Behavior Therapy/Behavioral Activation for Depression

Status: Strong Research Support

Description

A central assumption of most behavioral therapies for depression is that this disorder is associated with problematic behavior-environmental relationships. These therapies are based on early behavioral social learning theories of depression (e.g., Ferster 1973, 1981; Lewinsohn, 1974). According to these theories, depression is associated with low levels of positive reinforcement and high levels of aversive control, which can be due to problems in the environment or to skill deficits. When people get depressed, they increasingly withdraw from their environment, engage in escape behaviors, and disengage from their routines. Over time, this avoidance exacerbates depressed mood, as individuals lose opportunities to be positively reinforced through experiences, social activity, or experiences of mastery. Behavior therapies focus on increasing the frequency and quality of pleasant activities, increasing one's sense of mastery, decreasing aversive consequences, and improving mood. Behavior therapies usually involve techniques such as activity scheduling, ongoing monitoring of pleasant activities and feelings of mastery, gradual exposure to more challenging activities, and if needed, social skills and self-control training (e.g., Rehm, 1977).

A number of therapies for depression have grown out of this behavioral tradition. The Coping with Depression Course (Antonuccio, 1998; Lewinsohn, Youngren, & Zeiss, A. Z., 1992) is a psychoeducational group that includes behavioral and cognitive skills training. Muñoz and colleagues have developed programs for low-income and minority populations, such as the Reality Management group (Muñoz, Ippen, Rao, &. Dwyer,2000), which builds on behavioral principles and also includes cognitive and interpersonal components. These manuals are available in Spanish. Behavioral Activation (BA) is the most recent iteration of these early behavioral therapies. BA increases activation systematically with graded exercises to increase the patient's contact with sources of reward, identify processes that inhibit activation, teach skills to solve life problems, and improve one's life context (Martell, Addis, & Jacobson, 2001). BA does not include cognitive components. A version of behavioral activation has also been applied to a depressed inpatient sample in an initial pilot study (Hopko, LeJuez, LePage, Hopko, & McNeil, 2003). Cognitive-Behavioral Therapy for Late Life Depression applies behavioral principles to geriatric depression (Thompson, Gallagher-Thompson, & Dick, 1995, Revised, 2005) and also includes some cognitive components.


Key References (in reverse chronological order)


Clinical Resources

Coping with Depression and Reality Management
Behavioral Activation
Self-Management Therapy
Cognitive-Behavioral Therapy for Late Life Depression

Training Opportunities

Coping with Depression and Reality Management

Training in the various versions of the Coping With Depression Course is offered by Dr. Lewinsohn and his current staff at:
Oregon Research Institute
1715 Franklin Blvd.
Eugene, OR 97403-1983
Phone: (503) 484-2123
www.ori.org

Manuals and training opportunities for the programs of Muñoz and colleagues can be obtained at: http://medschool.ucsf.edu/latino

Behavioral Activation

Online training opportunities can be found at the Behavioral Technology Research, Inc. website.

Cognitive-Behavioral Therapy for Late Life Depression

Please contact: Dr. Dolores Gallagher-Thompson or Dr. Larry W. Thompson
Co-Direcectors, Older Adult Center (mail code: 182C/MP)
VA Palo Alto Health Care System
795 Willow Rd.
Menlo Park, CA 94025
650-617-2774