重性抑郁障碍（Major Depressive Disorder, MDD）是抑郁障碍的一个类别，主要的特征以情绪低落、空虚或易激惹为主，伴随有躯体症状和认知改变，对个体的生活有负性影响。抑郁障碍为全球四大疾病之一，世界卫生组织（World Health Organization, WHO）2019年12月在官网上推荐使用行为激活疗法（Behavioral Activation, BA）进行心理治疗，行为激活疗法是专门为抑郁症设计的一种操作简单，易于实施和推广的疗法。大学生群体除了有学业压力，还需要学习处理复杂的人际关系及突发生活事件，使大学生群体易出现抑郁症状甚至患有抑郁障碍。

本个案报告为对一名存在抑郁症状的大学生来访者进行的8次面对面的行为激活疗法干预。笔者作为心理咨询师，在行为激活疗法工作框架下，通过激活来访者的行为，探索其核心信念为“我是无力的”和“这个世界是无法掌控的”。这一类核心信念使得来访者面对生活中的突发事件常感到无法应对，选择回避生活中的活动。此外，来访者对自身有较高的要求，在进行回避时又会进行思维反刍，在这一过程中不断地批评自己。来访者因情绪低落伴随回避行为以及思维反刍，使其情绪低落的状态通常维持一至两周，难以自行恢复至愉悦的情绪，对喜欢的活动也逐渐失去兴趣。

笔者与来访者一共进行了8次面对面心理咨询。第1次咨询主要收集来访者主诉相关信息，建立咨询关系，介绍行为激活疗法基本原理与框架。第2~3次咨询根据行为激活活动表分析来访者目前活动现状，对来访者的回避行为进行干预，激活来访者的日常行为，使其从活动中获得正反馈，从而打破抑郁的循环模式。第4~ 6次咨询针对来访者抑郁症状中的思维反刍进行干预，帮助来访者学会关注当下，调整来访者“我是无力的”的不合理信念,聚焦在行为激活过程中遇到的问题进行讨论。第7~8次咨询对整体咨询进行回顾总结，讨论目标达成情况，预防复发。

经过8次咨询，来访者的抑郁行为激活量表分数的变化显示来访者的行为激活水平有所上升，同时，回避/沉思水平有所下降；贝克抑郁量表第二版的分数由中度抑郁水平（26分）降至临界值以下（13分）；此外，来访者的主观报告反馈和咨询师的观察显示，来访者对“我是无力的”的核心信念相信程度下降，面对生活中发生的刺激事件，会积极参与并主动调整自身状态以更有效应对。

本个案结果表明，行为激活疗法对该大学生抑郁症状来访者的干预是切实有效的，干预周期较短且效果明显，为使用行为激活疗法干预抑郁症状提供了一些资料和参考。但本文属于个案报告，具有一定的局限性。

Major Depressive Disorder (MDD) is a category of Depressive Disorder, with features of low mood, emptiness, or irritability accompanied by physical symptoms and cognitive changes, and has a negative effect on the individual’s life. Depressive Disorders is one of the world’s four major diseases. In December 2019, the World Health Organization (WHO) recommended the use of Behavioral Activation (BA) on its website for psychological treatment. BA is a therapy specially designed for depression that is simple to operate and easy to implement and promote. In addition to academic pressure, college students need to learn to deal with complicated interpersonal relationships and life events, which makes college students vulnerable to depressive symptoms and even depression disorders.

This case report presents an eight-session face-to-face behavioral activation intervention for a college student with depressive symptoms. The counselor explored the core beliefs of “I am powerless” and “The world is uncontrollable” by activating the client’s behaviors within the framework of behavioral activation. These types of core beliefs made the client feel unable to deal with the unexpected events in life and choose to avoid daily activities. In addition, with a high demand on herself, the client would ruminate after avoiding and constantly criticized herself in this process. Because the client’s low mood was accompanied by avoidance behaviors and ruminative thinking, her state of low mood was usually maintained for one to two weeks. Also, it was difficult for her to restore a pleasant mood by herself, and she gradually lost interest in her favorite activities.

The counselor and the client had eight sessions of face-to-face psychological counseling. The first session mainly focused on collecting the information related to the client’s chief complaint, establishing the counseling relationship, and an introduction of the basic principles and framework of behavioral activation. In the second and the third sessions, the counselor analyzed the current status of the client’s activity according to the BA activity table, intervened her avoidance behaviors, activated her daily behaviors, and enabled her to obtain positive feedback from the activities, thus breaking the cycle pattern of depression. The fourth to sixth sessions were conducted to intervene the ruminative thinking in the client’s depressive symptoms, help the client learn to focus on the present and adjust her irrational belief that “I am powerless”, with an attention to the problems encountered in the process of behavior activation. In the seventh and eighth sessions, the counselor and the client reviewed the whole counseling, discussed the achievement of the goals, and prevented relapse.

After eight sessions of counseling, the change in the score of the Behavioral Activation for Depression Scale showed that the client’s behavior activation level increased, while the avoidance/rumination level decreased. The score of Beck Depression Inventory II dropped from moderate depression (26 points) to minimal depression (13 points). In addition, the feedback of the client and the observation of the counselor showed that the client’s core belief of “I am powerless” decreased, and the client would actively participate in and adjust her own state to deal with triggering events in life more effectively.

The results showed that the intervention of behavioral activation on the college student with depressive symptoms in this case was effective, with a short intervention period and an obvious effect. which provided some information and reference for the use of behavioral activation in the treatment of depressive symptoms. However, this paper is a case report and has certain limitations.