Recently, while researching behavioral activation in depth, I explored its historical development. Though this historical angle proved irrelevant to my project and I had to set it aside (cf. kill your darlings), I thought I’d share those findings here!
The Origin of Behavioral Activation
Behavioral activation for depression is grounded in behavioristic tradition. In 1973, Ferster outlined a mechanistic behavioral description of the depressed state. Concomitantly, Lewinsohn (1974; as cited in Dimidjian et al., 2011) outlined a behavioral approach to depression. According to the behavioral tradition, depression was defined as a set of frequent instrumental behaviors (e.g., complaints and avoidance) that resulted in a loss of activity and loss of pleasure. Specifically, Ferster (1973) described a self-reinforcing feedback loop wherein a depressed individual acts upon the world in a passive manner via extended mands (i.e., complex instrumental behavior, incl. verbal behavior). These extended mands result in the depressed individual deriving less pleasure from their environment and performing fewer actions in the world (cf. anhedonia), which in turn reinforce the validity of the depressed mood. Consequently, the frequency of extended mands increases, in turn producing a self-perpetuating cycle of a depressed state (Dimidjian et al., 2021; Ferster, 1973; Martell et al., 2001; Sudak et al., 2014).
Taken together, depressed individuals have a tendency to signal to others that they feel bad through extended mands that can result in a loss of activity, loss of pleasure, or equate to avoidance behavior, which subsequently is negatively reinforced and thereby increases in frequency (Ferster, 1973). Moreover, low levels of response-contingent positive reinforcement (cf. loss of pleasure) act as eliciting stimuli for depressive behavior (e.g., passive extended mands), in turn perpetuating a negative feedback loop that maintains the depressive symptomatology (Dimidjian et al., 2011; Ferster, 1973; Martell et al., 2001).
Ferster’s (1973) mechanistic delineation of the depressed state had meaningful implications for guiding treatment. Specifically, the aspect of interest from the behavioristic perspective was frequency. Accordingly, the idiographic frequency of pathological behavior is the distinguishing characteristic of depressed individuals; the typography of behavior is not (Barlow & Nock, 2009). This can readily be understood when juxtaposed with the notion that all behavior is normal behavior. Behavior only becomes psychopathological (ceteris paribus) when its frequency becomes obtrusive, problematic, or abnormal. Thus, the typography of behavior is not the cardinal yardstick appropriate for distinguishing depression from non-depression; the frequency of pathological behavior is more appropriate to guide treatment (Ferster, 1973).
References
Barlow, D. H., & Nock, M. K. (2009). Why Can’t We Be More Idiographic in Our Research? Perspectives on Psychological Science. https://journals.sagepub.com/doi/10.1111/j.1745-6924.2009.01088.x
Dimidjian, S., Jr, M. B., Martell, C., Muñoz, R. F., & Lewinsohn, P. M. (2011). The Origins and Current Status of Behavioral Activation Treatments for Depression. Annual Review of Clinical Psychology, 7(Volume 7, 2011), 1–38. https://doi.org/10.1146/annurev-clinpsy-032210-104535
Dimidjian, S., Martell, C. R., Herman-Dunn, R., & Hubley, S. (2021). Behavioral activation for depression. In D. H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual (6th ed., pp. 339–380). Guilford publications.
Ferster, C. B. (1973). A functional analysis of depression. The American Psychologist, 28(10), 857–870. https://doi.org/10.1037/h0035605
Martell, C. R., Addis, M. E., & Jacobson, N. S. (2001). Depression in context: Strategies for guided action. W W Norton & Co.
Sudak, D. M., Majeed, M. H., & Youngman, B. (2014). Behavioral activation: A strategy to enhance treatment response. Journal of Psychiatric Practice, 20(4), 269. https://doi.org/10.1097/01.pra.0000452563.05911.c9
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