Behavior analytic conceptualization and treatment of depression: Traditional models and recent advances.

Abstract

In this article, we briefly consider the phenomenon of depression from a behavior analytic perspective. Then, we describe the history of behavior analytic conceptualizations and treatments for depression with an emphasis on how these conceptualizations and treatments may have failed due to a lack of adherence to two basic behavior analytic principles: (I) Idiographic, functional assessment, and (II) In-vivo application of interventions. Finally, we discuss more two recent conceptualizations--Behavioral Activation by Martell, Addis & Jacobson (2001) and Functional Analytic Psychotherapy by Kohlenberg & Tsai (1991)--that we see as improvements over earlier models in terms of basic principles and may hold promise for the future. Keywords: depression; Functional Analytic Psychotherapy; Behavior Analytic Conceptualization ********** Behavior analysis purports to provide a scientific philosophy and methodology that should maximize our ability to understand (predict) and change (control) behavior (Skinner, 1953). It is the only system of psychology that was built from the ground up to change behavior. Other systems, such as psychoanalysis and cognitive theory, were derived first and foremost as explanations of behavior that were then applied to change behavior. As such, behavior analysis should hold an advantage in the behavior change arena. Of course, this is ultimately an empirical matter, and empirical evidence suggests such an advantage is held in several clinical fields, notably developmental disabilities and autism. Despite great advances, however, the field has yet to offer a satisfying conceptualization of the most common presenting problem in the adult outpatient population (Kessler et al., 1994)--depression. Likewise, behavior analysis has only recently, and tentatively, demonstrated that it can develop treatment interventions for depression that improve on and outperform those developed by our nonbehavioral colleagues. In this article, we will briefly consider the phenomenon of depression from a behavior analytic perspective. Then, we will describe the history of behavior analytic conceptualizations and treatments for depression with an emphasis on how these conceptualizations and treatments may have failed due to a lack of adherence to two basic behavior analytic principles. Finally, we discuss more two recent conceptualizations, Behavioral Activation by Martell, Addis & Jacobson (2001) and Functional Analytic Psychotherapy by Kohlenberg & Tsai (1991). These treatments are best described as reformulations and reinventions of original material and basic principles rather than as thoroughly new conceptualizations. These new treatments represent a radical, radical behaviorism, returning radical behaviorism to its roots after efforts to abandon them failed, and are part of a third wave of behavior therapy (Naugle & O'Donohue, 1998; Hayes, in press). The Phenomenon of Depression Depression is a strange and unwieldy beast to behavior analysts for several reasons. First, depression evidences substantial heterogeneity of etiology, time course (e.g., depression may appear episodically or chronically), and functional impairment. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association, 2000) attempts to address the complexity by proposing an increasing number of diagnostic categories of depressive disorders or problems involving sad or irritable affect, in addition to Major Depressive Disorder and Dysthymic Disorder. This solution seems to only add to the complexity rather than reduce it. In Appendix B of DSM-IV-TR, the authors have proposed seventeen disorders for further study. Six of these new diagnostic categories (approximately 35%) deal with disorders of mood. Four of those six have several criteria that overlap with those of Major Depressive Disorder, differing only in the duration or number of symptoms necessary to meet criteria. …