BA Planning

Activity log, avoidance pattern, values domain, mastery/pleasure rating, and energy cost.

Scheduled activity, graded step, barriers, reinforcement, social support, and review date.

0/27 Score

0 of 9 Answered

minimal 0-4 minimal · 5-9 mild · 10-14 moderate · 15-19 mod-severe · 20-27 severe

Little Interest or Pleasure in Doing Things

0123

Unanswered

Feeling Down, Depressed, or Hopeless

0123

Unanswered

Trouble Falling/Staying Asleep, or Sleeping Too Much

0123

Unanswered

Feeling Tired or Having Little Energy

0123

Unanswered

Poor Appetite or Overeating

0123

Unanswered

Feeling Bad About Yourself — or That You Are a Failure

0123

Unanswered

Trouble Concentrating on Things

0123

Unanswered

Moving or Speaking Slowly, or Restless/Fidgety

0123

Unanswered

Thoughts of Being Better off Dead or Hurting Yourself

0123

Unanswered

Weekly Activity Schedule

Day	Planned activity	Value domain	Mood before	Mood after
Day 1:
Day 2:
Day 3:
Day 4:
Day 5:
Day 6:

Values domains reviewed (relationships, work/school, health, enjoyment, mastery, service).

SMART action for next week:

Plan and Follow-Up

Focus	Documentation
Target	Name the target situation, belief, behavior, value, skill deficit, or exposure item addressed. Target: Baseline rating / context: Patient goal:
Work completed	Record intervention steps, patient response, learning, barriers, and safety considerations. In-session work: Response / learning: Barriers / safety:
Practice plan	Specify homework, frequency, supports, measurement, and next session focus. Home practice: Measurement / review: Next focus:

Focus

Documentation

Target

Name the target situation, belief, behavior, value, skill deficit, or exposure item addressed.

Target:

Baseline rating / context:

Patient goal:

Work completed

Record intervention steps, patient response, learning, barriers, and safety considerations.

In-session work:

Response / learning:

Barriers / safety:

Practice plan

Specify homework, frequency, supports, measurement, and next session focus.

Home practice:

Measurement / review:

Next focus:

BA Planning

PHQ-9

Over the past 2 weeks, how often have you been bothered by...

Weekly Activity Schedule

Plan and Follow-Up

Counseling - Behavioral Activation Template

Preview