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CBT Role-Play - Behavioral Activation and Depression | Dr. Todd Grande | YouTubeToText
YouTube Transcript: CBT Role-Play - Behavioral Activation and Depression
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This content describes a therapeutic session focused on addressing depression by implementing a behavioral activation plan, encouraging engagement in previously enjoyed activities to improve mood.
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Hey, Carly. How you doing today? Doing
okay. You're doing okay, I guess. Yeah.
Yeah. Not sure.
I don't know. It's just the same. Yeah.
Still a little down. Yeah. I I've been
sleeping a lot. Um going to work's a
struggle. I don't really ever want to
go. Mhm.
Um just I haven't been eating
much. So Mhm. I think I've lost like 10 lbs
lbs
since past like four months or so. Past
Um just the guy. I don't know. I just haven't
haven't
really been doing anything.
You still been working? Well, yeah.
Yeah, but not much else. No, I usually
just go to work and go home. Tell me
what happens after you uh arrive at
home, like after work.
Um, well, my fiance tries to talk to me
and really I just kind of want to go to
sleep or just I don't know. I tried I
tried reading the other day cuz I used
to like that and it's just I think I got
like into two pages and put the book
down and decided to go to bed. What were
you thinking when you put the book down?
Just that I wasn't really happy doing
it. I didn't really get any enjoyment
And before you were depressed,
uh, which is, I guess, about 8 months
now, you did enjoy reading. Mhm. Oh,
yeah. All the time. So, what would you
have thought if you had to put a book
down back then? Oh, I used to fall
asleep reading. I would be up till like
2:00 in the morning just reading a book.
Something you look forward to. Yeah.
Yeah. But not now. No, I I just didn't
really get any. I just wanted to try it
and then I put it back down and was like,
like,
"Were the other things that you used to
enjoy doing
that you don't
feel motivated or comfortable to do
now?" Yeah. I used to be a runner. Mhm.
Um, and then I tried going for a run the
other morning with my dog
and I think we walked a block and that
was pretty much
it. I just couldn't wait for it to be over.
All right. So, it wasn't a pleasant
experience. Was there any part of it you
connected with when you were running?
Like when you first started? Not really.
I mean, it was the change to be
outdoors. Mhm.
And I realized I hadn't really seen the
sun in a while. So,
but other than that, I
just I I had the intention of going out
to run. I had my running shoes on and my
dog was really excited. Mhm. And then by
the time I got out there, I was like,
"Yeah, we're we're going to walk." And
then I thought about walking like our
normal route and by the time I got to
the corner, I was like, "Yeah, we're
So, what was the feeling like when you
um returned to your home after planning
to run and then kind of walking and
coming back?
Kind of a mix of like
relief just cuz it was over and then I
guess more sadness cuz I didn't do
anything. I didn't do what I had
intended to do. Sadness, maybe disappointment.
disappointment.
So, I've seen you a few times
now and based on those conversations and
of course what you've said today, it
seems like you have for variety of
reasons given up on the activities that
you used to
enjoy. You're not motivated toward them
anymore. Yeah, I guess you could say that.
that.
M and that's a common symptom of
depression, right? I think we've we've
talked about this a little bit before.
So, it's it's tough when you're
depressed to
find joy, satisfaction, happiness, and
activities that you once
enjoyed. Right? So, we've been working
with the the cognitive piece, right?
like we did last time where we talked
about the automatic thoughts that come
up and kind of how that leads to some of
the feelings of sadness and what we can
do with the selft talk but I'd like to
talk about different technique today
that approaches the problem from a
different angle and we'll we'll continue
to work the cognitive angle but I want
to add a new angle okay right and the
technique is called behavioral
activation right
So the theory behind it is
that if you
engage if you schedule and engage in the
activities that you once enjoyed even if
you kind of have to fight your way
through it a little bit right like with
the running Mhm. that that will connect
to your mood. Right? Remember we believe
in cognitive therapy that affect and
behavior and cognition are all
connected. Mhm. Right. It's what you're
thinking affects your behavior and your
mood and what you do, your behavior
affects your thinking and your mood.
Does that kind of make sense based on
what we talked about? It does. Yeah. Yeah.
Yeah.
So, you mentioned the reading was one
thing you you like to do that's that's
tough to do now. You try
unsuccessfully um with the reading and
the running. anything else you could
think of that uh maybe we could plan for
you to do even if it's just a short time
even if it's a little bit
uncomfortable that we could plan to do
that would be an activity that you used
to enjoy. Um,
Um,
well, my fiance and I used to go out
with two other couples and we used to go
out once or twice a week and even if
it's just each other's houses. Um, but
we haven't really seen them in a
while. Um, they've tried to schedule
things, but I've kind of come up with
reasons of not feeling well or to kind
of just stay home.
So, they're trying to
initiate meeting. Mhm. Going out, doing
something, and you're you're kind of
pushing them off. Yeah. I just I haven't
really wanted to see anybody lately.
All right. So, that's uh so we have
reading, running, and then going out
with these two other couples. Mhm.
Anything else you can think of that you
used to really enjoy before that you
can't can't quite motivate yourself to
Um, I mean, I used to like going for
like just walks and shopping with my
fiance. Like I we used to spend a lot of
time together and lately it's just kind
of I come home, I say hello, we eat
dinner and then I kind of do my own
thing. So spending time with your fiance
outside the house in some manner. Yeah.
Shopping was one example. Mhm. Any any
other activities?
um like movies or going out to eat or
Yeah, I would kind of put those in with
like the things that we would do outside
together. Like we would try to switch it
up every now and then. Okay. So that's
distinct from what you do with the
couples cuz that's just you and your
fiance. Yes.
So let's do this. Um what kind of books
do you like to read?
Um I like a lot of fiction. Mhm.
Um, I do a lot of reading for school, so
I usually enjoy those books, too.
Um, mystery novels. Mystery novels.
Okay. Uh, let's center on mystery
novels. How long would it take you to
read, say, a chapter of a mystery novel,
roughly? Um, depending on the size of
chapter, probably a couple minutes
normally. So, not long at all. No.
So, you could get a lot of reading done
in say 10 minutes,
like something worthwhile. Okay. And how
often would it how often would you what
was the duration of a run? Like when you
would go and run, how long would it take?
take?
Um, probably like a half hour. Half
hour. Half hour to 45 minutes. Yeah. I
used to do long distance running. So,
okay. And how often would you do that?
Uh, three to four times a week. So,
three or four times a week, half hour,
40 minutes. And you mentioned you went
out with the couple once or twice a
week. How often would you go out with
your fiance?
Um, I would say we try to do something
every day, like even if it was just
going for a walk together, like around
the park or walking the dog together.
Okay. So, I'd like to make
um collaboratively with you a
schedule that involves those four
activities. Okay. But I want to make it
realistic, right? You tried a couple
times, you weren't successful. So, we
don't want to be too ambitious. But I
want to try to plan a schedule. You can
get a habit on doing these activities
again. Okay. Right. So, let's start with
the kind of I guess the simplest in
terms of logistics, which would be
probably the reading. Mhm. Would it be possible
uh say five nights out of seven to read
for 10 or 15 minutes?
Like I know you're going to have to
force your way through it a little bit,
but I think it's something I could try
to do.
Mhm. So, you're going to have automatic
thoughts that come up, right? Like just
like you did before. Mhm. And you're
going to be tempted to give up. I want
you try to push through say just at
least 10 minutes. Okay. Okay. So, focus
on that as you go into it. It's a
behavioral exercise. Of course, it has a
cognitive component. So, kind of think,
you know, I just have to make this 10 minutes.
minutes.
Okay. All right. And again, you might
not really enjoy it the same way it did
before. We kind of know that. But over
time, that may change. Okay. All right.
So, does five nights a week seem
reasonable? It's 50 minutes a week.
Yeah, that seems fine. Okay. Then, um
let's move to the running because I just
recently tried that. You run with your
dog, you said? Yeah. Okay. How about that?
that?
Um twice a week. Would that be possible?
Yeah, I can try to do that. What days of
the week you think you could do it? Um
probably the weekends. So, probably like Saturday
Saturday
or Friday night or Saturday morning.
Okay. So, Saturday
morning and Friday night. Now, would you
would you run Friday night and then
again Saturday morning? Um no, I guess
not. So
probably I'd say maybe Wednesday night
and Saturday morning. Okay. So Wednesday
night and Saturday morning. Okay. Run
for say a minimum of a half hour.
I can track for that. Yeah. Now again
remember you're going to have these
automatic thoughts likely that will be
telling you that you should stop and but
you have to kind of talk your way
through that. Okay. Or do the best you
can. Yeah. Right.
um the the uh adaptive response maybe
being something like in the end this
will help me like it's tough now but
this will help me. Okay, so let's look
now toward the more social aspects u
logistically moving up the ladder here
to the most complex. It sounds like
going out with a fiance be the next at
the next level. Yeah, he's I don't know
if he's kind of just been mad at me
lately or if he just thinks I need to be
alone, but we've kind of been getting
some distance there.
So, I think that would out of everything
that would be the relationship I'd want
to work on the most. Focus on. All
right. So, maybe you're running
Wednesdays and Saturday mornings. Could
you go out and do something to fiance
twice a week?
Yeah, I think I think we could manage
that. Yeah, cuz sometimes you said you
just walk around the Yeah. Like the
neighborhood. So, it's not even doesn't
have to be necessarily like a lot of
time. It's just something. Mhm. All right.
right.
Uh what do you think you can do to
guess just having
like him maybe remind me or suggest it.
So you could you could tell him that
this is something that you're planning
to do and you might need a little push
to Yeah. to do it. Yeah, pretty much.
All right. Or to maintain it, right? So
you might get outside and the same thing
when you run, you might want to come
right back in. Yeah. All right. And then
moving to the most complex um but also
the one with the highest social
engagement going out with the other two
couples. Now, once or twice a week,
you'd mentioned before, how about we shoot
shoot
for How about we shoot for now once
every couple weeks?
I think I could handle that. Like maybe
a Saturday night or a Friday night.
Yeah, I think that could work. Right.
What can you see being an obstacle
there? Like what what might help you
motiv be motivated to continue that?
Just having to actually like go to their
houses or go somewhere cuz they don't
really live close to us.
They they're not far, but just the fact
that we would have to get in the car,
drive over there, and I would actually
have to like look relatively nice. I
can't just go in my pajamas. So, for
this to
work, that is for you to do it, you
really have to schedule at their house.
You can't have them come to you. Yeah.
All right. So, that's one thing we know.
You have to you have to make some time
and drive over there. Mhm. Or maybe if
your fiance drives, whichever. But you
have to Yeah, we we physically have to
go over, right? So once you're there,
like so it might be tough like to to get
in the car and make the drive over. Once
you're there, how do you think you would feel?
feel?
I don't know if it's like the run. I
probably just want to turn around and
come back.
I don't know.
Would these couples know that you're
been a little down? I think they've
noticed. And I think that's probably why
they've kind of started to back off with
asking us to do things.
Um, so I think they've noticed it, but
they don't know like any they don't know
Um, so are those relationships you're
worried about losing cuz they're backing off?
off?
Yeah. Yeah. Um, I mean they're our
closest friends, so like we've known
each other for a really long time. And
could you see this behavior being one
that brings you closer together with
them? Like restores some of that? Yeah,
I mean I think it would
definitely just us going. They might be
a little hesitant cuz the past couple
times they've invited us, we've backed
out, but I think it would probably be a
step in that
direction of restoring the relationship.
So, I mean, I would like to do that. Okay.
Okay.
So, I want to review the plan. Okay. All
right. And just make sure that we have
an agreement because we're we're
constructing this together, right? So, I
need your buy in. All right. Reading
five times a week for a minimum of 10
minutes, right? Mhm.
Um, the next level up was the running
and that was that was Wednesday night
and Saturday morning. Okay.
Going out two times with their fiance,
right? And then once every couple weeks,
driving to your friends, going to their
houses and spending an evening with
them. All that realistic?
I think so. Yeah, I mean I can try to
get accountability with my fiance just
to let him know my plan and then see if
he can help me follow through with it, I guess.
guess.
Good. All right. So, let's set that as
the plan. Okay. And I want you to be
aware that as I mentioned, the automatic
thoughts might come in, right?
And kind of tempt you in a direction
away from that. I also want to let you
know that if you are unsuccessful in any
one of those things, that doesn't mean
you have to stop and not try again,
right? Just take it as a small setback
and then the next time you know, for
example, it's time to read or go out
running, just try
again. Okay? It's not unusual uh in this
exercise that you won't be able to
complete all the behaviors that you've
planned for yourself. Sometimes life
gets in the way, things happen.
Sometimes the depression gets in the
way. So, can you appreciate that? That
might be discouraging like if you try it
and you stop like you told me in the
beginning. Yeah. Yeah. So just take that
as a um you know what it is just a small
setback and try to push forward the next
time. Okay? And I want you
to informally kind of keep a record of
it and when I see you next week we'll
see how you did and specifically I want
you to keep track of what you were
thinking and feeling through different
stages of the behavior. Okay. Can you
can you record that? Mhm.
Okay. So, we'll go from there. That'll
be your plan and I'll see you in a week.
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