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Depression in Context: Strategies for Guided Action Christopher R. Martell, Michael E. Addis, and Neil S. Jacobson. New York: W.W. Norton (www.wwnorton.com). 2001, 224 pp. $32.00 (hardcover).
In 1996, Neil Jacobson and his colleagues published the results of a component analysis of Beck's Cognitive Therapy in the Journal of Consulting and Clinical Psychology (JCCP). Surprisingly, a pure Behavioral Activation (BA) approach was shown to be as effective in treating unipolar depression as BA plus self-statement modification as well as the complete cognitive therapy package. The authors concluded that: "Treating depression by helping to activate people is just as effective as helping them to change their thinking" (p. xxiii). In light of the large numbers of people suffering from depression for whom treatment is often difficult to access, a potential added virtue of BA is that its simplified focus would make it easier to disseminate than CT which requires more rigorous training. However, the BA used in the component analysis has since evolved into to a more complex treatment. "Depression in context" is the description of the current level of evolution of behavioral activation as a stand-alone treatment for depression.
Three parts follow the book's introductory chapter, which discusses the background behind the development of BA and a description of five assumptions of the BA approach. The highlights of this chapter include a review of the JCCP study and the emphasis of BA as a contextual approach to understanding and treating depression.
Part I is the theoretical and conceptual section of the book. The three chapters in this section provide an overview of the theory of BA. The purpose of Chapter 1 is to consider the assumptions of common approaches to depression in order to illustrate where BA departs from these approaches. The authors conclude that, while there is nothing wrong with a search for internal causes for depression, it might be worthwhile to look at an alternative perspective such as BA.
Chapter 2 elaborates in more detail on the theoretical and conceptual underpinnings of BA. The chapter begins by contrasting mechanistic versus contextual models of depression. The latter is the foundation for BA, which is designed to change how the individual interacts with the environment in order to increase the likelihood of encountering natural...