The only people who think they are smart enough to tell others what to do aren’t.
The chapter on psychotherapy concludes with an exemplar program to alleviate depression. As usual, it will not look like any of the stuff that passes for psychology in the media. What it lacks in drama it makes up for in effectiveness. The program is multifaceted, outcome oriented and well scripted.
from the book: Shadow Dancing on the Grave of Hope:
A Multi-Faceted, Data-Oriented Program to Decrease Depression
Depression, like most undesirable human conditions, has two parts. The first is feeling "lousy", "awful", "blue" and, in the extreme, suicidal. The second is a behavioral deficiency which means that behavior related to work, recreation, interpersonal relationships and household chores occurs less frequently than before. At the extreme of this decrease, the person may sit in pyjamas all day, staring. In one case of extreme depression, a client was advised by several psychiatrists that, since there was nothing organically wrong, it was "…up to you to snap out of it." I wonder how long one needs psychiatric training to formulate that treatment program? In these extreme cases, the depression "feeds upon itself" so that lack of activity produces a reduction in reinforcers which decreases activity further.
The forerunners of some depressive episodes are fairly easy to identify such the death of a loved one, loss of a job or loss of a relationship or worse, several things at the same time. In other situations, depression may be part of a manic-depressive cycle or a biological deficiency. Most frequently, depression is caused by environmental deficiencies such as loss of or lack of, reinforcers. For one person’s life, the following occurred in fairly rapid succession: He found he could not get employment in spite of having a doctorate in astrophysics. His wife became pregnant. He committed suicide shortly after his car broke down and needed replacement or extensive repair. He was under psychiatric care at the time and was taking anti-depressants. This is an extreme and depression usually doesn’t lead to suicide, although depression usually precedes suicide.
N.H. Azrin and a colleague, V.A. Besalel conducted an experiment to alleviate depression by simultaneously using a variety of data-based techniques. Their concept of depression is that it is "…an emotional state induced by a reduction of reinforcers, either real or apparent, which results in loss of the behaviors maintained by the reinforcers and generalizes to other behaviors as well."
The results were that the four different depression indexes of the 29 subjects in the experiment dropped, or in the case of goal attainment, increased, significantly during and after the average of 6.8 sessions of 1.5 hr each. For example, the percentage of time spent being unhappy was 56.5 at the beginning of treatment and 12.5 at the end. Goal attainment was 12% at the beginning and 87% at the end.
The program was intended to increase the number of positive events during the client’s day. The program consisted of 14 procedures designed to increase reinforcers or have the client think or say positive things about him\herself. These procedures consisted of: 1). Filling out a list of Desirable Attitudes which they possessed, such as "Caring about people.", 2). Listing the "…activities and events that were pleasant, meaningful or interesting to you in the past.", 3) Listing the Possible Pleasant Activities in which the person now engaged or would like to engage and rank them on a scale of 1-4., 4) Listing all the people the client liked., 5) Practicing making positive statements about him\herself using the qualities listed in 1)., 6) Keeping a daily and weekly schedule which kept track of the activities listed above., 7) Filling out a Traumatic Events List of events which were unlikely to occur such as "My house burned down." to use as events to induce behavioral contrast with the aversive events the person had experienced., 8) Listing nonaversive correlates of traumatic events such as not being stuck in a dead-end job because of being fired., 9) Positive interaction training which included training in giving compliments, showing appreciation and prompting appreciation from others., 10) Training in marital, vocation or educational skills. If the person were having marital problems, he\she would receive brief marital counseling. If the client had vocational problems, he\she would receive training in the Job Club format of finding a job. If the person had study problems, he\she was shown how to arrange and follow a study schedule., 11) Filling out a "Happiness Scale" which identified areas such as sex, communication and money which were sources of happiness or unhappiness. If the rating of an area were low, skill training was given for the specific problem., 12) When depression occurred, the attempting mood reversal by engaging in self-praise statements., 13) Establishing specific behavioral objectives such having a certain number of job interviews per day until a job resulted., 14) Using a reminder list to ensure that the client would engage in those aspects of the program relevant to him\her. During each session, the counselor reviewed what the client did during the preceding week and reviewed and role-played the procedures of the program.
The Azrin and Besalel procedure has attracted little attention although it fulfills many of the requirements of a superior program. It produced dramatic results, required all involved to be active throughout and used many different techniques simultaneously. It was scripted, time-dense, gave immediate, continuous feedback, was based on principles of learning, had the agility to adjust to individual circumstances, was integrated, contained techniques for transfer to the “real” world, and dealt directly with the problem. It should be replicated.
Azrin, N. H., & Besalel, V. A. (1981). An operant reinforcement method of treating depression. Journal of Behaviour Therapy and Experimental Psychiatry, 12(2), 145-151.
Cheerio and ttfn,
Grant Coulson
