Depression in Context

Abstract

Depression in Context: Strategies for Guided Action serves as a thorough guide for those who wish to understand and treat depression from a purely behavioral perspective. While the book is intended for specialists in psychotherapy, there are many attributes that make it useful for the primary care clinician. This book provides a complete understanding of behavioral psychotherapy for depression, addressing theoretical foundations of behaviorism and delving into therapeutic approaches. Helpful comparisons are offered of the authors' “behavioral activation” psychotherapy with other treatment approaches such as cognitive-behavioral psychotherapy and pharmacotherapy. The authors compare and contrast theoretical and philosophical underpinnings of various approaches. They also present evidence-based comparisons of their behavioral activation technique with the more complicated and popular cognitive-behavioral approach. Behavioral activation therapy for depression places an emphasis on increasing a patient's activity levels, thereby increasing positive reinforcement in the patient's life. According to behavioral theories of psychology, such an increase in positive reinforcement serves to decrease depressive symptoms such as lethargy, anhedonia, and avoidance. The book offers helpful guidelines on clinician-patient communication regarding in-session agenda-setting, overall goal-setting, and increasing patients' motivation for self-care. Clinical examples, including verbatim transcripts from therapy sessions, are provided throughout the book. These case excerpts are helpful in understanding the nuances of behavioral activation therapy and in offering practical examples of effective ways to communicate with depressed patients. The appendices offer sample homework activities and a self-help reading assignment that can be given to patients. Most primary care practitioners will not want to use the book for its intended purpose of helping the reader become a behavioral activation therapist. Another weakness from the primary care perspective is that the authors assert that their behavioral activation therapy is often sufficient as a sole approach to treating depression. While there are helpful comparisons of the behavioral activation model with other models, the efforts in explaining how behavioral therapy fits into the picture of the patient's overall health care are weak. This is an unfortunate shortcoming, as most patients with depression first turn to their primary care clinicians for help. In spite of this oversight, the book can be a significant resource for understanding behavioral and social dynamics in conceptualizing and treating depression. While the physiologic influences in depression are acknowledged, the authors take a conceptual view of depression, emphasizing environmental, psychological, and social elements of depression. An understanding of these influences on depression provides the reader with powerful tools in helping to empower patients to become more active in their own treatment and less dependent on the practitioner. Such an approach offers the primary care practitioner a deeper understanding of the process and content of psychotherapy from the specialist's perspective, as well as many specific techniques that can be applied when treating depression in the primary care setting.