The nature of clinical depression: Symptoms, syndromes, and behavior analysis

Abstract

In this article we discuss the traditional behavioral models of depression and some of the challenges analyzing a phenomenon with such complex and varied features. We present the traditional model and suggest that it does not capture the complexity of the phenomenon, nor do syndromal models of depression that dominate the mainstream conceptualization of depression. Instead, we emphasize ideographic analysis and present depression as a maladaptive dysregulation of an ultimately adaptive elicited emotional response. We emphasize environmental factors, specifically aversive control and private verbal events, in terms of relational frame theory, that may transform an adaptive response into a maladaptive disorder. We consider the role of negative thought processes and rumination, common and debilitating aspects of depression that have traditionally been neglected by behavior analysts.

Behavioral activation for depression in older adults: Theoretical and practical considerations

“…In contrast to medical models that consider depression as a syndrome with an essential composition, behavioral models perceive depression as a multitude of overt and covert behaviors that vary considerably among individuals, consistent with the wide variety of historical and environmental controlling variables (Biglan, 1991;Kanter, Busch, Weeks, & Landes, 2008). A behavior-analytic examination of depression requires the determination of antecedent and consequent events within the individual's current living environment that maintain operationally defined depressed behavior, including overt behavior (e.g., social avoidance, changes in eating patterns), private events (e.g., feeling worthless or anxious), affective responses (e.g., crying episodes), and verbal behavior (e.g., rumination or self-critical statements).…”

“…For instance, rumination may be negatively reinforced through decreased or avoided engagement with the current environment (Kanter et al, 2008), and self-critical verbal statements may be positively reinforced with sympathetic social attention (Dougher & Hackbert, 2000). However, these verbal processes are likely to increase depression in the long term by reducing opportunities for engagement in positively reinforced healthy behaviors, and they may also result in social avoidance by others (Biglan, 1991), which could further contribute to depression maintenance.…”

Activación conductual y depresión: Conceptualización, evidencia y aplicaciones en Iberoamérica

“…En otras palabras, cuando el valor del refuerzo de conductas depresivas se incrementa, se decrementa el valor del refuerzo de las conductas no depresivas o saludables; por lo tanto, al recibir mayor refuerzo las conductas no saludables o depresivas, éstas incrementarán la posibilidad de mantenerse en el tiempo (Hopko et al, 2003;Kanter, Busch, Weeks y Landes, 2008). Esto implica que la reducción de comportamientos depresivos no es el simple resultado de la disminución de refuerzo positivo, sino que se debe a las tasas o proporciones de refuerzo de las conductas depresivas con respecto a las conductas no depresivas (Kanter, Busch, Weeks y Landes, 2008), lo que conlleva que en la evaluación es necesaria una mayor búsqueda de variables contextuales en las cuales la conducta ocurre, no sólo un reforzador que sigue a una conducta específica (Kanter, Busch y Rusch, 2009); es decir, la suma total del refuerzo disponible en el ambiente de una persona debe ser tenido en cuenta, no concentrarse exclusivamente en las conductas blanco y sus consecuencias .…”

Understanding the Functionality of Depression Among Australian Breast Cancer Patients: Implications for Cognitive and Behavioural Interventions

“…Standardised measures for identification of depression have been developed to determine the presence of relevant DSM-symptomatology, but accurate assessment of the individual causes of depression from a functional analytic perspective is also required for the reliable delivery of effective CBT interventions. Such individualised assessment of the causes of depression includes both biological [14] and environmental [15,16] stimuli that have contributed to the development of this condition, and has been described by Kanter et al [17] as needing to include both historical and recent antecedents as well as unlearned biological vulnerability, psychological vulnerability and the particular demands of the current situation. While previous history and biological vulnerability are part of the causal 'equation' for depression, it is the particular immediate environmental demands or stimuli which are most likely to 'trigger' the onset of depression among BCa patients [17].…”

“…Such individualised assessment of the causes of depression includes both biological [14] and environmental [15,16] stimuli that have contributed to the development of this condition, and has been described by Kanter et al [17] as needing to include both historical and recent antecedents as well as unlearned biological vulnerability, psychological vulnerability and the particular demands of the current situation. While previous history and biological vulnerability are part of the causal 'equation' for depression, it is the particular immediate environmental demands or stimuli which are most likely to 'trigger' the onset of depression among BCa patients [17]. With about two thirds of depressed BCa patients not having a previous history of depression [12], the nature of these immediate environmental stimuli that precede the onset of depression is of major importance in the development and delivery of effective cognitive and behavioural interventions aimed at reducing depression among this patient group.…”