Behavioral activation (BA), as a stand‐alone treatment for depression, began as a behavior therapy treatment condition in a component analysis study of the Beck, Rush, Shaw, and Emery version of cognitive therapy. BA attempts to help depressed people reengage in their lives through focused activation strategies. These strategies counter patterns of avoidance, withdrawal, and inactivity that may exacerbate depressive episodes by generating additional secondary problems in individuals' lives. BA is designed to help individuals approach and access sources of positive reinforcement in their lives, which can serve a natural antidepressant function. Our purpose in this article is to describe BA and the history of its development.

The past decade has witnessed a resurgence of interest in behavioral interventions for depression. This contemporary work is grounded in the work of Lewinsohn and colleagues, which laid a foundation for future clinical practice and science. This review thus summarizes the origins of a behavioral model of depression and the behavioral activation (BA) approach to the treatment and prevention of depression. We highlight the formative initial work by Lewinsohn and colleagues, the evolution of this work, and related contemporary research initiatives, such as that led by Jacobson and colleagues. We examine the diverse ways in which BA has been investigated over time and its emerging application to a broad range of populations and problems. We close with reflections on important directions for future inquiry.

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In a recent placebo-controlled comparison, behavioral activation was superior to cognitive therapy in the treatment of moderate to severely depressed adults. Moreover, a subset of patients exhibited a pattern of extreme nonresponse to cognitive therapy on self-reports of depression not evident on the clinician ratings. These patients were severely depressed, functionally impaired, and had primary support group problems; most also described themselves as having life-long depressions. Comparable numbers of patients with such characteristics were assigned to behavioral activation, indicating that randomization did not fail, and most instances occurred in the context of adequate cognitive therapy. If this pattern of self-reported extreme nonresponse to cognitive therapy replicates, it would suggest that there might be a subset of patients who see themselves as doing better with sustained attention to behavior change in time-limited treatment.

Objective This study aimed to examine implementation feasibility and initial treatment outcomes of a behavioral activation based treatment for adolescent depression, the Adolescent Behavioral Activation Program (A-BAP). Method A randomized, controlled trial was conducted with 60 clinically referred adolescents with a depressive disorder who were randomized to receive either 14 sessions of A-BAP or uncontrolled evidenced-based practice for depression (EBP-D). The urban sample was 64% female, predominantly Non-Hispanic White (67%) and had an average age of 14.9 years. Measures of depression, global functioning, activation and avoidance were obtained through clinical interviews and/or through parent and adolescent self-report at pre-intervention and end of intervention. Results Intent-to-treat linear mixed effects modeling and logistic regression analysis revealed that both conditions produced statistically significant improvement from pre- to end of treatment in depression, global functioning and activation and avoidance. There were no significant differences across treatment conditions. Conclusions These findings provide the first step in establishing the efficacy of BA as a treatment for adolescent depression and support the need for ongoing research on BA as a way to enhance the strategies available for treatment of depression in this population.

A pilot study was conducted to investigate the feasibility and effectiveness of behavioral activation (BA) therapy for veterans with posttraumatic stress disorder (PTSD). Eleven veterans seeking treatment at a Veterans Administration outpatient PTSD clinic were enrolled in the study protocol, consisting of 16-weekly individual sessions of BA. Nine veterans completed the protocol, one participant completed 15 sessions, and one dropped out after one session. Clinician-rated PTSD symptom severity showed significant pre- to posttreatment improvement and was associated with a moderate effect size. A number of participants also were improved on measures of depression and quality of life, but changes did not reach statistical significance. Findings suggest that BA is a well-tolerated, potentially beneficial intervention for veterans with chronic symptoms of PTSD.

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Cognitive-behavioral therapy (CBT) is highly effective for a wide range of problems; however, few studies address its use with lesbian, gay, or bisexual clients. Furthermore, although many cognitive-behavioral techniques are similar for heterosexual and nonheterosexual clients, cultural sensitivity and knowledge will enhance the use of CBT techniques and, if neglected, can hinder treatment. This chapter addresses the use of a culturally sensitive, affirmative CBT in treating lesbian, gay, and bisexual clients. TERMINOLOGYBecause nonheterosexual people are a stigmatized group, an awareness of terms can help to promote an affirmative environment for therapeutic For a more comprehensive treatment of affirmative cognitive-behavioral therapy with lesbian, gay, and bisexual clients see Martell, Safren, and Prince (2004)-223