Major Depressive Disorder – also referred to as Major Depression, or simply Depression – is a common mood disorder that has been reported as affecting at least 1 in 7 individuals at some point in their life (Kessler, Berglund, Demler 2003:186). This paper will outline specifically what Major Depressive Disorder (MDD) is – as defined by the DSM V – using the Behavioural Approach to explain how it develops & maintains in an individual. The behavioural approach has been used in favour of other theories, as it lends itself best to measuring the relative success of different treatment methods. The efficacy of behavioural activation treatment will then be examined against other prevailing treatment methods – namely cognitive-based, and medication based therapies – with an examination of empirical data used to show which method of treatment has the most efficacy in treating depression.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V) is the foremost publication available for defining mental illnesses. Key components of a MDD diagnosis include, but are not limited to: depressed mood, diminished interest in activities, significant weight change, Insomnia, agitation, loss of energy, feelings of worthlessness or excessive guilt, diminished ability or concentrate, and suicidal ideations. A number of these symptoms need to be observable within a two-week period, cause significant impairment in everyday functioning, and not be attributable to the effects of a substance, or another medical condition (American Psychiatric Association: 2013:1).
The behavioural approach has been chosen to describe how depression develops, and is maintained, as from the DSM V it is evident that observable behavioural change lies at the crux of identifying the illness . Its applicability to depression, was first posited by Ferster (1973), who established a model of depression where activities function as avoidance and escape from aversive thoughts, feelings or external situations. Lewinsohn, then ascribed the term depression to a distinct set of traits: “verbal statements of dysphoria, self-depreciation, guilt, material burden, social isolation, somatic complaints, and a reduced rate of several behaviours. (Lewinsohn 1974 :150). These observable traits lend themselves towards the symptoms listed in the DSM V today, highlighting the need to be able to measure behavioural change in order to diagnose MDD.
There are three primary treatment options considered for people with MDD. The most common form of treatment is Antidepressant medications (ADMs) (Olfson et al. 2002) cited in (Jacobson et al. 2001, p. 659) which seek to balance the chemicals in the brain that affect mood and emotion. Non-medicinal approaches to treatment come in the form of psychotherapy, with Cognitive therapy (CT) and Behavioural Activation (BA) seen as the most common forms of treatment. CT looks at behavioural dysfunction, combined with negative thinking, cognitive distortions, and dysfunctional beliefs (Jacobson et al. 2001, p. 660) which are underscored by the depressive state. The BA model focuses solely on the interrelationship between mood and activity.