Behavioral Model Of Depression

Behaviorism began as a form of research psychology. For the early part of the 20th century, behaviorists were strictly scientists, working in universities on psychological research problems. They did not really start to think about mental illness and psychotherapy until the 1930s and 40s, well after the psychodynamic therapists had all but cornered the market.

The behavioral model of depression posits that depressive symptoms stem from disruptions in behavioral patterns, such as reduced engagement in pleasurable activities, social withdrawal, and avoidance behaviors. By identifying and modifying maladaptive behaviors through behavioral activation, social skills training, and exposure-based techniques, experts believe you can alleviate depressive symptoms and improve overall functioning.[1],[2]

The behavioral model of depression is different than cognitive theories because the behavioral model focuses on observable behaviors and environmental influences, while cognitive theories emphasize the role of maladaptive thoughts and beliefs in shaping mood and behavior. Other differences include:[1],[2]

• Behavioral interventions target behavioral changes through activity scheduling and exposure techniques, whereas cognitive theories prioritize cognitive restructuring and challenging negative thought patterns.
• The behavioral model emphasizes the importance of environmental factors and reinforcement processes in depression, while cognitive theories highlight cognitive distortions and information processing biases as central to depressive symptomatology.

To the behaviorist, human behavior has nothing to do with internal unconscious conflicts, repression, or problems with object representations. Rather, a behavioral psychologist uses principles of learning theory to explain human behavior. According to behavioral theory, dysfunctional or unhelpful behavior such as depression is learned. Because depression is learned, behavioral psychologists suggest that it can also be unlearned.

Peter Lewinsohn’s Legacy

In the mid-1970s, Peter Lewinsohn argued that depression is caused by a combination of stressors in a person’s environment and a lack of personal skills. More specifically, environmental stressors cause a person to receive a low rate of positive reinforcement. Positive reinforcement occurs when people do something they find pleasurable and rewarding. 

According to learning theory, receiving positive reinforcement increases the chances that people will repeat the sorts of actions they have taken that led them to receive that reinforcement. In other words, people will tend to repeat those behaviors that get reinforced. For example, many people show up at work on a regular basis in order to receive money or insurance benefits. Most academically-minded children study in order to help ensure that they will continue to receive good grades. In these examples, working and studying are behaviors that are motivated by money, benefits, and good grades, which are positive reinforcers.

According to Lewinsohn, depressed people are precisely those people who do not know how to cope with the fact that they are no longer receiving positive reinforcements like they were before. For example, a child who has newly moved to a new home and has consequently lost touch with prior friends might not have the social skills necessary to easily make new friends and could become depressed. Similarly, a man who has been fired from his job and encounters difficulty finding a new job might become depressed.

Lewinsohn’s Contributions to the Behavioral Model of Depression

Lewinsohn’s key contributions to the behavioral model include:[3],[4]

• Development of the Behavioral Activation (BA) technique, focusing on increasing engagement in rewarding activities as a means to alleviate depressive symptoms.
• Identification of the role of environmental reinforcement in shaping behavior and mood, emphasizing the importance of social interactions and environmental factors in depression.
• Conceptualization of the Behavioral Model of Depression, which highlights the reciprocal relationship between behavior, mood, and environmental factors in the onset and maintenance of depressive symptoms.

Lewinsohn’s Impact on Modern Therapeutic Practices

Lewinsohn’s contributions have significantly influenced modern therapeutic practices, particularly in the treatment of depression. The Behavioral Activation (BA) technique, developed by Lewinsohn, has become a core component of evidence-based treatments such as Cognitive Behavioral Therapy (CBT) and Behavioral Therapy for Depression.[4]

BA techniques focus on increasing engagement in rewarding activities, enhancing social interactions, and improving environmental reinforcement, offering practical and effective strategies for alleviating depressive symptoms.[4]

Lewinsohn’s emphasis on the importance of behavioral patterns and environmental factors has shaped contemporary approaches to depression treatment, underscoring the value of addressing behavioral components alongside cognitive and emotional aspects in therapeutic interventions.

Core Concepts of the Behavioral Model

Environmental Stressors

Environmental stressors play a significant role in triggering depression by contributing to the onset and exacerbation of depressive symptoms. 

Stressful life events such as financial difficulties, relationship conflicts, work-related stress, and trauma can overwhelm individuals’ coping mechanisms, leading to feelings of hopelessness, helplessness, and despair.[5]

Chronic exposure to adverse environmental conditions, such as poverty, social isolation, and discrimination, can also increase vulnerability to depression by disrupting social support networks, limiting access to resources, and undermining feelings of safety and security.[6]

Additionally, environmental factors such as exposure to violence, abuse, or neglect during childhood can have long-lasting effects on mental health and increase the risk of developing depression later in life.[7]

Understanding the role of environmental stressors in depression can inform prevention and intervention efforts aimed at addressing underlying psychosocial factors and promoting resilience in individuals facing adversity.

Positive Reinforcement 

Positive reinforcement involves the presentation of rewarding stimuli or experiences following desired behaviors, with the aim of increasing the likelihood of those behaviors occurring again in the future.[8]

In the context of managing depression, positive reinforcement techniques focus on identifying and engaging in pleasurable or rewarding activities that bring a sense of enjoyment, satisfaction, and accomplishment.[3]

Examples of positive reinforcement strategies include participating in hobbies or interests, spending time with supportive friends and family members, engaging in physical activity or exercise, practicing relaxation techniques such as deep breathing or mindfulness, and setting achievable goals and celebrating small victories.[4]

By incorporating positive reinforcement into daily routines, individuals with depression can enhance their mood, increase feelings of self-worth and competence, and build a sense of mastery and control over their lives.

Behavioral Strategies for Depression

There are some techniques that can help you increase positive reinforcement and reduce depressive symptoms, such as:[9]

• Identify pleasurable activities: Begin by making a list of activities that you enjoy or have enjoyed in the past, no matter how small or simple they may seem.
• Schedule pleasant events: Set aside time each day to engage in at least one enjoyable activity from your list. It could be something as simple as taking a walk in nature, listening to music, or spending time with loved ones.
• Reward yourself: Acknowledge and reward yourself for completing tasks or engaging in positive behaviors. This could involve giving yourself praise, treating yourself to something you enjoy, or simply taking a moment to appreciate your efforts.
• Socialize and connect: Spend time with supportive friends, family members, or peers who uplift and encourage you. Positive social interactions can provide valuable opportunities for laughter, connection, and emotional support.
• Practice gratitude: Cultivate a daily gratitude practice by reflecting on things you are thankful for. Keeping a gratitude journal or simply expressing appreciation for the small joys in life can help shift your focus towards positivity and increase feelings of well-being.

Behavioral Activation

Behavioral activation is a therapeutic approach used in the treatment of depression that focuses on increasing engagement in rewarding and meaningful activities to alleviate depressive symptoms. It operates on the premise that depression often leads to withdrawal from activities and social interactions, which can perpetuate negative mood states and reinforce depressive behaviors. Behavioral activation aims to disrupt this cycle by encouraging individuals to identify and participate in activities that bring them pleasure, satisfaction, and a sense of accomplishment.

Here’s how to go about doing this:[4]

• Assessment: Begin by working with a therapist to identify specific behaviors and activities that contribute to feelings of pleasure, satisfaction, and accomplishment.
• Goal setting: Collaboratively set realistic and achievable goals related to increasing engagement in pleasurable activities and reducing avoidance behaviors.
• Activity scheduling: Develop a structured plan for incorporating enjoyable and meaningful activities into your daily routine. Break down larger goals into smaller, manageable steps to increase motivation and success.
• Implementation: Actively engage in scheduled activities, even when you may not feel motivated or inclined to do so. Focus on the benefits and rewards of participation rather than waiting for motivation to strike.
• Monitoring and evaluation: Track your progress and evaluate the impact of behavioral changes on your mood, energy levels, and overall well-being. Adjust and modify your activity plan as needed based on feedback and experiences.
• Expected outcomes: Behavioral activation aims to increase positive reinforcement, improve mood, and reduce symptoms of depression by increasing engagement in rewarding activities and enhancing overall quality of life.

Self-Awareness and Depression

In addition, depressed people typically have a heightened state of self-awareness about their lack of coping skills that often leads them to self-criticize and withdraw from other people (e.g., depressed people may avoid social functions and get even less positive reinforcement than before). To make matters worse, some depressed people become positively reinforced for acting depressed when family members and social networks take pity on them and provide them with special support because they are “sick.” For example, some spouses may take pity on their depressed partners and start to do their chores for them, while the depressed person lays in bed. If the depressed person was not thrilled to be doing those chores in the first place, remaining depressed so as to avoid having to do those chores might start to seem rewarding. Research suggests that Lewinsohn’s theory explains the development of depression for some individuals, but not for all.

Traditionally, behaviorists did not pay much attention to people’s thoughts, perceptions, evaluations or expectations and instead focused solely on their external and directly observable and measurable behavior. They did this not because they weren’t aware of these internal feelings and thoughts, but because they thought them relatively irrelevant to the process of influencing behavior, and too difficult to measure with any accuracy. It turns out that this position was too extreme. More recently, research has shown that internal events such as perceptions, expectations, values, attitudes, personal evaluations of self and others, fears, desires, etc. do affect behavior, and are important to take into account when doing therapy. As a result, old-fashioned “strict” behavioral approaches to treating depression are not as popular today as they used to be. Don’t let depression go undiagnosed – take a depression test now.

Sources

1. Beck, J. S. (2011). Cognitive Behavior Therapy: Basics and Beyond. Guilford Press.
2. Lewinsohn, P. M., Muñoz, R. F., Youngren, M. A., & Zeiss, A. M. (1986). Control Your Depression. Prentice-Hall.
3. Lewinsohn, P. M., & Graf, M. (1973). Pleasant activities and depression. Journal of Consulting and Clinical Psychology, 41(2), 261–268. https://doi.org/10.1037/h0035666
4. Dimidjian, S., Barrera Jr, M., 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, 1–38. https://doi.org/10.1146/annurev-clinpsy-032210-104535
5. Kendler, K. S., Karkowski, L. M., & Prescott, C. A. (1999). Causal relationship between stressful life events and the onset of major depression. American Journal of Psychiatry, 156(6), 837–84.
6. Lorant, V., Deliège, D., Eaton, W., Robert, A., Philippot, P., & Ansseau, M. (2003). Socioeconomic inequalities in depression: A meta-analysis. American Journal of Epidemiology, 157(2), 98–112.
7. McLaughlin, K. A., Green, J. G., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2012). Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication I: Associations with first onset of DSM-IV disorders. Archives of General Psychiatry, 69(11), 1159–1167.
8. Skinner, B. F. (1938). The Behavior of Organisms: An Experimental Analysis. Appleton-Century.
9. Wood, A. M., Froh, J. J., & Geraghty, A. W. A. (2010). Gratitude and well-being: A review and theoretical integration. Clinical Psychology Review, 30(7), 890–905.