By Rachel Leonard, PhD | Senior Director of Clinical Learning & Development
A recap of Guidelight Health’s continuing education session with Rachel Leonard, PhD. The full talk is available on demand, with CE credit through CE-Go.
Roughly 280 million people worldwide live with a depressive disorder, and among all mental health and substance use conditions, depression carries the heaviest burden of disease. For the clinicians treating it, the pressing question is rarely whether effective treatments exist. It’s whether people can reach care at the right level of intensity, delivered in a way that holds up in real-world settings.
That question framed Guidelight Health’s July 30 continuing education session, led by Rachel Leonard, PhD, Senior Director of Clinical Quality, Outcomes, and Growth. Designed for psychologists, social workers, counselors, and MFTs, the hour-long webinar made the case for behavioral activation as a first-line depression treatment, and for pairing it with DBT skills when clients need extra support to put it into practice. Dr. Leonard’s clinical and research work spans depression, anxiety, and OCD across residential, PHP, and IOP levels of care, with a consistent throughline of measurement-based practice.
Why behavioral activation
Behavioral activation (BA) is one of the most thoroughly studied treatments for depression. It outperforms control conditions and holds its own against other established approaches, including cognitive behavioral therapy. A seminal trial by Dimidjian and colleagues found that BA and CBT performed comparably for milder presentations, while BA did better for clients whose depression was more severe. Research out of the UK has also suggested BA can be easier to train and disseminate, and more cost-effective, which matters a great deal when access is the bottleneck.
BA has been tested across a wide range of populations: different racial and ethnic groups, medical populations, and ages from adolescents through older adults. Dr. Leonard noted that its underlying explanation of depression tends to land as destigmatizing, which helps engage clients from many backgrounds.
The core idea: change behavior to change mood
Most people assume they have to feel motivated before they can act. The trouble is that the feeling often arrives late, or never. BA works from the outside in instead. Change what someone does first, and shifts in thought, feeling, and mood tend to follow.
Dr. Leonard walked through the TRAP framework (Trigger, Response, Avoidance Pattern) as a way to explain how depression takes hold and persists. A trigger, whether a loss, an injury, or a stack of small stressors, leads to painful emotional responses, which lead to avoidance. Avoidance brings relief in the moment and cost over time: canceled plans, missed work, and strained relationships, each becoming a new trigger. She illustrated this point by sharing the story of Juan, a college athlete sidelined by a broken foot who stopped socializing, skipped his rehab exercises, and withdrew from the team.
The clinical move is to help clients catch avoidance early and swap it for active coping, the shift from TRAP to TRAC. Active coping is harder in the moment and pays off later. It responds to the situation rather than to the feeling.
Building the plan: routine, enjoyable, and valued activities
Activity monitoring reveals what a client is already doing and how it maps to their mood. From there, activity scheduling gets tailored across three categories:
- Routine activities: sleep, meals, hygiene, and the basic upkeep of daily life. Dr. Leonard recommended normalizing the shame that often surrounds this territory and getting specific about frequency, since consistency and structure predict better outcomes.
- Enjoyable activities: things a client once liked or has always wanted to try. Her biggest caution was to personalize them. Assigning every client the same three “fun” activities isn’t real BA. Start small, start early, and let the enjoyment catch up.
- Valued activities: the life directions that give behavior meaning, drawn from ACT. Being a present parent, staying connected to a craft, growing in a career. For clients who feel cut off from pleasure, values are often the way in. She pointed to tools like the 100th-birthday exercise and values card sorts for clients who struggle to name what matters to them.
Those activities get organized into a graduated hierarchy, much like an exposure hierarchy: specific, manageable, and built around early wins so clients don’t end up avoiding the very assignments meant to help.
Where DBT skills come in
BA asks clients to do hard things while they are depressed, and sometimes the skills to follow through aren’t there yet. That is where DBT earns its place alongside BA. Both are third-wave CBT approaches that emphasize mindfulness and behavior change, so they integrate cleanly.
Dr. Leonard highlighted distress tolerance in particular for higher levels of care, where clients tend to struggle most with painful emotion. A couple of examples she shared:
- A client who valued a weekly call with an aging parent but was flooded by difficult memories every time. Radical acceptance, opposite action, mindfulness of current emotion, and TIPP made the call possible.
- A client working up to asking a friend for coffee, who leaned on DEAR MAN, GIVE, FAST, and cope-ahead skills to manage the fear of a “no.”
She also addressed rumination, drawing on Susan Nolen-Hoeksema’s research, and framed the goal as shifting attention toward mindful, valued engagement rather than debating the content of the thoughts.
Safety first
Any depression treatment, Dr. Leonard emphasized, has to rest on a foundation of safety. She pointed to evidence-based tools including the Columbia Suicide Severity Rating Scale and the Stanley-Brown Safety Planning Intervention, regular check-ins on risk and problem behaviors, and lethal-means counseling. On the familiar question of “no-suicide contracts,” her answer was blunt: the evidence doesn’t support them. Collaborative safety planning and means restriction do more.
Watch the full session
This recap covers only a slice of a rich, example-filled hour, including a Q&A that ranged across neurodivergent clients, end-of-life care, and how to build client buy-in. The complete session is available on demand and carries 1 CE credit hour. Thanks to Joint Accreditation and APA co-sponsorship, credit is available across most behavioral health disciplines, so psychologists, social workers, counselors, and MFTs can claim it through CE-Go.
