BEHAVIORAL MODELS OF TREATING DEPRESSION
The behavioral models of depression concentrate on the most obvious
behavioral symptom of depression: the reduction in active behavior, which we
called the motivational deficit. They approach the question of depression by
asking why the depressed person does so little, and what the contingencies of
reinforcement are that cause depressed patients to be passive. All of the behavioral
models explain the reduction in active responding as a deficiency in
operant behavior and claim that therapies which increase operant behavior
will reverse depression.
How do operant theorists explain the reduction in active behavior in depression?
Psychologist Peter Lewinsohn suggests that these behaviors have
been extinguished by a low rate of response-contingent positive reinforcement;
that is, depressed individuals cannot cause good events to happen to
them at a rate that is frequent enough to motivate active behavior. The patient
who sits day after day immobile in the lounge and believes that there is
no point in being active fits the operant analysis of depression well. Lewinsohn
emphasizes that the cause of depression is not simply too few pleasant
events but also a lack of control over reinforcement. Passively experiencing
rewards will not be enough to counteract depression, rather these events
must be brought about by the individual's own actions.
Lewinsohn and his colleagues developed a pleasant events scale and
found that depressed patients do engage in fewer pleasant events, finding
these events less enjoyable than non-depressed patients (Lewinsohn, 1974,
1977; MacPhillany and Lewinsohn, 1974).
One major reason for this is that depressives often lack social skills.
An individual who complains, is passive, withdrawn, and who does not
become vigorously engaged with other people, will not get much social reinforcement.
Compounding the disadvantages of lack of social skills, the depressive symptoms
themselves will repel others. Individuals who display depressive symptoms
are less desired as companions than those who do not. Depressive behaviors may be initially
maintained by the solicitous concern they produce in others, but eventually
these depressive symptoms will drive others away and result in an ultimate,
substantial loss of social reinforcement (Coyne, 1976). Misery may love
company, but company does not love misery.
Psychologist Charles Ferster views the reduction in instrumental behaviors
as the main symptom of depression. Depressed individuals fail to stay in
effective contact with the rewards of their environment and fail to avoid its
aversive aspects. Ferster points to several environmental conditions that
would reduce instrumental behavior, for example, living by too lean a
schedule of reinforcement. Some people organize their lives in a way in
which too much work is required to gain too infrequent reinforcement.
Students, professors, and housewives, by the nature of their jobs, may be
victims of such lean schedules.
Behavior Therapy for Depression
Behavioral theories of depression see the reduced frequency of operant behavior
and the low rate of rewards as the key symptoms of depression. Because
of this, behavior therapies are designed to obtain rewards.
Here is a case in which Peter Lewinsohn raised the frequency of rewards
for a woman suffering depression in a marriage in which her reward schedule
was leaner than her husband's:
Mary K. was an attractive, twenty-four-year-old female who was referred to a
psychologist because she had been depressed for several months. She had been married to Bill for three years, and both had been employed as teachers since their graduation from college. During the preceding spring, however, Mary had resigned from her job-"because the pressure was too much," and she had obtained employment as a retail clerk. Bill had begun taking graduate courses and was preparing for a new teaching position. The therapist went into the K.'s home and observed their conversations closely. A striking regularity revealed itself: much more time was spent discussing topics of interest to him than to her. In addition, she "dispensed" a great number of positive reactions to his conversation, but he "dispensed" few positive reactions to her remarks. Therapy then centered around teaching the couple to spend more time on topics of interest to Mary and to increase the amount of positive reaction from Bill. Once this was achieved, Mary became less depressed and the K.'s reported that things were definitely better between them. They agreed that most of their problems had lain in the interactions between them and that they had now been able to break the pattern. (Adapted from Lewinsohn and Shaw, 1969.)
A variety of other behavior therapies are also directed toward increasing
social reinforcers for the depressed individual. Behavior therapists recognize
that one of the most impoverished aspects of the depressive's life is his inability
to bring about the love, affection, admiration, and esteem of others
by his own actions. Social skills training and assertiveness training are two
techniques used to increase the personal effectiveness of depressed individuals.
With these: techniques, the patients explore the social consequences of
their actions, behavioral goals are established, and social reinforcement is
used to increase active and assertive behaviors, and to extinguish depressive
behavior (Lewinsohn, Weinstein, and Shaw, 1968; Lewinsohn, Weinstein,
and Alper, 1970; Liberman, 1970; Liberman and Raskin, 1971; Seligman,
Klein, and Miller, 1976).
Graded task assignment is another technique used to raise the activity
level of depressed individuals and bring them into contact with more rewards.
The logic of graded task assignments is to increase the depressive's
actions by reinforcing her for taking one small step at a time, rather than allowing
her to become discouraged at the prospect of too overwhelming a
task. For example, shy people may become depressed. They are often afraid
of speaking in front of others. To treat such a person, the therapist will first
assign a very simple task to perform, such as reading a paragraph aloud.
When she completes this, she will go on to a more difficult task, reading a
paragraph and interpreting it in her own words. The culmination of such a
hierarchy is giving an extemporaneous speech on a topic of her own choosing.
A substantially lighter mood follows successful completion of graded
task assignments (Burges, 1968; Beck et al., 1974; Seligman, Klein, and Miller, 1976).
Treating:
Depression and Suicide
Post-Traumatic Stress Disorder (PTSD)
Social Anxiety
Generalized Anxiety
Panic Disorder
Major Depression Disorder
Agoraphobia
For the Therapy I recommend click here:
The Liberator Method
behavioral symptom of depression: the reduction in active behavior, which we
called the motivational deficit. They approach the question of depression by
asking why the depressed person does so little, and what the contingencies of
reinforcement are that cause depressed patients to be passive. All of the behavioral
models explain the reduction in active responding as a deficiency in
operant behavior and claim that therapies which increase operant behavior
will reverse depression.
How do operant theorists explain the reduction in active behavior in depression?
Psychologist Peter Lewinsohn suggests that these behaviors have
been extinguished by a low rate of response-contingent positive reinforcement;
that is, depressed individuals cannot cause good events to happen to
them at a rate that is frequent enough to motivate active behavior. The patient
who sits day after day immobile in the lounge and believes that there is
no point in being active fits the operant analysis of depression well. Lewinsohn
emphasizes that the cause of depression is not simply too few pleasant
events but also a lack of control over reinforcement. Passively experiencing
rewards will not be enough to counteract depression, rather these events
must be brought about by the individual's own actions.
Lewinsohn and his colleagues developed a pleasant events scale and
found that depressed patients do engage in fewer pleasant events, finding
these events less enjoyable than non-depressed patients (Lewinsohn, 1974,
1977; MacPhillany and Lewinsohn, 1974).
One major reason for this is that depressives often lack social skills.
An individual who complains, is passive, withdrawn, and who does not
become vigorously engaged with other people, will not get much social reinforcement.
Compounding the disadvantages of lack of social skills, the depressive symptoms
themselves will repel others. Individuals who display depressive symptoms
are less desired as companions than those who do not. Depressive behaviors may be initially
maintained by the solicitous concern they produce in others, but eventually
these depressive symptoms will drive others away and result in an ultimate,
substantial loss of social reinforcement (Coyne, 1976). Misery may love
company, but company does not love misery.
Psychologist Charles Ferster views the reduction in instrumental behaviors
as the main symptom of depression. Depressed individuals fail to stay in
effective contact with the rewards of their environment and fail to avoid its
aversive aspects. Ferster points to several environmental conditions that
would reduce instrumental behavior, for example, living by too lean a
schedule of reinforcement. Some people organize their lives in a way in
which too much work is required to gain too infrequent reinforcement.
Students, professors, and housewives, by the nature of their jobs, may be
victims of such lean schedules.
Behavior Therapy for Depression
Behavioral theories of depression see the reduced frequency of operant behavior
and the low rate of rewards as the key symptoms of depression. Because
of this, behavior therapies are designed to obtain rewards.
Here is a case in which Peter Lewinsohn raised the frequency of rewards
for a woman suffering depression in a marriage in which her reward schedule
was leaner than her husband's:
Mary K. was an attractive, twenty-four-year-old female who was referred to a
psychologist because she had been depressed for several months. She had been married to Bill for three years, and both had been employed as teachers since their graduation from college. During the preceding spring, however, Mary had resigned from her job-"because the pressure was too much," and she had obtained employment as a retail clerk. Bill had begun taking graduate courses and was preparing for a new teaching position. The therapist went into the K.'s home and observed their conversations closely. A striking regularity revealed itself: much more time was spent discussing topics of interest to him than to her. In addition, she "dispensed" a great number of positive reactions to his conversation, but he "dispensed" few positive reactions to her remarks. Therapy then centered around teaching the couple to spend more time on topics of interest to Mary and to increase the amount of positive reaction from Bill. Once this was achieved, Mary became less depressed and the K.'s reported that things were definitely better between them. They agreed that most of their problems had lain in the interactions between them and that they had now been able to break the pattern. (Adapted from Lewinsohn and Shaw, 1969.)
A variety of other behavior therapies are also directed toward increasing
social reinforcers for the depressed individual. Behavior therapists recognize
that one of the most impoverished aspects of the depressive's life is his inability
to bring about the love, affection, admiration, and esteem of others
by his own actions. Social skills training and assertiveness training are two
techniques used to increase the personal effectiveness of depressed individuals.
With these: techniques, the patients explore the social consequences of
their actions, behavioral goals are established, and social reinforcement is
used to increase active and assertive behaviors, and to extinguish depressive
behavior (Lewinsohn, Weinstein, and Shaw, 1968; Lewinsohn, Weinstein,
and Alper, 1970; Liberman, 1970; Liberman and Raskin, 1971; Seligman,
Klein, and Miller, 1976).
Graded task assignment is another technique used to raise the activity
level of depressed individuals and bring them into contact with more rewards.
The logic of graded task assignments is to increase the depressive's
actions by reinforcing her for taking one small step at a time, rather than allowing
her to become discouraged at the prospect of too overwhelming a
task. For example, shy people may become depressed. They are often afraid
of speaking in front of others. To treat such a person, the therapist will first
assign a very simple task to perform, such as reading a paragraph aloud.
When she completes this, she will go on to a more difficult task, reading a
paragraph and interpreting it in her own words. The culmination of such a
hierarchy is giving an extemporaneous speech on a topic of her own choosing.
A substantially lighter mood follows successful completion of graded
task assignments (Burges, 1968; Beck et al., 1974; Seligman, Klein, and Miller, 1976).
Treating:
Depression and Suicide
Post-Traumatic Stress Disorder (PTSD)
Social Anxiety
Generalized Anxiety
Panic Disorder
Major Depression Disorder
Agoraphobia
For the Therapy I recommend click here:
The Liberator Method