Table 2.

Summary of behavioral activation techniques contents in breast cancer patients

Session	Content
Session 1: Initial session	This session aimed to establish a therapeutic relationship, primarily through getting to know each other, stating the purpose of the sessions, and the client signing a simple behavioral contract. The core focus was on introducing and training the client in Behavioral Activation principles. Clients learned to track and record their daily thoughts, feelings, and behaviors using a structured worksheet. The exercise for the week involved completing the BA Worksheet daily, noting activities, associated mood levels, and any thoughts or feelings that arose.
Session 2: Understanding thoughts, emotions, and behaviors	The second session began with a review of the previous week’s completed BA worksheets, discussing patterns observed. The session included an explanation of the reciprocal relationship between thoughts, emotions, and behaviors, particularly in the context of illness. Discussions explored how inactivity or avoidance can perpetuate negative mood states and how increasing engagement in positive activities can improve emotional well-being. The impact of interpersonal interactions and drawing on others’ positive experiences were also discussed. Participants were instructed to continue filling out the BA Worksheet for the following week, paying specific attention to the link between their activities and their mood.
Session 3: Introducing positive reinforcement	This session involved reviewing the completed BA worksheet from the previous week. A key component was the introduction of verbal positive reinforcement techniques, specifically focusing on positive self-talk. Participants were guided on how to identify and challenge negative self-statements and replace them with more positive and realistic affirmations related to their activities and progress. The practical exercise for the following week involved completing the BA worksheet while actively practicing positive self-talk and noting its effect on their mood.
Session 4: Developing coping skills	In the fourth session of the Behavioral Activation (BA) intervention, participants reviewed their previous worksheet to reinforce the link between behavior and mood. The session focused on identifying and strengthening coping strategies as adaptive behaviors that align with BA’s goal of reducing avoidance and increasing engagement in meaningful activities. Participants explored coping methods such as problem-solving, seeking social support, and participating in pleasurable or value-driven actions, all of which promote psychological resilience and emotional well-being. The session also addressed how avoidance sustains distress and emphasized gradual exposure to feared or avoided situations to disrupt patterns of withdrawal. For home practice, participants were instructed to continue using the BA worksheet and deliberately implement the coping strategies, tracking their emotional responses and motivation.
Session 5: Problem-solving techniques	In this session, participants reviewed the previous week’s BA worksheet and were introduced to systematic problem-solving techniques as a core component of the Behavioral Activation model. Problem-solving is conceptualized in BA as an active, goal-directed behavior that counters the passivity and avoidance often associated with depression and anxiety. By equipping individuals with structured steps to tackle real-life challenges, this approach fosters a sense of efficacy and control, thereby enhancing engagement with life and reducing emotional distress. The session provided step-by-step instruction in the problem-solving process, which included: (1) clearly defining the problem; (2) gathering and analyzing relevant information to identify underlying causes; (3) setting realistic and measurable goals; (4) generating multiple possible solutions; (5) evaluating and selecting the most appropriate strategy; (6) developing a concrete action plan; (7) monitoring outcomes; and (8) reflecting on the process for future improvement. Participants practiced applying these techniques to their own life challenges, reinforcing BA’s emphasis on activating purposeful, adaptive behavior. For home practice, they were instructed to continue completing the BA worksheet while actively integrating the problem-solving steps into daily life, thereby reinforcing behavioral change through practical application.
Session 6: Prevention and review	The final session involved reviewing the previous week’s BA worksheet. Discussions centered on preventive measures to maintain the gains made during the intervention and avoid relapse into inactivity or negative patterns. Strategies for continuing to use behavioral activation principles in daily life were emphasized. The contents of all six sessions were summarized, reinforcing the key concepts and skills learned. The concluding exercise involved completing the BA worksheet for the forthcoming week, encouraging the continuation of activity tracking and engagement as a long-term strategy for well-being.