Helping you or your loved one be active physically, mentally, and socially is key to preventing or slowing cognitive decline. One way to do this is behavioral activation therapy, and it’s the type of therapeutic intervention MindAhead uses. Behavioral activation therapy is a type of therapy that works by increasing participation in healthy, rewarding activities. Science has shown that lifestyle changes to be more active can effectively prevent or slow cognitive decline. As people age, they often encounter challenges in engaging in activities they once enjoyed, particularly those experiencing cognitive difficulties. They can experience difficulties in recalling how to perform certain tasks, maintaining focus, or feeling motivated.
A negative cycle is created in which the person becomes less active as their condition progresses, which then causes further cognitive decline. Behavioral activation helps patients to break this cycle of inactivity by providing a guided and structured plan for activity engagement. Increasing activity levels particularly in the cognitive, social, and physical domains helps to prevent or delay cognitive decline.
One of the main reasons being active helps with brain health is a phenomenon called neuroplasticity. Neuroplasticity refers to the brain’s ability to form new neural connections and modify existing ones. The brain has many specialized areas that communicate through an intricate network of connections. These different brain areas need to communicate so that they can work together to help you do things, like talk, walk, or do a math problem.
Neuroplasticity ensures that this network remains dynamic and adaptable based on your body’s needs. When you repeatedly do a task, the brain reinforces and builds more connections between the relevant areas, making the task progressively easier. However, the brain also undergoes a pruning process, shedding unused connections to make room for new ones. If a particular skill is not practiced, the neural connections related to that skill diminish, making it more challenging. For example, if you learn a language in school but you stop practicing your speaking skills for a few years, you will be noticeably less fluent. You lost some of the brain connections that helped you speak that language because your brain noticed that you were not using them often.
For this reason, it is essential to keep the brain actively engaged and challenged throughout our entire lives. The more active someone is, the more connections the brain forms and maintains. Trying new activities and keeping up with regular activities keeps the brain healthy at a neural level.
The 3 Domains of Activities
There are 3 categories of activities that should be included in the journey toward being more active. Research studies have shown that a combination of these types of activities is critical for preventing or slowing down cognitive decline.
Cognitive Activities: These are activities that make you think or solve problems. If your brain was a muscle, this would be the equivalent of lifting weights. Some examples of cognitive activities are reading a book, doing a crossword puzzle, or playing brain training games.
Physical Activities: Physical activities are activities that improve strength or cardiovascular fitness. Being physically active is critical for the health of the whole body, including the brain. Some examples of physical activities are going for a walk, doing an exercise class, or gardening.
Social Activities: These are activities that increase social engagement. Humans are social animals, and being social is very important for our brains to function. Some examples of social activities are having lunch with friends, calling a family member, or playing with a pet.
A mix of these 3 types of activities has been shown to improve cognitive function in people with MCI and mild dementia. Behavioral activation helps with organizing and planning these activities, as well as enforcing these activities and motivating the person to do them.
Choosing Activities
The first step in behavioral activation is identifying the activities that would benefit the person. In cognitive impairment, we focus on social, cognitive, and physical activities, but there is a wide variety of activities that fit within these categories. It’s important that a person chooses activities that are personally enjoyable or rewarding to them in order to be motivated to do the activities.
Enjoyable activities are activities that are fun in the moment. This could be something like playing a card game with a spouse or listening to music, both of which are healthy cognitive activities. It also is important to choose activities that are the right level of difficulty. Activities should not be too easy or too hard. Activities that are too easy will not be exciting or engaging enough, while activities that are too difficult will not be enjoyable.
Rewarding activities are activities that are important and make a person feel good about doing them, whether or not they are enjoyable in the moment. This could be something like doing an exercise class. Many older people know that it is very important to get physical exercise, but physical exercise can be hard or strenuous (and generally unpleasant).
To better understand what activities are personally rewarding to a person, there is value-based behavioral activation. This provides a framework to personalize activities to a person’s values, or what they find most important in their life. Values are the things that matter most to a person; they can guide how the person lives or how they would like to live.
Let’s pretend you’re in a value-based behavioral activation session. Here are some questions a behavioral activation therapist might ask you at first:
What area of life matters most to you?
Many people answer “Family” to the first question. “Family” is a very common area of life that people value. This question helps you to determine the general category of the things you value most. Some other areas are career, social relationships, or physical well-being.
What do you value within that area of life?
Let’s continue with the category of “family.” There are many different values you could have within this category. For example, you might say: “I value being a caring son or daughter to my parent.” This is called a value statement.
What activities can you do that align with that value?
Once you have decided on a specific value, you can think of ways to live according to that value. These are the activities that you would find important and rewarding, because they align with your values. What are some activities you already do or could do more often to be caring toward your parent? This could be things like helping your parent around the house, taking your parent to appointments, or having a meal with your parent. Now you have some activities that you can plan as part of your behavioral activation treatment.
Planning
The next step of behavioral activation is to set a specific, achievable goal for practicing an activity more often. This means planning an exact time and date for an activity. While this might seem silly, it keeps the person accountable and makes it more likely that they actually do the activity. It is a critical piece of behavioral activation. Scheduling an activity is especially important for those who experience problems with memory or thinking. We encourage all of our users to keep a calendar and a notebook to keep track of their activities. A calendar is a simple but important tool for someone who experiences forgetfulness, even beyond planning BAT activities.
Another important part of preparing for an activity goal is creating an action plan. An action plan is a way to identify all of the planning steps that go into doing an activity so that these steps can be done in time for the activity itself. For example, someone might schedule a lunch date with a friend. There are several planning steps involved to do this activity. They would need to:
- Contact the friend they will have lunch with and invite them.
- Choose a restaurant or cafe to have lunch at.
- Make a reservation, if necessary.
- Arrange transportation to the restaurant or cafe if they cannot drive or otherwise get there on their own.
It is especially important for someone who experiences problems with thinking or memory to consider the action plan for an activity. They can even schedule the action plan steps in their calendar to keep themselves organized.
Reflection
Reflecting is an important part of the behavioral activation process. People often struggle with motivation to do their activity goals, especially when they experience cognitive decline. Activities can seem difficult, silly, or like they will not be fun or enjoyable. During the reflection process, individuals are encouraged to contemplate their experience with the activity. Many find, to their surprise, that they enjoyed the activity more than anticipated or found it easier than expected. This realization reinforces the idea that activities can be positive experiences.
On the other hand, reflection can also help if someone does not do an activity. It is important to reflect on why an activity was not done. The person can recognize whether that activity is at too difficult of a level, or it takes too much planning, or it simply doesn’t align with their interests. They can also think about the obstacles that stopped them from doing the activity and find a way to overcome them if they try the activity again. And that brings us to the final part of behavioral activation: If an activity is not successful, always try again. If the person is still interested in the activity, try the same activity again, maybe with some modifications to make it easier or more fun. If the person realizes the activity is not for them, schedule a new activity. It can take some persistence to get comfortable with the behavioral activation process, so keep at it until you find activities and routines that work.
