Behavioral activation for social connection: A systematic review and synthesized conceptual framework

Social disconnection represents a growing public health concern. While Behavioral Activation (BA), an evidence-based intervention that reduces behavioral withdrawal by increasing engagement in meaningful activities, demonstrates efficacy for depression, its potential for enhancing social connection remains largely unexplored. The purpose of this systematic review was to synthesize current evidence for BA’s impact on social connection and develop a conceptual framework explaining potential mechanisms among individuals across all ages. Following PRISMA guidelines, electronic databases (CINAHL, Embase, PsycInfo, and PubMed Central) were searched for studies published between January 2015 and June 2024 that met the following inclusion: (1) randomized controlled trial or pre-post studies that used BA as a standalone or core intervention component; and (2) reported social connection (functional, structural, and quality-related measures) as a primary or secondary outcome. Two reviewers independently screened articles, extracted data, and assessed quality of the studies. Narrative synthesis was used to synthesize the data. Eight studies met inclusion. BA delivered via telehealth with coaching support produced the strongest and sustained effects. BA improved functional dimensions of social connection (loneliness, perceived support) consistently. One study in residential care settings showed null effects, suggesting environmental/contextual moderators may be important. BA shows promise as an intervention for social disconnection, particularly for reducing loneliness and enhancing perceived support. The conceptual framework proposed in this review has identified five potential mechanisms: increased social reinforcement, environmental enrichment, value-based social actions, reduced avoidance, and enhanced social self-efficacy. BA’s adaptability suggests potential for scalable implementation. However, limited structural and quality outcome assessment and measurement heterogeneity limit definitive conclusions. Future research should employ comprehensive social connection measures, test proposed mechanisms, and optimize BA protocols specifically for social connection.