Depressive Disorders: First Wave Case Conceptualization

Abstract

Depressive symptoms have a debilitating impact on self, family and society. Lewinsohn’s (1975) behavioral model of depression proposes that depressive symptoms are maintained by a low rate of response-contingent positive reinforcement. From the behavioral theory emerged the first wave behavioral treatment for depression (i.e., behavioral activation) designed to achieve satisfactory levels of positive reinforcement in one’s life. In practice, functional assessment that identifies the antecedent-behavior-consequence (ABC) sequence of behaviors is an essential first step to treatment. Lewinsohn et al.'s (1980) treatment approach advocates for the application of the Pleasant and Unpleasant Event Schedules to form clients’ Activity Logs and encourages daily activity and mood monitoring for clinicians to graph and share with their clients. Behavioral activation, which is based on Lewinsohn’s model of depression, has demonstrated impressive clinical utility with ethnic minorities and in group format and continues to gain empirical support. When faced with challenges in treatment, clinicians will benefit from revisiting the treatment rationale and utilizing functional analyses to address and resolve barriers. Future research should work to identify the mechanisms of change in behavioral activation, with a particular focus on the aspects of culturally adapted treatment interventions that impact outcomes for culturally diverse populations and ethnic minorities.