Mental health articles

behavioral therapy for depressive disorders

The predominant behavioral model of MDD treatment is Lewinsohn and MacPhillamys (1974) approach. In this model, the primary goal is to increase the frequency of pleasant activities in the patient’s life. Using a group format for therapy, Shaw (1977) found that behavior therapy was superior to a wait-list control at the end of treatment. The largest study of behavior therapy for MDD found it to be significantly better than psychotherapy (an unstandardized, insight-oriented approach), relaxation therapy, and medication (amitriptyline) (McLean & Hakstian, 1979). In another study of MDD, Jacobson et al. (1996) compared three treatments: behavior therapy (behavioral activation), cognitive therapy with behavioral activation techniques plus techniques designed to address automatic negative thoughts, and cognitive therapy with behavioral activation techniques and automatic thought modification plus the addition of techniques designed to address enduringmaladaptive beliefs. At the end of acute-phase treatment, remission rates (Beck Depression Inventory [BDI] score _8, no major depressive disorder) ranged from 56% for the full cognitive therapy package to 46% for behavior therapy, but no significant differences were evident on any measure.

One version of behavior therapy has been developed specifically for couples in which at least one member has MDD. The outcome of behavioral marital therapy for MDD was found to be not different from cognitive therapy when the

couple was distressed, but inferior to cognitive therapy when the couple was not distressed (Jacobson, Dobson, Fruzzetti, Schmaling, & Salusky, 1991). Another study that included only distressed couples also found behavioral marital

therapy to be equally effective to cognitive therapy, with both therapies being better than waitlist in the treatment of depression in the wife.

The behavioral marital therapy, however, improved marital satisfaction more than cognitive therapy did. As with cognitive therapy, there appears to be evidence that behavior therapy is an efficacious, but not uniquely effective, acute treatment for MDD.

Tags: behavioral therapy, depressive disorders