ERIC EJ959658: Toward a Comprehensive Functional Analysis of Depressive Behavior: Five Environmental Factors and a Possible Sixth and Seventh

2011·0.09 MB·English

by  ERIC

TheInternationalJournalofBehavioralConsultationandTherapy ©2011,Allrightsreserved.
2011,Vol.7,No.1,5–14 ISSN:1555-7855
Toward a Comprehensive Functional Analysis of Depressive
Behavior: Five Environmental Factors and a Possible Sixth and
Seventh
JonathanW.Kanter JosephD.Cautilli
UniversityofWisconsin-Milwaukee St. Joseph’sUniversity
AndrewM.Busch DavidE.Baruch
UniversityofWisconsin-Milwaukee UniversityofWisconsin-Milwaukee
With recent advances in the behavioral treatment of depression and growing dissatisfaction
withmedicalandcognitiveinterventions,aresurgenceofinterestinbehavioranalytictreatment
ofdepressionhasoccurred. Currently,severalbehavioralandcognitivebehavioralmodelsof
depressionexist.Inreviewingthesemodels,certainagreeduponenvironmentalfactorsemerge.
Inthispaper,weexplorefivefactorsrelatedtoabehavioraltreatmentofdepression. Threeof
thesefactorsviewdepressivebehaviorasabi-productofperson-behavior-environmentinter-
action. These are (1) lack of response contingent reinforcement of behavior, (2) too much
punishment of behavioral responses, and (3) loss of effective operant behavior. In addition,
twomodelsviewdepressivebehaviorasoperantbehaviorascontrolledby(4)positiverein-
forcementand/or(5)negativereinforcement. Twofinalfactorstoconsiderare(1)depressive
behaviordevelopsasafailuretodeveloporanoverrelianceonrulegovernedbehaviorand
(2)environmentalfactorsthatprecipitatedepressionmaybeviewedasestablishingoperations.
Eachofthesefactorswillbeexploredaswellasmultiplecombinationsofthesefactorsinthe
generationandcontinuationofdepression.
Keywords: Depression, Functional Assessment, Clinical Behavior Analysis, & Behavioral
ModelsofDepression
Inthe1990’s,aresurgenceofinterestinbehavioraltheories Lewinsohn, 1974). In review of current behavioral mod-
ofdepressionoccurred. Thisresurgencederivedfromthees- els of depression, we found that several factors were high-
tablishmentofclinicalbehavioranalysisasavibrantadjunct lighted. First, early models incorporated Skinner’s (1953;
to applied behavior analysis (Dougher, 1993; 1994; 2000) 1974)stancethatfeelingssuchasdepressionarerespondent
withactivetheoreticalandempiricalinvestigationsandtreat- bi-productsofbehavior-environmentinteractions.Forexam-
mentdevelopmentsrelevanttooutpatientpsychotherapeutic ple, failure to achieve sleep as a reinforcer for insomniacs
treatment of depression. In addition, a component analysis mightproducedepressivesymptoms.Subsequentmodelsfo-
ofcognitive-behaviortherapyfordepressionshowedthatthe cusedondirectfunctionalaspectsofdepression.
behavioral component (behavioral activity scheduling was While many of the early pioneers of behavioral ap-
referredtoasbehavioralactivation)wassufficienttoexplain proaches to depression became focused on cognitive phe-
recovery from initial depression (Jacobson et al., 1996) and nomena after initial investigations, this behavioral work re-
at follow up (Gortner, Gollan, Dobson, & Jacobson, 1998). mains an excellent starting point for current theory explo-
The cognitive component of treatment appeared to add lit- ration. Inparticularthesemodelsemphasizeddepressionas
tle to the overall outcome. These findings renewed inter- a function of positive reinforcement deprivatio n, either in
est in behavioral approaches to depression treatment (Hol- termsoflowdensityofpositivereinforcement(Ferster,1973)
lon,2001;Jacobson&Gortner,2000)andsparkeddevelop- or low rates of response-contingent positive reinforcement
mentofacompleteBehavioralActivationapproach(Martell, (Hoberson & Lewinsohn, 1985; Lewinsohn, 1974, 1975).
Addis, & Jacobson, 2001; also see Kanter, Callaghan, Lan- Depression was also conceptualized in terms of aversive
des, Busch, & Brown, 2004). Other clinical behavior an- control by these early theorists (Ferster, 1973; Grosscup &
alytic approaches to depression have also been evaluated, Lewishon,1980)andintermsoflossofcontingencythrough
including Acceptance and Commitment Therapy (Zettle & punishment(e.g.,Seligman,1975). Inthesemodels,deficits
Hayes,1986;Zettle&Rains,1989)andFunctionalAnalytic in behavior are a function of reinforcement deprivation or
Psychotherapy(Kanter,Schildcrout,&Kohlenberg,inpress; punishment, emotional behavior is seen as respondent, and
Kohlenberg,Kanter,Bolling,Parker,&Tsai,2002). additionalbehaviors,includingthinkingandfeeling,maybe
The above sets the stage for a re-analysis of behavioral described as adjunctive behavior (schedule induced). Later
theories of depressive behavior (e.g., Bolling, Kohlenberg, modelsvieweddepressivebehaviorasoperantphenomenon.
& Parker, 2000; Dougher & Hackbert, 1994; 2000; Fer- Asoperantphenomenon,depressivebehaviorisdirectlysub-
ster, 1973; Hoberman & Clarke, 1993; Kanter et al., 2004; jecttoandmaintainedbypositiveandnegativereinforcement
5
6
KANTER,CAUTILLI,BUSCH,&BARUCH
(Hops, Sherman & Biglan, 1990). We will then review the RatioStrain
theoryandresearchonrule-governedbehaviorhasbeenused
It is often the case that reinforcers are not lost completely.
tomodeldepressionbothintermsofdeficitsinrule-governed
Instead, reinforcement rates are reduced but not to the
behavior (e.g., Kanfer, 1970, 1971 as played out in Rehm,
point of extinction. It is well known that this situation
1977, 1988) and excessive rule-governed behavior (Hayes,
produces extinction-resistant behavior (Ferster & Skinner,
Strosahl, & Wilson, 1999). Finally, the possible role of es-
1957). This calls the reinforcement deprivation model of
tablishing operations in depression will be explored. This
depression into question, as the model suggests behavioral
paperwillrevieweachofthesefactors.
frequency and variability should reduce. But extinction-
resistant behavior results from reducing reinforcementrates
for variable interval schedules not variable ratio schedules.
THEREINFORCEMENTDEPRIVATIONMODEL
Infact,astheprobabilityofreinforcementonaratiosched-
ule decreases, a maximum rate is achieved after which
The simple notion that a lack of or reduction in positive re- ratio strains—disruptions in responding that are not post-
inforcementproducesdepressionhasbeenthefoundationof reinforcement pauses—appear. This is especially the case
mostbehavioraltheoriesofdepression. Thesetheorieshave ifratioschedulerequirementsareraisedrapidly. Therateof
interpreted depression literally, emphasizing reductions in behaviorcharacterizedbyratiostrainmayappeartobesimi-
overallbehavioralfrequencyandvariability.Itiswellknown lartothatcharacterizedbyextinction,andiftherateisraised
that behavior that is seldom positively reinforced may slow highenoughorquicklyenoughforallpracticalpurposesthe
or stop altogether. In line with Skinner (1974), both Fester result is the same— responding will stop (see Stafford &
(1973)andLewinsohn(1974,1975)emphasizedthatdepres- Branch(1998)formoreinformationonratiostrain).
sion is a function of such reinforcement deprivation. Like- Forexample,consideragraduatestudentworkingonher
wise,DougherandHackbert(1994)describedlowdensityof dissertation. Each draft is submitted to her advisor after
reinforcement,extinction,andpunishmentallasconsequen- whichapredictablepost-reinforcementpauseinresponding
tial functions relevant to depression. Similarly, the present mayoccur.Eventually,however,withpositivefeedbackfrom
reviewrelatesdepressiontoseveralbehavioralprinciples,in- the advisor progress will be made, subsequent drafts com-
cluding reinforcement loss, ratio strain, reinforcement ero- pletedandpositivelyreviewed,andworkonthedissertation
sion, and skill deficits. We also consider adjunctive and re- may be maintained on such a variable ratio schedule until
spondentbehaviorinthissection. it is completed. However, consider an advisor who returns
thedraftasunacceptableandrequiresmoreworkbeforere-
submission. Thismaybeconsideredanincreaseintheratio
ReinforcementLoss requirement. Several cycles of such increases may produce
ratio strain. The student, depending on relevant historical
The reinforcement deprivation model of depression posits
variablessuchastheprobabilitythatpersistencehasbeenre-
that reductions in reinforcement rates will produce reduc-
inforcedinthepast,mayeventually,inessence,giveup,and
tions in responding. This certainly is the case when rein-
depressionmayfollow.
forcers have been lost completely. Reinforcer loss is the
moststraightforwardaspectofthereinforcementdeprivation
model. Reducedratesoforcompletelyextinguishedbehav- ReinforcementErosion
iormayresultfromlossofthereinforceritself,thepotential
toexperiencethereinforcer,orthepotentialtoexperiencethe Reinforcementerosionisatermcoinedbythedevelopersof
reinforcing properties of the reinforcer. Probably the most BehavioralMaritalTherapy(Jacobson&Margolin,1979)to
commonexampleoftheformerisdeathofordivorcefroma refer to processes such as satiation and habituation through
spouse, but examples can also include loss of a job, reloca- whichpreviouslyreinforcingstimulibecomelessreinforcing
tiontoanewenvironment,andlossofphysicalorcognitive overtime. Inadditiontosatiationandhabituation,otherfac-
activity due to aging or injury. Functionally, the important torssuchasageandhistorycanalsoplayarole.Forexample,
pointisthatitisageneralizedreinforcerthatislostandex- apartner’sjokes,sofunnyatthebeginningofarelationship,
tinction over-generalizes to many behavioral repertoires at begin to sound boorish after being repeated time after time.
least partially controlled by or associated with the lost re- Likewise, sexual attractiveness fades with familiarity and a
inforcer. Research clearly indicates that risk for depression couple’ssexlifemaybecomeboringandroutineovertime.
isincreasedaftertheoccurrenceofsuchmajornegativelife Inthesesituations,althoughoncereinforcingeventsarestill
events (Billings & Moos, 1984). However, most depressed presentinthecurrentenvironment,thereinforcingproperties
individuals do not report such a loss precipitating their de- of the events have changed and the reinforcer is effectively
pression; instead, the accrual of smaller, multiple stressors lost. Thisprocessawaitsexperimentalanalysis.
over time predicts depression in a larger proportion of indi-
viduals(Kanner,Coyne,Schaefer,&Lazarus,1981;Paykel,
SkillsDeficits
1982).Thisforcesbehavioranalysistoadvanceamorecom-
plexmodelifthegoalistoaccountformorethanasubsetof The role of social skills deficits in depression has been in-
depressedindividuals. vestigatedformanyyearsbybehavioralandnon-behavioral
7
TOWARDACOMPREHENSIVEFUNCTIONALANALYSISOFDEPRESSIVEBEHAVIOR
researchers. The original view was that an individual must silenceandinactivity,whichareaversive. Depressivebehav-
have in his/her repertoire the skills necessary to obtain so- iors such as complaining, hand wringing, pacing and com-
cial reinforcement; if these skills are deficient, rates of so- pulsive talking may be evoked and function to mask these
cial reinforcement will be reduced and depression will en- aversiveconditions. Thus,astheavailabilityofprimarypos-
sue (Lewinsohn, 1974, 1975). Unfortunately, much of the itivereinforcersdecreases,negativereinforcersassumecon-
research in support of this model was based on correlations trol. If strong enough, the adjunctive contingencies may
and only showed that depressed individuals also displayed come to prevail over the primary contingencies and make
socialskillsdeficits(e.g.,Youngren&Lewinsohn,1980). In adjunctive behavior prepotent even during times previously
fact,someresearchfoundthatsocialskillsdeficitsareacon- controlledbytheprimaryschedule. Insuchacaseaperson
sequence,notacause,ofdepression(e.g.,Cole&Milstead, maybecomechronicallydepressed.
1989).Ontheotherhand,itisquiteclearthatdisturbancesin Othershavedescribedthesedepressivebehaviors,particu-
interpersonalfunctioning,whichmaybeaproductofsocial larlytheemotionalresponses,asrespondentlyelicitedbyhis-
skillsdeficitsorotherfactors,arebothprecipitantsandcon- torical events that also result in the dearth of reinforcement
sequences of depression (Barnett & Gotlib, 1988). As with (Dougher and Hackbert, 2000; Lewinsohn, 1974). So, for
thereinforcerlossmodel,thebehavioralsocialskillsdeficits example, a person may stop going to work if reinforcement
modelofdepressionhasbeenshowntoberelevanttodepres- doesnotmaintainsuchbehaviorandstarttofeeldepressed.
sionbuttoosimpleasafullexplanationforthephenomena. Likewise, when a person leaves his/her childhood home for
Abroaderviewofskillisimpliedbytheliteratureoncop- the first time much behavior can no longer be emitted and
ingskills(e.g.,Lazarus&Folkman,1984). Inthisview,the depressive feelings may appear in turn (Skinner, 1974). In
individualmusthaveinhis/herrepertoiretheskillsnecessary line with the conceptualization of secondary depressive be-
notjusttoobtainsocialreinforcement,buttoobtainwhatever haviors as respondently-elicited, several authors have sug-
is required to adjust successfully to adverse life events and gestedthatthesedepressivebehaviors,particularlysleepand
stressors. Thebenefitofacopingskillsmodelofdepression appetitedisturbancesandthinkingdifficulties,serveanadap-
isthatitallowsfortheidentificationofidiographichistorical tive function that may have been produced through contin-
andsituationalvariablesthatmayresultinaparticularindi- gencies of survival (Bolling, Kohlenberg, & Parker, 2000;
vidual lacking the behavioral repertoire to obtain necessary Costello,1977;Schmale,1973).
reinforcement in a particular situation. Thus, social skills
deficitsmayberelevantforsomebutnotalldepressedindi-
viduals. Thisparticularlymaybethecaseforadolescentsas TOO MUCHPUNISHMENT
they transition into more complicated social arrangements.
Requisite social skills may be seen as a behavioral cusp in
AversiveControl
this situation (Baer & Rosales-Ruiz, 1998; Rosales-Ruiz &
Baer,1997),andthismayhelpexplaintheburstofdepressive Skinner may have had the ubiquity of depression in mind
behaviorthatRutter(1991)pointedoutforthepointofado- whenhe emphasizedthe needfor asocial structurethaten-
lescence. Inadditiontosocialskills,activeproblemsolving courages positive rather than aversive control of behavior
skills (Nezu, 2004; D’Zurilla & Goldfried, 1971) and emo- (e.g., Skinner, 1986). Likewise, Ferster (1973) emphasized
tion regulation skills (Linehan, 1993) have been considered theroleofescapeandavoidancebehaviorindepression.Fer-
importantcopingskillsrelevanttodepression. ster did not distinguish between escape and avoidance be-
haviors,however,andtherolesofnegativereinforcementvs.
punishmentwerenotclarified. Traditionally, thebehavioral
AdjunctiveandRespondentBehavior
viewhasbeenthatdepressionisafunctionofpositiverein-
Reinforcement deprivation easily accounts for the paucity forcementwhileanxietyisafunctionofnegativereinforce-
of behavior and other behavioral deficits displayed by de- ment, and punishment has received less attention. This dis-
pressed people, especially if the reinforcers lost or reduced tinctionbetweendepressionandanxietyistoosimpleasco-
weregeneralizedreinforcers,butthistheorydoesnotdirectly morbidityhascometobeseenastheruleratherthantheex-
explain the increases in behavior also displayed, especially ception(Barlow,2002). Infact,inlightofthesubstantialco-
emotional behavior. These additional behaviors often have morbidity,Barlow,Allen,andChoate(2004)proposedcom-
been conceptualized as adjunctive and respondent sequelae bining the diagnostic categories of anxiety and depression
oftheprimaryproblemswithpositivereinforcement. intoalargercategory.Behaviorally,thismaymakesenseasit
First, some of these increased private behaviors may be isdifficulttoconceiveofahistorywhichproducessignificant
seen as forms of adjunctive behavior (Cantor & Wilson, disruptions in positive reinforcement but does not also in-
1984;Falk,1971),evokedbysecondarystimulithatbecome cludesignificantaversivecontrol(althoughwewouldargue
prepotent until the original schedule reasserts control. As againstdiagnosticcategorizationonothergrounds[e.g.,Fol-
reinforcement rates are reduced, control of non-depressive lette, Naugle, & Linnerooth, 2000; Hayes, Wilson, Gifford,
behavior by previous controlling stimuli weakens, and de- Follette, & Strosahl, 1996; Koerner, Kohlenberg, & Parker,
pressivebehaviorssuchasnegativethinkingandfeeling“de- 1996]). AsFerster(1973)noted,anabsenceofpositivelyre-
pressed” may increase adjunctively. For example, Ferster inforcedbehaviormaybeduetothestrengthandprepotency
(1973)emphasizedthatalossofreinforcementmayresultin ofescapeandavoidancebehaviors,anditmaybedifficultto
8
KANTER,CAUTILLI,BUSCH,&BARUCH
ascertainthecontrollingvariablesinagivencase.Acommon porarily increases in frequency, intensity, and variability of
history of excessive aversive control may produce a host of formmightbeatthecoreoftheseresults.
private events, which are tacted as “depression,” “anxiety,”
orboth.
Researchbynon-behavioristsclearlyestablisheslinksbe- POSITIVEREINFORCEMENTFORDEPRESSIVEBEHAVIOR
tweenaversiveexperiencesanddepression,althoughthespe-
cificrolesofnegativereinforcementvs.punishmenthaveyet
Positive reinforcement for depressive behavior is central to
to be clarified. For example, it is well known that stress-
several non-behavioral models of depression (e.g., the psy-
ful life experiences produce depression in adults (Kessler,
choanalyticnotionofsecondarygains,Shmagin&Pearlmut-
1997). In addition, several lines of research suggest that
ter, 1977; Fenichel, 1945). Even if one sees depressive be-
risk for depression is a function of negative reinforcement
haviorasanadjunctivebi-productofpunishment,thendis-
and punishment density for children and adolescents. Chil-
tressedbehaviors, suchascomplainingorotherexpressions
dren who display academic difficulty often experience high
ofworry,maybeseenasaclassofbehaviorshistoricallyre-
ratesof depressivebehavior (Cole, 1990). Inaddition, ado-
inforced by the verbal-social community. Complaining, for
lescents in less supportive and more aversive environments
example, oftenprovidesexplanationsfordepressedindivid-
experience higher rates of depressive behaviors (Sheeber &
uals’primarydepressivesymptoms. Reason-giving,inturn,
Sorensen, 1998). Depressed children and adolescents, as
ishighlyreinforcedbytheverbal-socialcommunity(Hayes
well as their parents describe family contexts as more hos-
&Hayes, 1989; Baum, 1994). Romanoetal. (2000)found
tilethannonclinicalsamples(Hopsetal., 1990; Lewinsohn
that the rate of both verbal and nonverbal pain behaviors in
etal.,1990),andchildrenoftenreportsadnessinresponseto
chronicpainpatientswasassociatedwithhigherratesofso-
parentalconflict(Cummings,Inonotti&Zahn-Waxler,1985;
licitouspartnerresponses, suggestingthatpartnersolicitous
Cummings, Vogel, & Cummings, 1989; El- Sheikh, Cum-
behavior may be maintaining high rates of pain behaviors
mings,&Goetsch,1989;Cummings,Ballard,El-Sheikh,&
throughpositivereinforcement.Socialsolicitationofdepres-
Lake,1991).
sive behavior may help to maintain depression in much the
If depression is to be interpreted literally, as in behavior
sameway.
being “pressed down” or reduced, then the relationship be-
Reassurance seeking provides another example. Mildly
tween punishment and depression is made clear, as punish-
depressedexcessivereassuranceseekersrepeatedlyelicitso-
ment by definition reduces behavior. Generalized punish-
cialsupportfromtheirenvironment(i.e. familyandfriends)
ment should be of particular importance, and it is common
(Coyne, 1976). Reassurance seeking may increase in fre-
forclientswithchronicdepressiontoreportchildhoodhisto-
quencyovertimeinordertoverifythatpastassuranceswere
riesofprolongedandinescapablepunishment. Itissurpris-
credibleandnottenderedoutofasenseofobligation. Main-
ing, therefore, how little has been written by behavior ana-
tenanceofthisbehaviormaybeunderstoodasresistanceto
lystsaboutthisrelationship. Thismaybebecausetheearly
extinction following an intermittent schedule of reinforce-
researchonpunishmentanddepression,thelearnedhelpless-
ment. Gradually,thosegivingreassurancemaybecomefrus-
ness model, while behavioral in method and interpretation
trated by the frequent demands that seemingly never suc-
(e.g., Overmier & Seligman, 1967), grew increasingly cog-
ceed in reassuring the depressed individual. As a result,
nitiveovertime(Abramson,Metalsky,&Alloy,1989;Selig-
reassurance providers may make themselves less available,
man,1975).
leadingtodecreasedandintermittentreinforcement. Rejec-
However, the basic behavioral repertoires involved in
tionbythereassuranceproviders,whetherdirectorindirect,
learnedhelplessnesshavebeendemonstratedinanimalsand
canconcomitantlyexasperatedepression. Researchhassup-
humansandmaybetakenasamodelforsomeformsofde-
ported the notion that this vicious cycle strengthens a de-
pression without endorsing related hypotheses about causal
pressedmood(Joiner&Metalsky,2001).
cognitive concepts. Experiments with humans have shown
that failure to display effective operant behavior over time
leads to the extinction of entire operant classes of behavior.
NEGATIVEREINFORCEMENTFORDEPRESSIVEBEHAVIOR
Forexample,KleinandSeligman(1976)showedthatpartici-
pantsexposedtoinescapablenoiseweresubsequentlyslower
toescapethenoisewhenitwasescapable. Similarly,Hiroto As previously mentioned, Ferster (1973) alleged that sev-
andSeligman(1975)showedthatwhenparticipantsexposed eral depressive behaviors served avoidance or escape func-
toinescapableshocksubsequentlyfailedtoemitescapeoper- tions. For example, forms of withdrawal, such as avoid-
antswhentheshockwasescapable. Finally,RothandKubal ingcontactwiththesocialcommunityorexcessivesleeping,
(1975) showed that participants presented unsolvable prob- help to avoid exposure to environmental stimuli that elicit
lems later failed to solve problems that were solvable. The aversive thoughts or feelings, thus maintaining depressive
extinctionofoperantclassesofescapebehaviormaybestex- behaviors and reducing contact with potential reinforcers
plaintheresultsofWortmanandBreham(1975)whofound (Martell,Addis,&Jacobson,2001).Otherdepressivebehav-
in some helplessness experiments that participant behavior iors,suchascomplaining,pacing,orcryingmayfunctionto
for escape was facilitated. A behavioral model would sug- avoidaversiveconditions,suchassilence,inactivity,orother
gest that the classic extinction burst, where behavior tem- anxiety-producingactivities. Rumination, accordingtoFer-
9
TOWARDACOMPREHENSIVEFUNCTIONALANALYSISOFDEPRESSIVEBEHAVIOR
ster(1981),canbeexplainedinthat,negativeandaggressive has been challenged and altered recently in line with Rela-
statements, in general, are punished when voiced publicly. tional Frame Theory (Hayes, 1989; Hayes, Barnes-Holmes,
Consequently,suchcritical,anxious,orhostilelanguagebe- &Roche,2001);theanalysisfordepressiondoesnotchange
comes private. These private statements, while inherently substantiallyhowever.
negativeandmostlikelypunishing,neverthelessreducefur-
therpublicpunishment.
Alackofrule-governedbehavior
Some evidence exists to support the notion that negative
reinforcement maintains depressive behavior. This can be We first consider a lack of rule-governed behavior. Reigler
a very powerful but not very reported factor in outpatient and Baer (1989) provided a model of the normal develop-
therapy. Forexample,inthelaboratorysetting,usinganex- ment of rule following and rule-governed behavior. In this
aminationofconditionalresponding, Biglanandcolleagues model,achildinitiallylearnstorespondtoaparent'sverbal
(1985) found that depressive statements lowered the prob- instructions for compliance. The verbal instructions serve
abilityofaggressivebehaviorfrombothhusbandsandchil- as discriminative stimuli that produce consequences for the
dren.Inaddition,Biglan,Hops,andSherman(1987)showed childbothdirectlyfromthesituationandindirectlythrough
thatdepressivebehaviorssuppresspartneraggressivebehav- collateralcontingenciesfromtheparents(Cerutti,1989).Af-
ior. Is this likely to be a functional operant in the natural ter multiple exemplars of compliance training children de-
environment? Jenkins,Smith,andGraham(1989)foundthat velop a generalized compliance response class. When this
a majority of children reported that they intervened to stop occurs,thechildbeginstogeneratehis/herownrulesandin-
their parents’ quarrels and that greater frequency of quar- structionsby imitatingtherule-giving behaviormodeledby
rels was associated with greater level of intervention. In- adults. In addition to this, the child begins to discriminate
volvementinparentalquarrelsisrelatedtochildinternalizing his/her own behavior and others behavior related to conse-
problems(Jouriles,Murphy,&Farris1991).Usingdirectob- quenceevents. Forexample,thechildmightsay,“IfIhitmy
servationHopsandcolleagues(1987),showedthatdepressed brother,thenmomwillputmeintimeout.”ZettleandHayes
mothersemitteddysphoricaffect,whichsuppressedhusband (1982)statedthatplianceistheresponsetoSkinner's(1957)
hostility more often than nondepressed mothers. Distressed mandcategory.
behaviorsemittedbychronicpainpatientswerealsoshown Gradually,thechildlearnsfromadultstoaskhim/herself
to reduce partner aggressive statements (Biglan & Thorsen, “What am I doing?” The use of self-instructions can now
1986, cited in Biglan, Lewin & Hops, 1990). The reverse generalize to novel situations. Goldiamond (1976) took the
isalsotruethataggressivestatementsmadebyfamilymem- development of rule-governed behavior as the basis of self-
bersoftenreducemotherdepressivestatements(Hopsetal., control. Of particular interest are rules that Malott (1981)
1987). Thissetsupaninterestingcircularsysteminwhich, describedasweakrulesbecausetheconsequenceswerede-
thepartnersaggressivebehaviorisreducedbydepressivebe- layed,incremental,and/orunpredictablewithrespecttoout-
haviorandthepersonsdepressivebehaviorissuppressedby come. Zettle and Hayes (1982) discuss this as "tracking"
aggressivebehavior. Thus, depressioncancometobeaco- which is a response to a tact or better described as a gen-
ercive response to an aggressive partner. And the partner’s eral awareness of rules. For example, the child who delays
increased aggressive behavior can be seen as a method to the start of study later and later for a test the next day soon
decreasethedepressivebehavior. finds no time left to study. He goes to school the next day
and fails the test. Thus, a person who fails to develop rule-
governedbehaviorandgeneralizedself-instructionmayfind
THEROLEOFRULEGOVERNEDBEHAVIORINDEPRESSION him/herself too controlled by immediate contingencies, and
long-termgoalsandplanningmaysuffer.Forexample,acol-
Skinner (1953, 1957, 1966, 1974) described rules as verbal lege student may go drinking the night before a major final
discriminativestimuli(tacts)specifyingcontingentbehavior- andthensuffersignificantconsequences.Putsimply,theper-
consequence relationships that function as antecedents for sonmaysellouthis/herdreamsfortheirmomentarydesires
operant behavior. As Skinner (1966) points out nonver- andthendepressionmayresult.
bal creation of a discriminative stimulus is common across This model of rule-governed behavior predicts that de-
species.Bearsmaymarktreeswithclawmarks,andaperson pressed individuals, depending on where the breakdown in
mightputachalkXontheirluggage.Bothsolvetheproblem the developmental pathway occurs, might have problems
of making the situation easier to identify. The organism’s withself-monitoring,formulationofself-rulesinspecificsit-
abilitytogeneraterulesislearnedthroughahistoryofsocial uations,andgivingupshort-termrewardsforlong-termcon-
reinforcementforrulefollowing.Rulesemergeasalargerre- sequences. For example, a person might become depressed
sponseclassandcanlessenthetimeneededtoderivecontin- becausetheykeepdatingthewrongtypeoforultimatelyin-
genciescomparedtodirecttrialanderrorexperiences(Skin- compatiblepeople.He/shemightenjoyapersonwhoisalav-
ner,1974). Thus,itisthroughrulesthattemporalextension ishspenderwhendatingbutwhentherelationshipbecomes
occursfromthepresenttothefuture(Skinner,1989). Botha serious the person’s accrued debt might be problematic and
lack of rule-governed behavior and excessive rule governed lead to an end in the relationship. The model thereby sug-
behavior have been posited as relevant to depression. We geststhatrelativelynormalpeoplemightbecomedepressed
note that this original definition of rule-governed behavior ifrepeatedlyplacedinsituationswithconsequencesthatare
10
KANTER,CAUTILLI,BUSCH,&BARUCH
delayed, incremental, and/or unpredictable with respect to & Barnes-Holmes, 2004) examined depressed adolescents’
outcome. In accord with this view, Rehm (1979, 1989) ar- sensitivitytocontingencychangesthatmadeapreviouslyes-
guedthatdepressedindividualshavedeficitsintheabilityto tablishedruleineffective.Resultsindicatedthatoncetherule
monitortheirownbehavior. Inaddition,theyhavedifficulty was no longer reinforced, depressed adolescents followed
generatingrulesandsolutionsforproblemsituations. Rehm verbalruleslongerthandidnon-depressedsubjects.
has presented considerable evidence to support the notion Note that this theory highlights additional verbally-
thatrule-governedbehaviordeficitsexistinmanydepressed mediated avenues of reinforcement deprivation. For exam-
individuals and developed a self- management therapy pro- ple,adepressedpersonwholiveslifebythemantra“tohave
gram aimed at improving self-monitoring, self-evaluation, asuccessfullife,Imustcontrolmyemotions”wouldbeun-
andself-reinforcement(reviewedinRehm&Rokke,1988). dertheverbalcontrolofanexperientialavoidancerule. This
Similarly,manycognitivetherapytechniquescanbereinter- personmaybesuccessfulintheshorttermatavoidingneg-
pretedasattemptstotrainappropriaterule-formulationand ativeemotions,butinthelongtermthismaycompoundde-
rule-governance(Poppen,1989;Zettle&Hayes,1982). pression. According to Hayes et al. (1999), many negative
privateeventsareclassicallyconditioned,soattemptstocon-
trolthemverballywillbeunsuccessful. Inaddition,attempts
Excessiverule-governedbehaviorandexperientialavoidance
tocontrolprivateeventsmaybackfireandproducearebound.
Analternativeaccountpositsthatdepression(andotherpsy- Finally,anunwillingnesstoexperiencestrongemotionsmay
chopathology) may result from excessive rule-governed be- produceineffectiverespondingwhenopportunitiesforrein-
havior. Hayes et al. (1999) suggest that rules that lead to forcement necessitate strong emotional responses, such as
experiential avoidance are particularly detrimental. Experi- familyinteractionsandintimaterelationships.
ential avoidance has been described as an unwillingness to
remain in contact with private experiences, followed by at-
temptstoescapeoravoidtheseexperiences,evenwhenthis ESTABLISHING OPERATIONSIN DEPRESSION
avoidance causes psychological harm (Blackledge, 2003;
Hayes, Wilson, Gifford, Follette, & Strosahl, 1996). Al-
Eachoftheaforementionedfactorsmayresultinbehavioral
though,notechnicaldefinitionofexperientialavoidancehas
deficits and generate depressive behavior. In addition, set-
been established, experimental evidence from several areas
tingeventsandsubsetsofsettingeventssuchasestablishing
(e.g. thoughtsuppression,copingstyles)suggeststhatexpe-
operationsmayincreasethelikelihoodofdepressivebehav-
rientialavoidanceisanimportantcomponentofmanyclini-
ior. Forexample, sleep may serve asan establishingopera-
calsyndromes(Hayesetal.,1996).
tion that increases escape behavior (Cautilli & Dziewolska,
Thehistoricalconditionsnecessaryforthedevelopmentof
2004).Schmale(1973)foundthatlackofsleepingandeating
rule-governedexperientialavoidancehaveonlybeenloosely
contributedtoaconversationwithdrawalresponse. Dougher
described. Hayes, Strosahl, &Wilson(1999)describeava-
andHackbert(1994;2000),indescribingdepressioninterms
rietyofreasonswhyexperientialavoidanceoccurs. First, if
ofestablishingoperations,suggestedthattheperiodoftime
avoidanceofnegativepubliceventsisreinforced,thebehav-
during which establishing operations have been previously
iormaygeneralizetonegativeprivateevents. Second,expe-
describedtoexerttheirinfluencesshouldbeextendedtoin-
rientialavoidanceitselfwillbenegativelyreinforcinginthe
cludelong-termaswellasshort-termoperations. Theyspec-
shortrun(becausetheaversivestateisavoidedorescaped),
ulatedthatdepressiveestablishingoperationsmaybetempo-
however,becausemanyprivateeventsareelicited,avoidance
rally distant from their effects and may include events such
willfailunlessenvironmentalstimulationisrestricted.Third,
asdeathofalovedone,rape,andlong-termchildhoodabuse.
experiential avoidance is modeled and reinforced by care-
Thus,manyofthefactorsdescribedabovemaybeconceptu-
givers(e.g.“bigboysdon’tcry”).Fourth,experientialavoid-
alizedasestablishingoperationsthatabolishnon-depressive
ance may be a direct result of natural language processes,
contingenciesandestablishdepressivecontingencies.
as described by relational frame theory (Blackledge, 2003;
Hayes et al., 1999; Hayes & Wilson, 1993; Wilson, Hayes,
Gregg&Zettle,2001).
CONCLUSION
Hayesandcolleagues(1999)positthat,givensuchhistori-
calfactors,anindividual’srepertoiremaybecomedominated
by rule-governed experiential avoidance. This is detrimen- The diversity of the above factors highlights the need for
tal and may lead to depression and other psychopathology suchanalyses,asaconceptualizationofdepressionthathigh-
for several reasons. First, an over-reliance on verbal rules lightsbroadprinciplesofpositivereinforcement,negativere-
preventsdirectenvironmentalcontingenciesfromcontrolling inforcement,punishment,rule-governedbehavior,andestab-
behavior(Hayes,Kohlenberg&Melancon,1989). Thus,ex- lishing operations is not of much use given the ubiquity of
cessiverulefollowingcouldleadtoineffectiverepertoiresof theseprocesses. Thediversityoftheabovefactorsalsoclar-
behaviorthatareinsensitivetochangingcontingencies. This ifies that depression is not a unitary phenomena, a specific
claimissupportedbyseveralresearchstudies(e.g. Catania, disease state, or a simple reaction. It is a complex, multi-
Shimoff, & Matthews, 1989; Hayes, Brownstein, Hass, & ply controlled, and co-occurring set of operant and respon-
Greenway, 1986). One study (McAuliffe, Barnes-Holmes, dentbehaviors,andanysimilaritybetweentwocasesofde-
11
TOWARDACOMPREHENSIVEFUNCTIONALANALYSISOFDEPRESSIVEBEHAVIOR
pression is assumed, not determined. This calls for greater (Ed.), Rule-governed behavior: Cognition, contingencies, and
useoffunctionalassessmentintreatment(Augustson,2002; instructionalcontrol(pp.119-150).NewYork:PlenumPress.
Greenway & Wulfert,2002; Kohlenberg, Boiling, Kanter & Cautilli,J.D.,&Dziewolska,H.(2004). Neutralizingsleepasan
Parker, 2002). This means that many different types of in- establishing operation. Journal of Early and Intensive Behav-
dividualandcoupleorientedtechniquescouldbesuccessful ioralIntervention,1(2),160-165.
(Cordova,2003) Cerutti, D.T.(1989). Discriminationtheoryofrule-governedbe-
havior.Journalof theExperimentalAnalysisof Behavior,51(2),
259-276.
REFERENCES Cole,D.A.(1990).Therelationofsocialandacademiccompetence
todepressivesymptomsinchildhood.Journalof AbnormalPsy-
chology,99,422-429.
Abramson,L.Y.,Metalsky,G.I.,&Alloy,L.B.(1989).Hopeless-
Cole, D.A., &Milstead, M.(1989). Behavioralcorrelatesofde-
nessdepression:Atheory-basedsubtypeofdepression.Psycho-
pression: Antecedentsorconsequences? Journalof Counseling
logicalReview,96(2),358-372.
Psychology,36,4,408-416.
Augustson(2002)AnOverviewofSomeCurrentChallengeswithin
Costello,C.G.(1977). Adaptivefunctionofdepression. Canada’s
the Field of Clinical Behavior Analysis. The Behavior Analyst
Mental Health, 25. 20-21. Coyne, J. C. (1976). To-
Today,3(3),265-285.
ward an interactional description of depression. Psychia-
Baer,D.M.,&Rosales-Ruiz,J.(1998). Intheanalysisofbehav- try, 39, 28-40. Cummings, E. M., Ballard, M., & El-
ior, what does “develop” mean? Mexican Journal of Behavior Sheikh, M. (1991). Resolution and children’s response to
Analysis,24,127-136. interadultanger.DevelopmentalPsychology,27(3),462-470.
Barlow, D.H.(2002). Anxietyand itsdisorders: Thenatureand Cummings,E.M.,Iannotti,R.J.,&Zahn-Waxler,C.(1985).Influ-
treatmentof anxietyandpanic(2nded.). NewYork,NY:Guil- enceofconflictbetweenadultsontheemotionsandaggression
ford. ofyoungchildren.DevelopmentalPsychology,21(3),495-507.
Barlow,D.H.,Allen,L.B.,&Choate,M.L.(2004).Towardauni- Cummings, E. M., Vogel, D., & Cummings, J. S. (1989). Chil-
fiedtreatmentforemotionaldisorders.BehaviorTherapy,35(2), dren's responses to different forms of expression of anger be-
205-230. tweenadults.ChildDevelopment,60(6),1392-1404.
Barnett, P. A., & Gotlieb, I. H. (1988). Psychosocial function- Dougher, M. J. (1993). Introduction. The Behavior Analyst, 16,
inganddepression:Distinguishingamongantecedents,concomi- 269-270. Dougher, M. J. (1994). Introduction. The Behavior
tants,andconsequences.PsychologicalBulletin,104(1),97-126. Analyst,17,287-288.
Baum,W.M.(1994).Understandingbehaviorism:Science,behav- Dougher, M. J. (Ed.) (2000). Clinical Behavior Analysis. Reno,
ior,andculture.NewYork:HarperCollins. NV:ContextPress.
Biglan,A.,Hops,H.,&Sherman,L.(1987). Coercivefamilypro- Dougher,M.J.,&Hackenbert,L.(1994). Abehavioralaccountof
cessesandmaternaldepression. InR.Peters&R.J.MacMahon depressionandacasereportusingacceptancebasedprocedures.
(Eds.), Marriage and families: Behavioral system approaches. TheBehaviorAnalyst,17,321-334.
NewYork:Brunner-Mazel.
Dougher, M. J., & Hackbert, L. (2000). Establishing operations,
Biglan, A., Hops, H., Sherman, L., Friedman, L., Artur, J., & cognition,andemotion.BehaviorAnalyst,23(1),11-24.
Osteen, V. (1985). Problem solving interactions of depressed
D’Zurilla, T. J. & Goldfried, M. R. (1971). Problem solving and
womanandtheirhusbands.BehaviorTherapy,16,431-451.
behaviormodification. Journalof AbnormalPsychology,78(1),
Biglan, A. Lewin, & Hops, H. (1990). A contextual approach to 107-126.
theproblemsofaversivepracticesinfamilies.InG.R.Patterson
El-Sheikh,M.,Cummings,E.M.,&Goetsch,V.L.(1989).Coping
(Ed.),Depressionandaggressioninfamilyinteractions.Hillside,
withadults'angrybehavior: Behavioral,physiological,andver-
NJ:LawrenceErlbaumAssociates
balresponsesinpreschoolers.DevelopmentalPsychology,25(4),
Billings, A. G., & Moos, R. H. (1984). Chronic and nonchronic 490-498.
unipolardepression:Thedifferentialroleofenvironmentalstres-
Falk,J.L.(1971).Theoreticalreview:Thenatureanddeterminants
sorsandresources.TheJournalof NervousandMentalDisease,
ofadjunctivebehavior.PhysiologyandBehavior,6,577-588.
172,65-75.
Fenichel,O.(1945). Thepsychoanalytictheoryof neurosis. New
Blackledge. J.(2003). AnIntroductiontoRelationalFrameThe-
York,NY:Norton.
ory: Basics and Applications. The Behavior Analyst Today, 3
Ferster, C.B.(1973). Afunctionalanalysisofdepression. Amer-
(4),421-46
icanPsychologist, 28, 857-870. Ferster, C.B.(1981). Afunc-
Bolling, M., Kohlenberg, R.J., &Parker, C.R.(2000). Behavior
tionalanalysisofbehaviortherapy.InL.P.Rehm(Ed.),Behavior
analysis and depression. In M. J. Dougher (Ed.), Clinical Be-
therapyfordepression:Presentstatusandfuturedirections(pp.
haviorAnalysis(pp.127-152).RenoNV:ContextPress.
181-196).NewYork:Academic.
Cantor,M.B.,&Wilson,J.F.(1984). Feedingtheface: Newdi-
Follette,W.C.,Naugle,A.E.,&Linnerooth,P.J.N.(2000).Func-
rectionsinadjunctivebehaviorresearch. InF.R.Brush&J.B.
tional alternatives to traditional assessment and diagnosis. In
Overmier(Eds.),Affect,conditioning,andcognition. Hillsdale,
M.J.Dougher(Ed.),Clinicalbehavioranalysis,(pp. 99-125).
NJ:Erlbaum.
Reno,NV:ContextPress.
Cordova, J(2003). BehaviorAnalysisandtheScientificStudyof
Goldiamond,I.(1976).Self-reinforcement.Journalof AppliedBe-
Couples.TheBehaviorAnalystToday,3(4),412-425.
haviorAnalysis,9,509-514.
Catania, A. C., Shimoff, E., & Matthews, B. A. (1989). An ex-
Gortner, E. T., Gollan, J. K., Dobson, K. S., & Jacobson, N. S.
perimentalanalysisofrule-governedbehavior. In,S.C.Hayes
12
KANTER,CAUTILLI,BUSCH,&BARUCH
(1998). Cognitive-behavioral treatment of depression: Relapse Hops,H.,Biglan,A.,Sherman,L.,Arthur,J.,Friedman,L.,&Os-
prevention. Journalof ConsultingandClinicalPsychology,66, teen, V. (1987). Home observation of family interaction of de-
377-384. pressedwoman.Journalof ConsultingandClinicalPsychology,
Greenway&Wulfert(2002)TheCurrentStatusandFutureDirec- 55,341-346.
tion of Clinical Behavior Analysis: Introduction to the Special Jacobson, N. S., & Gortner, E. (2000). Can depression be de-
Section.TheBehaviorAnalystToday,3(3),246-248 medicalizedinthe21st century? Scientificrevolutions,counter
Greist,D.L.,Wells,K.C.&Forhand,R.(1979). Anexamination revolutions,andmagneticfieldofnormalsciences.BehaviorRe-
ofpredictorsofmaternalperceptionofmaladjustmentinclinic- searchandTherapy,38,103-117.
referredchildren.Journalof AbnormalPsychology,88,277-281. Jacobson,N.S.&Margolin,G.(1979).Maritaltherapy:Strategies
Grosscup,S.J.,&Lewinsohn,P.M.(1980).Unpleasantandpleas- basedonsociallearningandbehaviorexchangeprinciples.New
antevents,andmood. Journalof ClinicalPsychology,36,252- York:Brunner/Mazel.
259. Jacobson, N. S., Martell, C. R., & Dimidjain, S. (2001). Behav-
Hayes, S.C.(1989). Rule-governedbehavior: Cognition, contin- ioralactivationtreatmentfordepression:Returningtocontextual
gencies,andinstructionalcontrol.NewYork,NY:Plenum. roots. Clinical Psychology: Science and Practice, 8, 255-270.
255-270.
Hayes,S.C.,Barnes-Holmes,D.,&Roche,B.(2001). Relational
frametheory:Apost-Skinnerianaccountofhumanlanguageand Jacobson, N. S., Dobson, K., Traux, P. A., Addis, M. E., Ko-
cognition.NewYork,NY:Kluwer/Plenum. erner, K., Gollan, J. K. et al. (1996). A component analysis
ofcognitive-behavioraltreatmentofdepression.Journalof Con-
Hayes, S.C., &Hayes,L.J.(1989). Theverbalactionofthelis-
sultingandClinicalPsychology,64,295-304.
tenerasabasisforrule-governance. InS.C.Hayes(Ed.),Rule-
governedbehavior: Cognition,contingencies,andinstructional Jenkins,J.M,Smith,M.A.,&Graham,P.J.(1989). Copingwith
control(pp.153-190).NewYork:Plenum. parentalquarrels. Journalof theAmericanAcademyof Child&
AdolescentPsychiatry,28(2),182-189.
Hayes,S.C.,&Wilson,K.G.(1993). Someappliedimplications
of a contemporary behavior- analytic account of verbal events. Joiner, T.E.Jr., &Metalsky, G.I.(2001). Excessivereassurance
BehaviorAnalyst,16(2),283-301. seeking:Delineatingariskfactorinvolvedinthedevelopmentof
depressivesymptoms.PsychologicalScience,12,371-378.
Hayes, S. C., Brownstein, A. J., Haas, J. R., & Greenway, D. E.
(1986). Instructions, multiple schedules, and extinction: Dis- Jouriles, E. N., Murphy, C. M., & Farris, A. M. (1991). Marital
tinguishing rule -governed from schedule-controlled behavior. adjustment,parentaldisagreementsaboutchildrearing,andbe-
Journal of the Experimental Analysis of Behavior, 46(2), 137- haviorproblemsinboys:Increasingthespecificityofthemarital
147. assessment.ChildDevelopment,62(6),1424-1433.
Hayes,S.C.,Kohlenberg,B.S.,&Melancon,S.M.(1989).Avoid- Kanfer,F.H.(1970). Self-monitoring: Methodologicallimitations
ingandalteringrule-controlasastrategyofclinicalintervention. and clinical applications. Journal of Consulting and Clinical
InS.C.Hayes(Ed.), Rule-governed behavior: Cognition, con- Psychology,35,148-152.
tingencies,andinstructionalcontrol(pp. 359-385). NewYork: Kanfer, F. H. (1971). The maintenance of behavior by self-
PlenumPress. generatedstimuliandreinforcement.InA.Jacobs&L.B.Sachs
Hayes, S. C., Strosahl, K. D., Wilson, K. G. (1999). Acceptance (Eds.),Thepsychologyof privateevents:Perspectivesoncovert
andcommitmenttherapy: Anexperientialapproachtobehavior responsesystems.NewYork:Academic.
change.NewYork:GuilfordPress. Kanner,A.D.,Coyne,J.C.,Schaefer,C.,&Lazarus,R.S.(1981).
Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Comparison of two modes of stress measurement: Daily has-
Strosahl,K.(1996). Emotionalavoidanceandbehavioraldisor- slesandupliftsversusmajorlifeevents. Journalof Behavioral
ders: Afunctionaldimensionalapproachtodiagnosisandtreat- Medicine,4,1-39.
ment.Journalof ConsultingandClinicalPsychology,64,1152- Kanter, J. W., Schildcrout, J.S., & Kohlenberg, R. J. (in press).
1168. Thefrequencyandbenefitsofafocusontheclient-therapistrela-
Hiroto,D.S.,&Seligman,M.E.P.(1975). Generalityoflearned tionshipincognitivetherapyfordepression. PsychotherapyRe-
helplessnessinman.Journalof PersonalityandSocialPsychol- search.
ogy,31,311-327. Kanter, J. W., Callaghan, G. M., Landes, S. J., Busch, A. M., &
Hoberman, H. M., & Clarke, G. N. (1993). Major depression in Brown, K. R. (2004). Behavior analytic conceptualization and
adults. InR.Ammerman&M.Hersen(Eds.),Handbookof be- treatmentofdepression:Traditionalmodelsandrecentadvances.
havior therapy with children and adults: A developmental and TheBehaviorAnalystToday,5(3),255-274.
longitudinalperspective(pp.73-90).Boston:Allyn&Bacon. Klein, D. C., & Seligman, M. E. P. (1976). Reversal of perfor-
Hoberman,H.M.,&Lewisohn,P.M.(1985).Thebehavioraltreat- mancedeficitsandperceptualdeficitsinlearnedhelplessnessand
ment of depression. In E. E. Beckham & W. R. Levers (Eds.), depression.Journalof AbnormalPsychology,85,11-26.
Handbook of depression: Treatment, assessment, and research Kessler,R.C.(1997).Theeffectsofstressfullifeeventsondepres-
(pp.39-81).Homewood,IL:DorseyPress. sion.AnnualReviewof Psychology,48,191-214.
Hollon, S. D. (2001). Behavioral activation treatment for depres- Kohlenberg, R.J., Kanter, J.W., Bolling, M.Y., Parker, C.R., &
sion: Acommentary. ClinicalPsychology: Science&Practice, Tsai, M. (2002). Enhancing Cognitive Therapy for Depression
8,271-274. with Functional Analytic Psychotherapy: Treatment guidelines
Hops,H.,Sherman,L.,&Biglan,A.(1990). Maternaldepression, andempiricalfindings.CognitiveandBehavioralPractice,9(3),
marital discord, and children's behavior: A developmental per- 213-229.
spective. InG.R.Patterson(Ed.),Depressionandaggressionin Kohlenberg, Boiling, Kanter & Parker (2002) Clinical Behavior
familyinteraction(pp.185-208).Hillsdale,NJ:Erlbaum. Analysis:WhereItWentWrong,HowItWasMadeGoodAgain,
13
TOWARDACOMPREHENSIVEFUNCTIONALANALYSISOFDEPRESSIVEBEHAVIOR
andWhyItsFutureisSoBright. TheBehaviorAnalystToday,3 NewYork:Guilford.
(3),248-250. Reigler,H.C.,&Baer,D.M.(1989). Adevelopmentalanalysisof
Koerner,K.,Kohlenberg,R.J.,&Parker,C.R.(1996). Diagnosis rule-following.InH.W.Reese(Ed.),Advancesinchilddevelop-
ofpersonalitydisorder:Aradicalbehavioralalternative.Journal mentandbehavior(Vol.21,pp.191-219).NewYork:Academic
of ConsultingandClinicalPsychology,64(6),1-8. Press.
Lazurus,R.S.,&Folkman,S.(1984). Stress,appraisal,andcop- Rosales-Ruiz,J.,&Baer,D.M.(1997).Behavioralcusps:Adevel-
ing.NewYork:Springer. opmentalandpragmaticconceptforbehavioranalysis. Journal
Lewisohn,P.M.(1974). Abehavioralapproachtothetreatmentof of AppliedBehaviorAnalysis,30,533-544.
depression. InR.M.Freidman&M.M.Katz(Eds.) Thepsy- Roth, S., & Kubal, L. (1975). The effects of noncontingent re-
chologyof depression: Contemporarytheoryandresearch(pp. inforcement on tasks of differing importance: Facilitation and
157-185).NewYork:Wiley. learnedhelplessnesseffects. Journalof Personalityand Social
Lewinsohn, P. M. (1975). The behavioral study and treatment of Psychology,32,680-691.
depression. InM.Hersen, R.M.Eisler, &P.M.Miller(Eds.), Rutter,M.(1991). Agechangesindepressivedisorders: Somede-
Progressinbehaviormodification.NewYork:Academic. velopmentalconsiderations. InJ.Garber&K.ADodge(Eds.),
Lewinsohn, P. M., Clarke, G. N., & Hops, H. (1990). Cognitive- Thedevelopmentof emotionalregulationanddysregulation.(pp.
behavioraltreatmentfordepressedadolescents. BehaviorTher- 273-300).NewYork:CambridgeUniversityPress.
apy,21(4),385-401. Schmale,A.H.(1973). Adaptiveroleofdepressioninhealthand
Linehan,M.M.(1993).Cognitive-behavioraltreatmentof border- disease. InJ.P.Scott&E.C.Seney(Eds.),Separationandde-
linepersonalitydisorder.NewYork:GuilfordPress. pression:Clinicalandresearchaspects(pp.187-214).Washing-
ton,DC:AmericanAssociationfortheAdvancementofScience.
Martell, C. R., Addis, M. E., & Jacobson, N. S. (2001). Depres-
sioninContext: Strategiesforguidedaction. NewYork: W.W. Sheeber, L., & Sorensen, S. (1998). Family relationships of de-
Norton. pressed adolescents: a multi- method assessment. Journal of
ClinicalChildPsychology,27,268-277.
Malott,R.W.(1981).Notesfromaradicalbehaviorist.Kalamazoo,
MI:Author. Seligman,M.E.P.(1975). Helplessness: Ondepression,develop-
ment,anddeath.SanFrancisco:W.H.Freeman.
McAuliffe, D., Barnes-Holmes, D., & Barnes-Homes, Y. (2004).
Excessive rule-following and depressive symptomology. In Shmagin,B.G.,Pearlmutter,D.R.(1977).Thepursuitofunhappi-
Smyth, S. (Chair), Acceptance and commitment therapy: Core ness:Thesecondarygainsofdepression.PerspectivesinPsychi-
principles and measures. Symposium presented at the annual atricCare,15(2),63-65.
meetingoftheAssociationforBehaviorAnalysis,NewOrleans, Skinner, B. F. (1953). Science and human behavior. New York:
LA. Mcmillian. Skinner, B.F.(1957). Verbalbehavior. NewYork:
Miller,T.W(Ed.). Clinicaldisordersandstressfullifeevents. CT: Appleton-Century-Croft.
InternationalUniversitiesPress. Skinner,B.F.(1966).Anoperantanalysisofproblemsolving.InB.
Nezu,A.M.(2004). Problemsolvingandbehaviortherapyrevis- F.Skinner(Ed.),Contingenciesof Reinforcement: Atheoretical
ited.BehaviorTherapy,35(1),1-33. analysis.NewYork:Appleton-Century-Croft.
Overmier,J.B.,&Seligman,M.E.P.(1967).Effectsofinescapable Skinner,B.F.(1986). Whatiswrongwithdailylifeinthewestern
shockuponsubsequentescapeandavoidanceresponding. Jour- world?AmericanPsychologist,41,568-574.
nalof ComparativeandPhysiologicalPsychology,63(1),28-33. Skinner,B.F.(1989). Thelistener. InB.F.Skinner's(Ed.),Recent
Romano,J.M.,Jensen,M.P.,Turner,J.Good,A.B.,&Hops,H. issuesintheanalysisof behavior(pp. 35-47). Columbus,OH:
(2000). Chronicpainpatient-partnerinteractions: Furthersup- Merrill.
portforabehavioralmodelofchronicpain. BehaviorTherapy, Skinner,B.F.(1992). VerbalBehavior. Action,MA:CopleyPub-
31(3),415-440 lishing.
Poppen,R.L.(1989). Someclinicalimplicationsofrule-governed Stafford,D.,&Branch,M.(1998). Effectsofstepsizeandbreak
behavior. InS.C.Hayes(Ed.),Rule-GovernedBehavior: Cog- pointcriteriononprogressiveratioperformance. Journalof the
nition, Contingencies, and Instructional Control. Reno, NV: ExperimentalAnalysisof Behavior,70,123-138.
ContextPress. Wilson, K. G., Hayes, S. C., Gregg, J. & Zettle, R. (2001). Psy-
Paykel,E.S.(Ed.). (1982). Handbookof affectivedisorders. New chopathologyandpsychotherapy. InS.C.Hayes&D.Barnes-
York: Guilford. Rehm, L. P. (1977). A self-control model of Holmes(Eds.), Relationalframetheory: Apost-Skinnerianac-
depression.BehaviorTherapy,8,787-804. count of human language and cognition (pp. 211-237). New
Rehm, L. P. (1979). A comparison of self-control and assertion York:KluwerAcademic/Plenum.
skills treatments of depression. Behavior Therapy, 10(4), 429- Wortman,C.B.,&Brehm,J.W.(1975). Responsestouncontrol-
442. lable outcomes: An integration of the reactance theory and the
Rehm, L. P. (1988). Self-management and cognitive processes in learnedhelplessnessmodel. InL.Berkowitz(Ed.),Advancesin
depression. InL.B.Alloy(Ed.),Cognitiveprocessesindepres- SocialPsychology.NewYork:AcademicPress.
sion.NewYork:Guilford. Youngren,M.A.,&Lewinsohn,P.M.(1980). Thefunctionalrela-
Rehm,L.P.(1989). Behavioralmodelsofanxietyanddepression. tionbetweendepressionandproblematicinterpersonalbehavior.
In P. C. Kendall & D. Watson (Eds.), Anxiety and depression: Journalof AbnormalPsychology,89,333-341.
Distinctiveandoverlappingfeatures.NewYork:Academic. Zettle, R. D., & Hayes, S. C. (1982). Rule governed behavior:
Rehm,L.P.,&Rokke,P.(1988).Self-managementtherapies.InK. A potential framework for cognitive-behavior therapy. In P. C.
S.Dobson(Ed.),Handbookof Cognitive-BehavioralTherapies. Kendall (Ed.), Advances in cognitive-behavioral research and
14
KANTER,CAUTILLI,BUSCH,&BARUCH
therapy(Vol.2,pp.73-119).NewYork:AcademicPress. Fax: [phone]
Zettle,R.D.,&Hayes,S.C.(1986).Dysfunctionalcontrolbyclient E-mail: [email protected]
verbalbehavior: Thecontextofreasongiving. TheAnalysisof
VerbalBehavior,45,438-445. JosephCautilli
Zettle,R.D.,&Rains,J.C.(1989).Groupcognitiveandcontextual ChildrenCrisisTreatmentCenter
therapies in treatment of depression. Journal of Clinical Psy- 1823Callowill
chology,45,438-445. Philadelphia,Pa. 19130
[email protected]
AUTHORCONTACTINFORMATION AndrewM.Busch/DavidE.Baruch
UniversityofWisconsin-Milwaukee
DepartmentofPsychology
JonathanW.Kanter,Ph.D.
P.O.Box413
UniversityofWisconsin-Milwaukee
Milwaukee,WI53211
DepartmentofPsychology
Phone: [phone]
P.O.Box413
Fax: [phone]
Milwaukee,WI53211
Phone: [phone]