Behavioral Action is the "Phonics" of Therapy
Proven with patients - but the therapists don't particularly like it
Every field has a technique that’s, shall we say, uncomfortable. Something simple, effective, and powerful. But also something professionals quietly avoid.
In reading instruction, that technique was phonics. In mental health, it is behavioral activation.
An Inconvenient Finding
Behavioral activation, or BA, is almost offensively simple. You help people do more things that generate positive reinforcement and reduce avoidance. You schedule activity—hopefully pleasant activity. You act first—get the patient off the couch—and let mood change follow.
In the 1990s, psychologist Neil Jacobson asked a dangerous question: What if the cognitive part of cognitive behavioral therapy—the “C” in CBT—was not doing the work? What if behavior change alone—just the “B”—was enough?
So, he tested it. He stripped CBT down to its parts and removed the “C” part where you challenge bad thoughts. The result was awkward for the field: behavioral activation on its own worked just as well.
That finding replicated. In fact, in this trial, BA beat CBT and was as effective as medications. BA was simpler, required less abstract self-monitoring, and could be delivered as a standalone treatment.
This was the phonics moment. The evidence was not subtle.
Spinach is the wrong metaphor. I couldn’t think of the right one. Spinach “works” but the eater doesn’t like it. Phonics works but the teacher (not student) doesn’t like it. BA works but the therapist (not patient) doesn’t like it.
How the Field Reacted
If mental health care worked like engineering, the response would have been obvious: Dramatically expand this technique.
Instead, the field absorbed the threat rhetorically and neutralized it operationally.
Behavioral activation was folded into the CBT brand. Training programs began to say they included BA. Manuals mentioned activity scheduling, and everyone nodded.
This is what balanced literacy looked like in reading: everyone claimed to teach phonics, but the actual instruction drifted elsewhere. The same thing happened to BA….
An Immodest Proposal
So, here is what we plan to do next.
We are a small startup lab called the Center for Teen Flourishing. We have tested many K–12 instructional interventions at scale over the years. However, in mental health, we are novices!
Rather than pretending otherwise, we will partner with experienced clinicians and methodologists for this work. But we will bring something the field has been oddly reluctant to test: curiosity about the revealed preferences of teens themselves.
Phase 1: Ask teens what they want. We will present adolescents with clear, neutral descriptions of major evidence-based therapies. Cognitive behavioral therapy. Acceptance and commitment therapy. Behavioral activation. No marketing language allowed, just what the work actually involves…..
[Hi friends. Mike here. Sean and I wrote this for Harvard’s journal called Education Next. So you can read the rest of the article and our Immodest Proposal (no Demi Moore alas) in today’s issue.]