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Delivering Behavioural Activation for Depression in Secondary Care Settings: The GOALs Programme

Dr Helen Harding

Thursday 26 June 2025

Introduction

Service users with depression or ‘low mood’ commonly present with reduced levels of activity – they might struggle to have much of a daily routine, find it difficult to manage things like self-care and household chores and spend little time doing pleasurable or rewarding activities, such as socialising and hobbies. In the short-term, we know that this is a normal way of slowing ourselves down to rest and recuperate when we are not feeling good, particularly if we are struggling with motivation, physical exhaustion and difficult thoughts, feelings and experiences. However, in the longer-term, this withdrawal and reduction in pleasurable and rewarding activities actually maintains these feelings of low mood.


Behavioural activation is a well-established and effective talking treatment for depression, aiming to support people to build regular routines and to gradually increase pleasurable and/or rewarding activities. The GOALs programme is a structured and manualised brief therapy intervention  designed specifically to allow health professionals working in secondary care settings to deliver behavioural activation with service users experiencing more severe mental illness. GOALs was originally designed to support service users with psychosis, but has since been used in a range of settings for people with severe mental illness.


The event will be equivalent to 2.3/4 hrs of CPD.

Content

The webinar will include some background around behavioural activation and the development of the GOALs programme, with a focus on how to deliver the work with your own clients in secondary care.

It will include building a good understanding of depression, its signs and symptoms and how this can lead to reductions in activity levels for service users.

By the end of the session you should have a good understanding of how the GOALS manual and accompanying handouts can be used to guide delivery of behavioural activation for depression, to support service users to reach important goals that they are struggling to achieve due to low mood.

The key stages covered include:
• Understanding low mood and depression and its link with reductions in activity levels
• Setting personal goals for service users to work towards
• Breaking goals down into manageable steps
• Completing and reviewing the steps
• Troubleshooting areas of difficulty

Learning Objectives

• To be able to recognise the signs and symptoms of depression
• To understand what behavioural activation is and when this might be appropriate to try out with service users in secondary care settings
• To understand how to use the GOALs manual and handouts to deliver behavioural activation
• To consider some of the possible difficulties and options for troubleshooting these, including ways of implementing this work in a busy service

Training Modalities

Training will include didactic content, demonstrations of how to deliver the work and with time for Q&As throughout.

Key References

Garety, P., Craig, T.K.J. & Iredale, C. et al. (2018) Training the frontline workforce to deliver evidence-based therapy to people with psychosis: challenges in the GOALS study. Psychiatric Services, 69(1): 9-11.

Waller, H., Landau, S. & Fornells-Ambrojo, M. et al. (2018) Improving implantation of evidence based practice for people with psychosis through training the wider workforce: results of the GOALS feasibility randomised controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 59: 121-8.

Waller, H., Garety, P., Jolley, S. et al. (2013) Training frontline mental health staff to deliver ‘low intensity’ psychological therapy for psychosis: a qualitative analysis of therapist and service user views on the therapy and its future implementation. Behavioural and Cognitive Psychotherapy, 43(3): 1-16.

About the presenter

Helen Harding (Nee Waller) is a Clinical Psychologist with over 10 years experience working in secondary care mental health settings in South London, mostly supporting service users with psychosis and/or Bipolar Spectrum Disorders. She was the Study Coordinator for both the GOALs pilot study and Randomised Controlled Trial, working together with an experienced team of research psychologists including the Principal Investigators, Professors Philippa Garety and Tom Craig. As part of this work Helen led the training and supervision of all health professionals taking part in the studies and the development of the manual and handouts. Following completion of the trials Helen continued to offer training and supervision to clinical staff within local secondary care services to deliver the GOALs work. Following a relocation Helen currently works in NHS staff wellbeing within a large acute NHS Trust.

Who should attend

The GOALS work has been trialled with a range of health professionals working in adult secondary care mental health settings including Assistant Psychologists, Mental Health and Wellbeing Practitioners, Support Workers and Occupational Therapists. We have found that whilst it is possible for those in a care coordination role to train and to use these methods as part of regular meetings, this has tended to be very difficult for most given high caseloads. Clinical Psychologists and CBT Therapists working in Secondary Care may also wish to attend with a view to supervising staff members in delivering this type of work.

Details coming soon

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