Direct behavioral prescriptions means that the therapist is prescribing specific behaviors to a client. I might encourage a client to do something that he isn't used to doing. Or I might encourage him to refrain from doing something that he is used to doing. Or I might try to get him to try something in a different way.
In each of these cases the therapist is making a direct prescription to the client. Now this has to be a collaborative process. You can't just throw a whole bunch of prescriptions at the client and expect that he's gonna do them. But if the client has been on board with your conceptual model, your targets for treatment, then the prescriptions are a natural extension of that. Activity scheduling is a major component of a CBT package called behavioral activation.
The idea behind activity scheduling is this, clients with depression in particular often suffer from a lack of positive reinforcement. And that's in part because of their absence of behavior. They don't do enough things that give them a sense of mastery or accomplishment. And they don't do enough things that give them a sense of pleasure. So in activity scheduling we start by surveying what the client is doing with their day.
Sometimes that means hour by hour, what were you doing yesterday? And we figure out where we might plug in some activities that involve a higher probability of mastery or pleasure. So by encouraging the client to gradually build up the things that he is doing that give him a sense of mastery or pleasure, we're increasing his experience of positive reinforcement, which in turn creates more of those behaviors, and in turn brings the mood up. One thing that sometimes helps with activity scheduling is a little bit of stimulus control.
I might have the client set an alarm on his or her phone saying it's time to go for a walk. That's a cue, stimulus control, that's designed to get the client to engage in a more adaptive behavior, activity scheduling. Activity scheduling is one of those interventions that's so important I would not attempt to treat depression without it. But it's tricky because you have to get the client to actually do those things.
And that's where the art of CBT comes into play. A CBT therapist is also gonna make use of a strategy called graded task assignment. The idea behind graded task assignment is that some of the things we're trying to get our clients to do are really hard and complex. So we might start with little pieces of it to get them to build up to the more complicated behavior. For example, it may be hard to get an unemployed client to just get a job because his or her symptoms are holding him back from doing that.
But what you could do is encourage the client first to look at want ads online. Second, to identify some jobs that might appeal. Third, to make a phone call about the job. Fourth, to apply, and so on. The idea is that you can take a big task and break it down into smaller subtasks to maximize the client's likelihood of success. By using graded task assignment, we're also encouraging the client because we're giving them little wins along way.
So rather than staring down some big beast of a task, we've given them smaller things to focus on and succeed at.