Two current variants of BA exist, BA ( Martell, Addis, & Jacobson, 2001) and brief behavioral activation treatment for depression (BATD Lejeuz, Hopko, & Hopko, 2001). FAP is based on a broad functional analysis of the therapeutic relationship (e.g., Follette, Naugle, & Callaghan, 1996) rather than a specific behavioral model of depression thus it will not be described here. A third behavior-analytic approach, functional analytic psychotherapy (FAP Kohlenberg & Tsai, 1991) has been used to improve cognitive therapy for depression ( Kanter, Schildcrout, & Kohlenberg, 2005 Kohlenberg, Kanter, Bolling, Parker, & Tsai, 2002). This paper will focus on two behavior-analytic treatments for depression that have emerged: acceptance and commitment therapy (ACT Hayes, Strosahl, & Wilson, 1999) and behavioral activation (BA). These behavioral interpretations also recognize that depression is characterized by great variability in time course, symptom severity, and correlated conditions. To the extent that the various responses labeled depression appear to be integrated, it is because the behaviors are potentiated by common environmental events, occasioned by common discriminanda, or controlled by common consequences. These descriptions generally accept Skinner's (e.g., 1953) view that emotional states, such as depressed mood, are co-occurring behavioral responses (elicited unconditioned reflexes, conditioned reflexes, operant predispositions). Toward this end, several behavior-analytic descriptions of depression are now available ( Dougher & Hackbert, 1994 Ferster, 1973 Kanter, Cautilli, Busch, & Baruch, 2005).
Instead, of greater interest are the patterns of behavior that lead to the label of depression being applied and how best to characterize and alter these patterns to improve lives. The costs of depression are significant, not only for those who are suffering but also because of the high economic burden of depression, much of which is attributed to work-related absenteeism and lost productivity ( Greenberg et al., 2003).Ĭlinical behavior analysts, historically skeptical of using the DSM as the basis for understanding problem behavior, are especially cautious to avoid reifying a descriptive label, such as major depressive disorder, into a thing and using it as an explanation for the symptoms it describes ( Follette & Houts, 1996). sample indicate a lifetime prevalence rate for major depressive disorder of 16% (and an annual prevalence rate of 7%), which suggests that over 30 million Americans will struggle with diagnosable depression during their lifetimes ( Kessler, McGonagle, Swartz, Blazer, & Nelson, 1993). Epidemiological data from a large representative U.S.
The most common diagnosis, major depressive disorder, is applied when an individual reports a combination of feelings of sadness, loss of interest in activities, sleep and appetite changes, guilt and hopelessness, fatigue or restlessness, concentration problems, and suicidal ideation that persist for most of the day, nearly every day, for at least 2 weeks.
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The phenomenon of depression currently is parsed into several diagnostic categories by the Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV-TR American Psychiatric Association, 2000). To have such an impact, the field must provide a formulation of and intervention strategies for clinical depression, the “common cold” of outpatient populations. After beginnings documented in this journal ( Dougher, 1993 Dougher & Hackbert, 1994) and elsewhere ( Dougher, 2000), it has become an integral part of a “third wave” of behavior therapy ( Hayes, 2004 O'Donohue, 1998) that has the potential not only to influence but also to transform mainstream cognitive behavior therapy in meaningful and permanent ways. The field of clinical behavior analysis is growing rapidly.
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