Monday, October 8, 2007

The Importance of Context...

I really enjoyed the Jacobson et al. (2001) article on Behavioral Activation, especially the section on "demedicalizing depression" (pg. 257). I completely agree with the general theme of BA that one has to take into account the environment and the context within which a disorder, especially depression, arises. Jacobsen et al (2001) presented some really powerful examples that make it hard for someone to deny the importance of individual life events as risk factors for depression. Models that focus exclusively on genes are flawed, as Jocobson et al (2001) point out. For example, a genetic predisposition to depression cannot comprehensively explain why so many people experience depression after traumtic events, such as the loss of a parent or spouse. Furthermore, I appreciate the idiographic approach that BA takes on and the emphasis on not making "a priori assumptions that an event is reinforcing until we have seen that it increases behavior or has a positive effect on mood" (pg. 257). This makes so much sense to me because what may be a positively reinforcing activity for one person may not be for another person (i.e, "focused activation"). I imagine that clients in BA therapy probably feel that the therapist takes a genuine interest in their specific problem and really tries to understand how they, as an individual, can improve. I also like that BA focuses on specific, goal-directed behaviors and does not assume that mood needs to change before behavior can. BA seems to be a very proactive, practical approach to positive change, and I really like that! However, I did find myself questioning the effectivess of the "attention to experience" part of BA. Jacobson et al (2001) readily points out the tendency for depressed people to ruminate, which is a type of negative thinking. However, because BA is strictly a behavioral model, the content of these negative thoughts is never addressed, only the context or the function of the thought. The BA therapist, therefore, trains clients to pay more attention to their environment as an exposure exercise inorder to attempt to decrease their rumination and increase their activation strategies. I don't know if there is efficacy literature on this particular BA component but in my opinion, it seems like targeting the negative thought itself might be more productive. This was one area of BA that I found to be pretty abstract as compared to other components of the model. Overall though, I really like the basis of Behavioral Activation and I'm interested to know the outcome of Jacobson et al's clinical trial that compares BA to CT!!

1 comment:

jcoan said...

The attention to experience is a really interesting component. It is one of the main ingredients in mindfulness based mediation practices, which are starting to build up quite a database of their own in terms of EST status. Interestingly, adding mindfulness meditation to CBT turns out to fairly dramatically decrease relapse rates in depression (see the work of Teasdale and colleagues)