Skinner’s Theory: A Basis for the Treatment of Depression
Skinner’s behavioral theory has given rise to some criticisms as a result of his disagreement with the role of free will and such intrapersonal factors as thoughts, cognitions, and instinctive needs in motivating human behavior. However, his theory of operant conditioning has had a great impact on various disciplines in natural and social sciences. One important domain in which his theory has been applied in the last few decades is the treatment of depression. Despite the long-standing assumption that psychological interventions such as cognitive and behavioral strategies would yield better outcomes when combined with pharmacotherapy, recent findings from relevant research have suggested otherwise.
According to the operant conditioning, a behavior is more likely to recur if its consequence (1) generates pleasure (positive reinforcement) or (2) removes an aversive state (negative reinforcement). In contrast, a behavior is less likely to recur if it leads to (i) undesirable consequences or (ii) removes a pleasant state (punishment) (Skinner, 1938). On this basis, Ferster (1973) and Lewinsohn (1974) developed their behavioral model of depression. They emphasized that depression develops as a result of maladaptive transactions between the individual and the environment. In other words, when the environment becomes less rewarding and more punishing, the individual gets depressed. To avoid these aversive stimuli, they withdraw themselves from the environment. For example, a person who works in a stressful environment might want to excuse himself from work in order to avoid the hassles and criticisms of his boss (Dimidjian et al., 2006)
This behavioral model gave rise to the development of new effective treatment modalities for depression. For example, a component analysis of cognitive therapy (CT) which aimed to identify the causally active ingredients of cognitive therapy for depression indicated that the behavioral component alone was as effective as the full CT package (Jacobson et al., 1996). This study compared three conditions: (a) behavioral activation (BA) only, (b) behavioral activation plus cognitive restructuring focused on automatic thoughts, and (c) the full cognitive therapy package, including behavioral activation and cognitive restructuring focused on automatic thoughts and core beliefs. The dominant assumption at the time was that the full cognitive therapy package would outperform the component conditions (Jacobson & Gortner 2000). Surprisingly, however, behavioral activation only, performed as well as the full cognitive therapy package. This lack of significant differences held true not only for the treatment of acute major depression (Jacobson et al. 1996) but also for the prevention of relapse over a two-year follow-up period (Gortner, Gollan, Dobson, & Jacobson, 1998; Dimidjian et al., 2006; Jacobson et al., 1996). They defined (BA) as a structured, brief psychotherapeutic approach that aims to (a) increase engagement in adaptive activities (which often are those associated with the experience of pleasure or mastery) and (b) decrease engagement in activities that maintain depression or increase risk for depression and (c) solve problems that limit access to reward or that increase aversive control.
To sum up, these findings (1) provided further evidence for behaviorists, who had long questioned whether the cognitive strategies in cognitive– behavioral therapies were necessary to its success (Jacobson, Martell, & Dimidjian, 2001) and (2) created more interest in purely behavioral treatments for depression (Martell, Addis, & Jacobson, 2001). Ferster (1973) and Lewinsohn (1974), identified the link between avoidant behavior and depression and recommended activation strategies to mitigate punishment and enhance positive reinforcement (Rehm, 1977). Research on CT has highlighted the value of behavioral approaches, suggesting that a focus on creating cognitive changes about interpersonal relationships was associated with worse functioning after CT, whereas a focus on creating actual interpersonal change was associated with improvement (Dimidjian et al., 2006).
In conclusion, it must be noted that skinner’s theory has had a great contribution to various disciplines, especially psychology. The recent findings that BA is as efficacious as antidepressant medication (ADM) and the full CT package in treatment of depression, indicates the importance of operant conditioning in human behavior. The finding that BA activation was as effective as BA combined with cognitive restructuring, is consistent with Skinner’s emphasis on the role of behavioral motivations rather than insights, cognitions and instinctive needs in human activities.
Dimidjian, S., Hollon, S. D., Dobson, K. S., et al. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. J Consult Clin Psychol., 74(4), 658-670.
Ferster, C. B. (1973). A functional analysis of depression. Am. Psychol. 28, 857–70.
Gortner, E. T., Gollan, J. K., Dobson, K. S., & Jacobson, N. S. (1998).Cognitive– behavioral treatment for depression: Relapse prevention.Journal of Consulting and Clinical Psychology, 66, 377–384.
Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K.,Gollan, J. K., et al. (1996). A component analysis of cognitive– behavioral treatment for depression. Journal of Consulting and Clinical Psychology, 64, 295–304.
Jacobson, N. S., Gortner, E.T. (2000). Can depression be de-medicalized in the 21st century: scientific revolutions, counter-revolutions and the magnetic field of normal science. Behav. Res. Ther. 38, 103–17.
Lewinsohn, P. M. (1974). A behavioral approach to depression. In R. J. Friedman & Katz, M. (Eds.), The psychology of depression: Contemporary theory and research (pp. 157–178). Oxford, England: Wiley.
Martell, C. R., Addis, M. E., & Jacobson, N. S. (2001). Depression in context: Strategies for guided action. New York: Norton.
Rehm, L. (1977). A self-control model of depression. Behavior Therapy, 8, 787–804.
Skinner, B. F. (1938). The behavior of organisms.An experimental analysis. New York: Appleton-Century.
Williams, J. B. (1988). A structured interview guide for the Hamilton Depression Rating Scale. Archives of General Psychiatry, 45, 742–747.