Rationalities

 

When depressive symptoms are recognized, a number of treatment
alternatives are available. If you decide to seek treatment, consultation
with your mental health provider is recommended to determine the
approach best suited to meet your needs. This manual is environmental/
behavioral in nature, which means that it targets changes in your environment
and behavior as a method for improving your thoughts,
mood, and overall quality of life. Although we are focusing on behavior
change, we are not ignoring thoughts and feelings. Instead, we suggest
that negative thoughts and feelings often will change only after
positive events and consequences are experienced more frequently.
Said more simply, it is difficult to feel depressed and have low
self-esteem if you are regularly engaging in activities that bring you a
sense of pleasure and/or accomplishment (see Figure 1).
To place the focus on your behavior and motivation level, we refer
to actions related to your depression and depressive symptoms as
depressed behavior. Accordingly, we refer to positive actions that are
inconsistent with depressed behavior as healthy behavior. In general,
both depressed and nondepressed behaviors occur (a) to obtain or to
acquire something or (b) to avoid or to escape something. Despite this
simple formula, it is sometimes difficult to determine the specific reasons
why we behave in particular ways.

With regard to depressed behavior, possible benefits include the
avoidance of certain unpleasant or stressful activities, other people
completing your responsibilities, or receiving more attention and
sympathy from your family and friends. Because of these immediate
benefits, it is not surprising that depressed behaviors may become
more frequent, especially if the benefits of healthy behavior appear to
be more difficult to achieve and less immediate. Unfortunately, as the
frequency of depressed behaviors increase and the frequency of
healthy behaviors decrease, important life areas may become
neglected (work absences or decreased social contact), and long-term
negative consequences often result. Again not surprisingly, these consequences
produce a downward spiral that may make you feel both
overwhelmed and trapped in your depression.
Assessing reasons for your depressed behavior is not designed to
make you feel badly or guilty. Instead, it is meant to highlight the fact
that the experience of depression often is the result of natural
responses to stressful environmental situations and changes. Indeed,
the depressed behavior you are currently engaging in may be the best
way you know to cope with overwhelming life events and situations.
Nevertheless, we believe that the bestway to stop the downward spiral
of depression is that one must become active first and then the exposure
to more positive experiences will produce positive changes in
thoughts and mood. More positive and adaptiveways of responding to
negative events require one to behave in a way that initially may feel
uncomfortable and awkward. However, persistence and hard work
eventually will produce favorable results.
Is this treatment right for you? This manual can be used independent
of other interventions, and research has shown that it can be effective
for many individuals when used this way. We acknowledge that
262 BEHAVIOR MODIFICATION / April 2001
Figure 1. A diagram outlining the treatment rationale.
for some individuals, however, their depression may be too overwhelming
to presently work toward directly changing their behavior.
Additionally, particular individuals might prefer greater emphasis on
addressing other potential causes of depression including biological,
cognitive (thoughts and feelings), and social factors. In these cases,
the manual may be used as a treatment supplement. Indications that
this manual may be appropriate for you are as follows:

• You are experiencing depressive symptoms.
• You believe that changing your behavior can help change your mood.
• You are willing to actively work toward changing your behavior.
• Other treatment strategies have been ineffective.
• You are worried about potential side effects of medications.