Coping with Depression

Description of the Strategy

The World Health Organization cites unipolar depression as the most prevalent psychiatric condition currently in the world and predicts that it will become the second most significant cause of global psychiatric disease by 2020. Similar findings have been reported within American society, in that unipolar depression affects between 3% and 13% of Americans annually. It is estimated that between 20% and 55% of American adults will experience a lifetime incident of depression.

The Coping With Depression (CWD) course is based on social learning theory. Lewinsohn was the first to develop the behavioral treatment of depression, and the Coping With Depression course was the product of these efforts. The CWD course has been used to treat various populations and achieved consistent positive outcome in alleviating symptoms of depression.

Depression is assumed to occur when a psychosocial stressor disrupts important behavioral patterns of the individual. This disruption causes a reduction in the rate of response-contingent positive reinforcement. Positive reinforcement is assumed to be related to the availability of reinforcing events in the person's environment, the person's skills (interpersonal and cognitive), and to the person's ability to reverse the effects of the stressor. When the individual fails to reverse the negative balance of reinforcement, an increased self-awareness follows, which can lead to a negative self-evaluation and subsequent depressive state.

Another issue in the etiology of depressive symptoms is the fact that patients who suffer from depression tend to lack social skills, especially during the depressive episode. In addition, according to this model, the patient's familial environment and social networks may inadvertently reinforce depressive behavior by providing increased attention to negative behaviors, such as depressive talk and suicidal behaviors, and thus “maintain” the “depressed” behaviors.

An important part of the behavioral treatment of depression stems from the fact that depressed patients have low rates of engagement in pleasant activities. The DSM-IV recognizes this by listing a reduction in pleasurable activities as one of two primary criteria for a diagnosis of depression. Since mood covaries with rates of pleasant and aversive activities, mood improves with increases in pleasant activities and/or a reduction of aversive activities.

The CWD course is a psychoeducational intervention that can be delivered individually or in small groups and has become the most comprehensive behavioral treatment of depression. It focuses on teaching patients techniques and strategies through the extensive use of participant workbooks, a therapist manual, and homework assignments to learn new ways to cope with their depression. Specifically, the CWD course involves helping patients increase the frequency and quality of their engagement in pleasant activities and reduce the frequency of aversive events. The CWD course takes a “smorgasbord” approach to training patients in skills that are most directly related to their depression. The specific skills taught include relaxation, increasing pleasant activities, changing depressogenic cognitions, and social skills.

Treatment sessions are highly structured and use the text Control Your Depression, which was designed as a self-help manual. Reading assignments from this text are an integral component of the treatment approach. Studies have shown that clients do well with manuals (i.e., bibliotherapy) but many need the social facilitation and structure provided by the Coping With Depression course. A therapist manual provides session scripts, exercises (homework), and guidelines for the course of treatment. A Participant Workbook for the Coping With Depression Course provides the patient with the session syllabi and forms necessary to track and implement various aspects of treatment.

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