Behavioral activation

Behavioral Activation is a third generation behavior therapy for treating depression. It is one of many functional analytic psychotherapies which are based on a Skinnerian psychological model of behavior change, generally referred to as Applied Behavior Analysis. This area is also a part of what is called Clinical Behavior Analysis (CBA) and makes up one of the most effective practices in the professional practice of behavior analysis.

Theoretical underpinnings

Behavioral activation emerged from a component analysis of cognitive behavioral therapy. This analysis found that the cognitive component added little to the overall treatment of depression [cite journal | author = Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K., Gollan, J. K., Gortner, E., & Prince, S. E. | year = 1996 | title = A component analysis of cognitive-behavioral treatment for depression. | journal = Journal of Consulting and Clinical Psychology | volume = 64 | pages = 295-304 | pmid = 8871414] . The behavioral component had existed as a stand-alone treatment in the early work of Peter Lewisohn [Lewinsohn, P. M. (1975). The behavioral study and treatment of depression. In M. Hersen, R. M., Eisler, & P. M. Miller (Eds.), "Progress in behavioral modification" (Vol. 1, pp. 19-65).New York: Academic.] and thus a group of behaviorists decided that it might be more efficient to pursue a purer behavioral treatment for the disorder. The theory holds that not enough environmental reinforcement or too much environmental punishment can contribute to depression. The goal of the intervention is to increase environmental reinforcement and reduce punishment.

The theoretical underpinnings of behavioral activation [Jacobson, N. S., Martell, C. R., & Dimidjian, S. (2001). Behavioral Activation for depression:Returning to contextual roots. "Clinical Psychology: Science and Practice, 8," 255-270] [Martell, C. R., Addis, M. E., & Jacobson, N. S. (2001). "Depression in context: Strategies for guided action." New York: W. W. Norton.] for depression is Charles Ferster’s functional analysis of depression [cite journal | author = Ferster, C. B. | ear = 1973 | title = A functional analysis of depression. | journal = American Psychologist | volume = 28 | pages = 857-870 | pmid = 4753644] [Kanter, J. W. Callaghan, G. M., Landes, S. J., Busch, A. M., & Brown, K. R. (2004). Behavior analytic conceptualization and treatment of depression: Traditional models and recent advances. "The Behavior Analyst Today, 5", 255-274.] . Ferster's basic model has been strengthened by further development in the study of reinforcement principles which led to the matching law and continuing theoretical advances in the possible functions of depression [Kanter, J.W., Cautilli, J.D., Busch, A.M. and Baruch, D.E. (2005). Toward a Comprehensive Functional Analysis of Depressive Behavior: Five Environmental Factors and a Possible Sixth and Seventh. "The Behavior Analyst Today, 6(1)," 65- 81. [http://www.behavior-analyst-online.org] ] , as well as a look at behavior analysis of child development in order to determine long-term patterns which may lead to dysthymia.

Methods

The Behavioral Activation (BA) approach to depression was as follows [cite journal | author = Hopko, D. R., Lejuez, C. W., Lepage, J. P., Hopko, S. D., & McNeil, D. W. | year = 2004 | title = A Brief Behavioral Activation Treatment for Depression | journal = Behavior Modification | volume = 27 | pages = 458-469 | doi = 10.1177/0145445503255489 | url = http://web.utk.edu/~dhopko/BAinpatient.pdf] . Participants were asked to create a hierarchy of reinforcing activities which were then rank-ordered by difficulty. Participants tracked their own goals along with clinicians who used a [token economy] to reinforce success in moving through the hierarchy of activities. Participants were measured before and after by the Beck Depression Inventory (BDI) and a great effect on their depression was found as a result of their treatment. This was then compared to a control group who did not receive the same treatment. The results of those who received Behavioral Activation treatment were markedly superior to those of the persons in the control group. Multiple clinics have since piloted [ Cullen, J.M., Spates, C.R., Pagoto, S. and Doran, N. (2006). Behavioral Activation Treatment for Major Depressive Disorder: A Pilot Investigation - The Behavior Analyst Today, 7.(1), 151-165. ] and developed the treatment Spates, C. R., Pagoto, S. and Kalata, A. (2006). A Qualitative And Quantitative Review of Behavioral Activation Treatment of Major Depressive Disorder. "The Behavior Analyst Today, 7(4)," 508-518 ]

Research support

A recent review of behavioral activation studies for depression find that it has a robust effect and that policy makers should consider it an effective treatment. A large-scale treatment study found behavioral activation to be more effective than cognitive therapy and on a par with medication for treating depression. [cite journal | author = Dimidjian, S., et al | year = 2006 | title = Randomized Trial of Behavioral Activation, Cognitive Therapy, and Antidepressant Medication in the Acute Treatment of Adults With Major Depression. | journal = Journal of Consulting and Clinical Psychology | volume = 74 | pages = 658–670 | pmid = 16881773] .

Recently, behavioral activation has been applied to anxiety and appears to give promising results [ Hopko, D.R., Robertson, S.M.C. & Lejuez, C.W. (2006). Behavioral Activation for Anxiety Disorders. "The Behavior Analyst Today, 7.(2)," 212-224 [http://www.behavior-analyst-online.org BAO] ] . One study found it to be effective with Fibromyalgia-related pain anxiety [cite journal | author = Lundervold, D.A, Talley, C. & Buermann, M. | year = 2006 | title = Effect of Behavioral Activation Treatment on Fibromyalgia-Related Pain Anxiety and Cognition | journal = International Journal of Behavioral Consultation and Therapy | volume = 2(1) | pages = 73-78 | issn = 15557855 | url = http://www.behavior-analyst-online.org] .

Future Direction

Several proponents of behavior therapy believe that behavioral activation will have much to offer other areas such as post-traumatic stress disorder [Mulick, P.S., Landes, S.J. and Kanter, J.W. (2005). Contextual Behavior Therapies in the Treatment of PTSD: A Review - IJBCT, 1.(3), 223-229 [http://www.behavior-analyst-online.org] ] .

Other Third Generation Behavior Therapies

Other Behavior Therapies are Acceptance and Commitment Therapy (ACT), as well as Dialectical Behavior Therapy (DBT) and Functional Analytic Psychotherapy (FAP). Behavioral Activation owes its basis to Charles Ferster's "Functional Analysis of Depression" (1973) which developed B.F. Skinner's idea of depression, within his analysis of motivation, as a lack of reinforcement.

References