Introduction in the treatment

 

This manual provides a step-by-step outline of a brief behavioral
activation treatment for depression. It is designed for use in treatment
sessions with your counselor, psychologist, psychiatrist, or physician.
It may be used as a complete treatment or as a component of therapy
that may include other therapeutic techniques and possibly medication.
Units 1 through 3 provide you with general information about
depression and the treatment approach taken in this manual, whereas
Units 4 through 6 outline the process of treatment, including assignments
for you to complete. Your treatment provider will assist in customizing
the treatment to meet your individual needs and will help to
ensure that treatment is moving at a comfortable pace.
UNIT 2: RECOGNIZING DEPRESSION
Definition and prevalence of depression. Depression is defined as
an extended period of time (at least 2 weeks) in which a person experiences
depressed mood or a loss of interest or pleasure in activities that
were once enjoyed. Between 10% and 25% of women and 5% to 12%
of men will experience at least one episode of major depression in
their lifetime (Diagnostic and Statistical Manual of Mental Disorders
[DSM-IV], American Psychiatric Association, 1994). Although
depression most often occurs between the ages of 25 and 45, it can
Lejuez et al. / BEHAVIORAL ACTIVATION 259
affect people of all ages, cultures, income, education, and marital
status.
For some people, the onset of depression is clearly related to stressful
life events (e.g., loss of a loved one, financial difficulty, job loss).
For others, the specific causes of depression may be unclear, and onset
may occur without warning. Theorists have proposed that the development
of depressive symptoms is influenced by a variety of behavioral/
environmental, cognitive (i.e., thoughts, beliefs), social, and biological
influences. These factors may act independently or together to
produce and maintain depressive symptoms.
Whether it lasts a couple of weeks or as long as several years, an
episode of depression may produce significant impairment in life functioning
(e.g., unable towork, cook, or take care of children). Psychological
consequences may include decreased optimism/motivation, low
self-esteem, impaired concentration, fatigue, and possibly extreme
behaviors such as self-injury and/or suicide. Medical consequences of
depression may include heart disease, autoimmune disease, substance
abuse or dependence, and impaired nutrition. Individuals with depression
may isolate from others and/or assume a more negative approach
to life that may result in a depletion of social support, divorce,
decreased job satisfaction or unemployment, and educational failure.
Given these possible consequences, identification and treatment of
depression is critical.
If depressive symptoms are severe, major depression may be diagnosed.
Major depression can be distinguished from ordinary “blues”
or “feeling down” by several factors. DSM-IV (American Psychological
Association, 1994) specifies that to meet criteria for a major
depressive episode, there must be a period of at least 2 weeks during
which there is either depressed mood or the loss of interest or pleasure
in nearly all activities. Additionally, at least four of the following
symptoms must be present:
• significant weight loss or weight gain
• decrease or increase in appetite
• insomnia or oversleeping
• feelings of agitation or irritability
• fatigue or loss of energy
• feelings of worthlessness or excessive or inappropriate guilt
260 BEHAVIOR MODIFICATION / April 2001
• diminished ability to think or concentrate, or indecisiveness
• suicidal thoughts or attempts
Although most individuals experience some form of many of the
above symptoms, these symptoms must either result in significant
feelings of distress or interfere with day-to-day functioning (e.g.,
making it difficult to work, manage household or family responsibilities,
or interact socially with other people) for a diagnosis of depression
to be made. Additionally, the depressed mood cannot be a result
of a medical condition or be caused by medications, alcohol, or other
drug use.