Behavior-analytical therapy of depression: an old or a new applied science?

Abstract

BACKGROUND: The present review addresses the history of behavioral studies in depression. OBJECTIVE: To present and analyze the advances in behavior-analytical therapies. METHODS: 37 references reporting conceptual, basic and applied studies, all of them published between 1961 and 2006, were examined. The theoretical and methodological features are considered and their implications are discussed. RESULTS: The behavior-analytic models of Ferster and Lewinsohn propose that the low frequency of positive reinforcements is a critical variable related to depressive repertoires. In spite of this plausible annunciation, little attention was paid to the interventions directed to modifying the coping strategies to aversive events that may suppress positive reinforcements. Within this pragmatic-conceptual impasse, Beck's cognitive-behavioral model was further developed and turned out to be a gold standard in the psychological management of depression. However, recent studies have illustrated the limitations of the cognitive conceptualization, yielding the reconsideration of behavior-analitical models. Jacobson revisited the Ferster's model creating a new proposal of therapy called behavioral activation (BA). CONCLUSION: Beck's cognitive-behavioral models addressed primarily the treatment of depression. Nevertheless, certain psychological manifestations of major depression not fully covered by Beck's model may be better understood by behavior-analytical approaches.