Clinical picture. T., a woman in her late thirties, presents with a moderate depressive episode and reports spending most evenings motionless on the sofa, waiting to feel ready to do something. During session, the clinician introduces the Positive Activities List as a written resource to be prepared in advance, and works through the ease/reward rating with her for eight candidate activities. T. identifies a brief warm shower and texting one friend as scoring high on both scales, while a gym session is flagged as a future goal rather than a starting point. Over the following week she completes two of the listed activities on four separate evenings, reporting not that her mood lifted dramatically, but that the flatness felt less total afterward. The exercise shifted her frame from waiting for motivation to treating action as the starting condition.
Positive Activities List: PDF Worksheet, Tools and Exercises for Behavioral Activation
A visual PDF worksheet clinicians can use in session to explain behavioral activation, break the depression cycle, and give patients a concrete, pre-rated activity menu to take home.
Clinical vignettes
Building a List Before the Next Slump
Mastery Items Alongside Pleasure in Recovery
Clinical picture. R., a man in his mid-fifties recovering from a second depressive episode, expresses scepticism that small activities could matter given the severity of his previous low periods. The clinician presents the fiche and invites him to rate activities across the six domains without committing to any of them yet, which R. finds less threatening than a behavioral contract. He notices that mastery items, specifically watering his plants and washing two dishes, score higher on ease than any social activity at this stage, and the clinician validates this as clinically meaningful rather than a consolation option. R. schedules one mastery and one sensory item per day for the next week, using the pre-written list on his fridge as the decision point so that low-energy moments do not require fresh deliberation. At the following session he reported completing at least one item on five of seven days, with no significant mood lift documented but a modest reduction in the subjective sense of paralysis.
Behavioral activation is one of the most evidence-based interventions for depression, yet the core principle ("act first, mood follows") routinely lands flat when delivered verbally. Patients nod, then go home and wait to feel motivated. This fiche PDF gives you a visual scaffold to make the mechanism genuinely click in session and sends the patient home with a ready-made, personalised tool.
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Handout, exercises and materials ready to use, right inside SessionFuel.
Why behavioral activation resists oral explanation
The problem is not the concept. It is the anhedonia-driven reasoning that intercepts it. When you explain that action precedes motivation, the patient's inner critic answers faster than you can: "It won't help anyway." The fiche names that voice explicitly as a symptom, not a forecast, which shifts the footing of the conversation.
There is also the issue of vague intentions. Patients who understand behavioral activation intellectually still collapse within two days because they leave with no written, pre-rated list. Research grounded in Lewinsohn's (1974) pleasant events model and the Martell and Dimidjian (2010) protocol consistently shows that specificity is the active ingredient: the activity needs to exist on paper, rated for ease and reward, before the slump arrives. You can say this in session a dozen times; the diagram makes it structural.
If you work with patients presenting the cycle of depression, or those who need coping skills specifically for depression, this fiche integrates naturally into psychoeducation from session two onward.
What the fiche contains: a visual tool for explaining the activation model
The printable is structured across five numbered panels, each doing distinct clinical work.
Panel 1 opens with the slump loop: a circular diagram showing how low mood reduces activity, which shrinks rewarding moments, which deepens the flatness, which further reduces activity. Beneath it sits the counter-move framing: "You don't wait until you feel like it, then act. You act first, in tiny doses, and let the mood follow." Showing this diagram is faster and more memorable than describing the loop verbally.
Panel 2 introduces a double rating scale: Ease (1 to 10, current energy cost) and Reward (1 to 10, pleasure or mastery delivered). A 2×2 quadrant map then places activities into four cells. The prescription is explicit: start in the top-right quadrant, easy and rewarding. High-reward but low-ease activities are flagged as future goals, not today's medicine. This visual prevents a common error where patients attempt ambitious activities and confirm that "nothing works."
Panel 3 provides a brainstorm grid across six life domains: Body, Senses, Social, Mastery, Creative, and Nature, with two to four concrete examples per domain. The instruction is to build a list of 10 to 15 entries mixing pleasure (feels nice) with mastery (quiet "I did a thing"), grounding the distinction Beck drew between the two mood-repair pathways.
Panels 4 and 5 address the two traps that sink activation attempts between sessions: the gap between predicted and actual reward (the fiche asks patients to rate before and after, so the data argues against the inner critic), and the micro-bar adjustment for hard days ("Drinking a glass of water by the window is a valid entry"). Panel 5 closes with the wishful-to-plan conversion: a simple arrow showing how "a walk" becomes "a 10-minute walk around the block, after lunch, headphones on."
> Key point: This fiche is not a self-administered questionnaire. It is a visual support that facilitates your in-session explanation of the behavioral activation model. You work through it with the patient, building their personalised list together, then they leave with something concrete rather than an intention.
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Access all the toolsWhen and how to introduce the fiche in session
This fiche fits best after the initial anamnèse and case formulation, once you have established that reduced activity and anhedonia are central maintaining factors. For patients presenting the symptoms of depression, or those beginning a structured program for understanding depression, it works well in session two or three.
A low-threshold introduction: "I'd like to show you a diagram that explains something we're going to work on together. It's not a test; we'll build it out as we go." Walk through the slump loop in panel 1 together, invite the patient to locate themselves in it, then move to the brainstorm grid. Rate two or three activities collaboratively so the patient understands the dual-axis logic before they try it alone.
For patients with significant avoidance patterns or those stuck in low motivation cycles, the micro-bar panel often carries the most therapeutic weight. Naming absurdly small actions as clinically valid reduces the perfectionist contraction that causes activation homework to fail.
Debrief at the next session using the predicted-versus-actual reward gap. If that gap stays near zero for several weeks, or if the patient's list fills with duties rather than recharging activities, the fiche itself flags both as points to bring back into the consultation. Pair it with a structured weekly review exercise or a weekly activity planning tool to maintain momentum between sessions.
The fiche does not replace clinical judgment on medication, comorbid conditions, or suicidality. It handles one job: making the behavioral activation rationale visible, negotiable, and portable for your patient.
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Sources
- Martell, C. R., Dimidjian, S., & Herman-Dunn, R. (2022). Behavioral Activation for Depression: A Clinician's Guide (2nd ed.). Guilford Press.
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