The graded task assignment technique for treating depression

The graded task assignment technique for treating depression

Cognitive therapy for the treatment of depression includes a variety of emotional, cognitive and behavioral techniques aimed at decreasing depressive symptoms. In this article we will talk about graduated task assignment , a technique especially indicated in the first phases of psychological treatment.

Graduated Task Assignment is focused on decreasing the patient’s apathy and promoting behavioral activation, so that little by little his mood improves. We will know in detail how this is achieved through this technique.

Behavioral techniques

Cognitive therapy for depression includes different components or techniques grouped into 3 main areas: behavioural, cognitive and emotional techniques. Within the behavioural techniques, we find the assignment of graduated tasks.

Behavioral techniques are used to promote behavioral changes and palliate motivational and affective symptoms, especially in very depressed patients . They also help to detect and modify maladaptive cognitions used as small experiments.

Within them, they are distinguished:

  • Techniques of mastery and/or satisfaction.
  • Test or cognitive practice.
  • Role-playing.
  • Coping techniques.
  • Programming of activities.
  • Assignment of graduated tasks.

Let’s see what the latter consists of, the assignment of graduated tasks.

Graduated task assignment: characteristics

Graduated task assignment is a behavioral technique widely used in Aaron Beck’s cognitive therapy for the treatment of depressive disorders.

Graduated task assignment is used mainly in the early stages of therapy , and/or when the patient is very depressed, with the aim of bringing him or her out of that state of absolute apathy and abulia. The goal of the therapist will be to restore the patient’s previous level of functioning before the depression.

The application of the graduated tasks will allow the incorporation of more cognitive techniques in more advanced phases of treatment, when the patient’s mood is better.

The technique consists of assigning the patient tasks with different degrees of difficulty, that pose a challenge for him but with a high probability of success . The tasks will be graduated, that is, their level of difficulty will go from less to more, and they will be increasingly complex for the patient.

The therapist should record the patient’s expectations of difficulty and effectiveness of the different tasks or activities, as well as the degree of realism regarding these expectations.

It will also be important, as the therapy progresses, to contrast the patient’s assessments of their performance .

Theoretical Foundations of Graduated Task Assignment

The theoretical basis of this method is based on the clinical observation that the severely depressed patient believes that he is no longer capable of performing the functions that are “expected of him” as a student, worker, mother or father, etc. In the same way, his significant people sometimes begin to think so too.

In addition, the patient may no longer have any hope of gaining gratification from activities he or she once enjoyed. That is why the assignment of graduated tasks is also considered a behavioural experiment , where the patient proves that he can develop all these tasks and can even enjoy them again.

Similarly, the therapist, by helping the patient modify certain behaviors, may show him that his negative and overly general conclusions were wrong.

When to use the technique?

As mentioned above, graduated task assignment is often used at the beginning of psychotherapy, in the early stages of treatment. Specifically, we can differentiate three phases of cognitive therapy :

  • Phase 1: Behavioral activation techniques.
  • Phase 2: Questioning of automatic thoughts.
  • Phase 3: Questioning basic assumptions and beliefs.

In phase 1 is the assignment of graduated tasks. In this phase, a series of activities or graduated tasks will be planned with the patient and developed.

First, you will need to record your daily activities and your mood.

Then the therapist will program with him activities aimed at increasing his level of activity, his satisfaction and his feeling of achievement (the aim is for the patient to feel “useful” even when faced with simple tasks).

Finally, the activities will be broken down into smaller steps when necessary .

Additional benefit of the technique

This first phase of therapy, as well as the assignment of graduated tasks, is of additional benefit to the patient, as it will help prevent or control the tendency to ruminate.

In this way, by increasing the level of activity, attention and energy will be focused on aspects other than one’s own thinking (they will be directed at the outside world, and not so much at the inside).

Thus, when the patient focuses his interest and attention on concrete activities, the therapist will induce him to counteract his flight into ruminative or depressive thoughts and allow him to engage in more constructive activities.

On the other hand and as we have already seen, there are other techniques similar to the assignment of graduated tasks. Specifically, one that is very similar is the programming of activities. We will see the differences between them, since they are concepts that are sometimes used interchangeably (although they are slightly different techniques).

Differences between Scheduling Activities and Graduated Task Assignment

The programming of activities is more demanding and structured than the assignment of graduated tasks, and the assignment of graduated tasks, on the other hand, is focused on activities of daily life of the patient.

In addition, the schedule of activities should include a patient’s agenda where he or she notes the tasks scheduled with the therapist.

Bibliographic references:

  • Feixas, G; Miró, T. (1993). Approaches to psychotherapy. An introduction to psychological treatments. Barcelona: Paidós Publishing House
  • Labrador, F.J. et al. Manual of behavior modification and therapy techniques. Madrid: Pirámide

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