural Couples Therapy](https://viacara.com/approaches/behavioural-couples/)

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## References

1. National Health Service (2023). *Treatment: depression in adults*. [nhs.uk](https://www.nhs.uk/mental-health/conditions/depression-in-adults/treatment/)
2. National Institute for Health and Care Excellence (2022). *Depression in adults: treatment and management (NG222)*. [nice.org.uk](https://www.nice.org.uk/guidance/ng222)
3. NHS England (2024). *NHS Talking Therapies for anxiety and depression manual, version 7*. [england.nhs.uk (PDF)](https://www.england.nhs.uk/wp-content/uploads/2018/06/nhs-talking-therapies-manual-v7.1-updated.pdf)
4. Richards, D. A., Ekers, D., McMillan, D., Taylor, R. S., Byford, S., Warren, F. C., Barrett, B., Farrand, P. A., Gilbody, S., Kuyken, W., O'Mahen, H., Watkins, E. R., Wright, K. A., Hollon, S. D., Reed, N., Rhodes, S., Fletcher, E. & Finning, K. (2016). *Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial*. The Lancet. [doi:10.1016/S0140-6736(16)31140-0](https://doi.org/10.1016/S0140-6736(16)31140-0)
5. Ekers, D., Webster, L., Van Straten, A., Cuijpers, P., Richards, D. & Gilbody, S. (2014). *Behavioural activation for depression; an update of meta-analysis of effectiveness and sub group analysis*. PLoS ONE. [doi:10.1371/journal.pone.0100100](https://doi.org/10.1371/journal.pone.0100100)
6. Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K., Gollan, J. K., Gortner, E. & Prince, S. E. (1996). *A component analysis of cognitive-behavioral treatment for depression*. Journal of Consulting and Clinical Psychology. [doi:10.1037/0022-006X.64.2.295](https://doi.org/10.1037/0022-006X.64.2.295)
7. National Health Service (2026). *Facing your fears*. [nhs.uk](https://www.nhs.uk/every-mind-matters/mental-wellbeing-tips/self-help-cbt-techniques/facing-your-fears/)
8. NHS inform (2026). *Phobias*. [nhsinform.scot](https://www.nhsinform.scot/illnesses-and-conditions/mental-health/phobias/)
9. Wolitzky-Taylor, K. B., Horowitz, J. D., Powers, M. B. & Telch, M. J. (2008). *Psychological approaches in the treatment of specific phobias: A meta-analysis*. Clinical Psychology Review. [doi:10.1016/j.cpr.2008.02.007](https://doi.org/10.1016/j.cpr.2008.02.007)
10. National Health Service (2023). *Treatment: tics*. [nhs.uk](https://www.nhs.uk/conditions/tics/treatment/)
11. National Health Service (2024). *Trichotillomania (hair pulling disorder)*. [nhs.uk](https://www.nhs.uk/mental-health/conditions/trichotillomania/)

## Related

### [Cognitive Behavioural Therapy (CBT)](https://viacara.com/approaches/cbt/)

Learn how CBT works, what happens in sessions and what NICE says about it, and read about its forms for sleep, pain and self-help.

### [Exposure and Response Prevention (ERP)](https://viacara.com/approaches/erp/)

Learn how ERP works, what sessions involve and where it sits in the NICE guideline for OCD.

### [Acceptance and Commitment Therapy (ACT)](https://viacara.com/approaches/acceptance-and-commitment-therapy/)

Learn how acceptance and commitment therapy (ACT) works, what NICE says about it for long-term pain and what research shows for anxiety and low mood.

### [Low Mood and Depression](https://viacara.com/support/depression/)

Low mood that lasts two weeks or more can be a sign of depression. It is common and treatable. Find a professional who works with low mood.

### [Understanding Anxiety](https://viacara.com/support/anxiety/)

Learn about anxiety, its symptoms and how therapy can help. Find the right practitioner for anxiety support.

### [Understanding Different Approaches](https://viacara.com/guides/understanding-approaches/)

A plain-English guide to the main therapeutic approaches including CBT, person-centred therapy, psychodynamic and integrative methods.

### [Behavioural Couples Therapy](https://viacara.com/approaches/behavioural-couples/)

Learn how behavioural couples therapy works, when NICE recommends it for depression, and how integrative behavioural couple therapy differs.