Annotated Bibliography R.F.

C.W. Lejuez, D.R. Hopko, J.P. LePage, S.D. Hopko and D.W. McNeil. “A Brief Behavioral Activation Treatment for Depression” Cognitive and Behavioral Practice (Spring 2001): 164-175. Web. 17 Feb. 2015. <>

The purpose of this article is to inform psychologists and other medical professionals of the potential benefits of using Behavioral Activation (BA) as a means of treating depression. BA is based on the matching law, similar to the law of effect, suggests that behavior is maintained by its consequences. Depressive behavior, which usually consists of a lack of activity, is systematically replaced with healthier, prosocial behaviors. These goal behaviors are categorized during behavioral therapy sessions from 1-5 based on the perceived difficulty for each individual participant. 1 being something that should be fairly easy for them to accomplish (e.g. doing the dishes, or taking a shower daily, etc.) to 5 which would be a very difficult for them (e.g. public interaction with strangers, exercising daily, etc.). This may not work for all forms of depression.

This source is reliable but complex because it is written by professionals and published in a journal. It may be slightly biased towards a behavioral approach to treatment but is relatively objective. It informs medical and psychological professionals that altering behavior, even slightly, can help people who suffer from depression. There are three case studies provided that show how individualized each treatment is in replacing depressive behavior with healthier alternatives, rather than just medicating it away and not dealing with the problems potential environmental root.

This fits my research because it shows a behavioral approach that can be effectively used by people to treat their symptoms of depression and take back control of their lives. While it may not work for everyone, it provides an alternative method to the norm of pharmacological depression treatment.

R.J. DeRubeis, G.J. Siegle and S.D. Hollon. “Cognitive therapy versus medication for depression: treatment outcomes and neural mechanisms” Nature Reviews Neuroscience (Oct. 2008): 788-796. Web. 17 Feb. 2015. <>

This article informs psychological and medical professionals that cognitive therapy (CT), a cognitive model based on the idea that repetitive negative thinking, associated with increased limbic activity and decreased activity in the prefrontal cortex, is a causal role in depression. When this maladaptive thinking is corrected the acute distress and the effects are more enduring. CT has been shown to be just as effective as antidepressant medications (ADM) at treating depression. CT also seems to reduce the risks of relapse after cessation of therapy, something that definitely can not be said about about ADM, the current standard of treatment that generally requires higher and higher doses to continue to be effective. These researchers hypothesize that CT and ADM engage similar neural mechanisms.

This source compares a cognitive approach to the traditional medication. The language is complex as it is written by and intended for neurologists and cognitive therapists. However they explain their ideas well enough that a layperson can figure it out their intent. It is reliable and relatively unbiased as it is published in a reputable journal and written by professionals. The purpose being to show their peers that CT can be just as effective, if not more so in some cases, than ADM.

It fits my research by showing a cognitive approach to depression reversal that has been shown to be just as effective and longer lasting than antidepressants in some cases. I will use it to show that ADM is not necessarily the best form of therapy for severe cases of depression.

R.J. DeRubeis, PhD; S.D. Hollon, PhD; J.D. Amsterdam, MD; R.C. Shelton, MD; P.R. Young, PhD; R.M. Salomon, MD; J.P. O’Reardon, MD; M.L. Lovett, MEd; M.M. Gladis, PhD; L.L. Brown, PhD; R. Gallop, PhD. “Cognitive Therapy vs Medications in the Treatment of Moderate to Severe Depression” Arch Gen Psychiatry (April 2005): 409-416. Web. 19 Feb. 2015. <>

This study was performed by two of the psychologists from the last Cognitive Therapy (CT) vs. Antidepressant medication (ADM) study. Although this one expands upon the last by adding a placebo as well as expanding their scope to 240 participants at two Universities (U of Pennsylvania and Vanderbilt U). These participants were also diagnosed with moderate to severe major depressive disorder (MDD). They were randomly assigned to one of the three treatment goups: CT, ADM, or placebo. The pharmacotherapy groups were double blind, neither the participants or the researchers knew who was receiving the ADM or placebo. The findings of this study did not support the current APA guideline that “most MDD patients will require medications” Instead it showed that CT can be just as effective (not more effective as claimed in the other study) as ADM if administered properly by a qualified professional.

This continues to expand upon the comparison of CT vs ADM with the addition of a placebo. As well as tapping into a larger, more severely depressed population. This study is extremely complex and loaded with statistical analysis and psych jargon that most people without a doctorate will not understand. That said the information is also extremely reliable having been tested even more intensely, with additional criteria (placebo, severe MDD), over a larger scale. The goal is to disprove the current APA guideline to immediately medicate severe MDD patients and show that CT has a comparable success rate.

This study will be used to strengthen and expand upon the former CT vs ADM study with the addition of the placebo and lager, more varied population. I am including it for the similar reasons, to show that therapy is comparable to medication. I will still primarily use the other study because it is easier to cite and understand in its entirety. Also to show that CT is not necessarily more effective as that study claims, at least with severely depressed patients.

S. Dimidjian, S.D. Hollon, K.S. Dobson, K.B. Schmaling, R.J. Kohlenberg, et al. “Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression.” Journal of Consulting and Clinical Psychology (August 2006): 658-670. Web. 20 Feb. 2015. <>

This study explains and expands specifically upon the use of behavioral activation (BA), which is usually combined with cognitive therapy (CT), then referred to as CBT (or sometimes confusingly just CT). Then compares the individual effectiveness of BA,CT and ADM respectively. They even suggest that the inclusion of BA is large part of the reason why the combined CBT is shown to be an equally effective treatment of major depression as ADM. According to this study CT alone is shown to be less effective than BA, ADM as well as the combined CBT.

This article is relatively current, being published in 2006. It strongly relates to the topic, not only comparing the combination of cognitive-behavioral therapies to pharmacological therapies but also separating the cognitive from the behavioral and comparing their efficacy also. The authority and accuracy is strong as it is published in a reputable journal of clinical psychology and written by doctors. The purpose is to inform clinical psychologists that BA may be used separately from the cognitive approach with similarly equal results to both the combined form of CBT as well as anti-depression meds.

This article will be used to further explain the behavioral activation method and compare it not only to antidepressant medications but also to the strictly cognitive methodology as well as the combined cognitive-behavioral approach. CBT is commonly found to be an equally effective therapy to ADM this article claims that the behavioral aspect of the CBT approach is the main reason why it is so effective.

N.S. Jacobson, C.R. Martell and S. Dimidjian. “Behavioral Activation Treatment for Depression: Returning to Contextual Roots.” Clinical Psychology: Science and Practice (Fall 2001): 255-270. Web. Feb. 21 2015. <>

This article delves deeply into the roots of the behavioral activation treatment (BA) for depression. BA was initially developed as a stand alone behavioral therapy by D’zurilla and Goldfried (1971) but it was eventually integrated as just a component of the overall CT package popularized by Beck, Rush, Shaw and Emery (1979). The CT package was designed to produce change in negative attitudes by analyzing and altering thoughts. Whereas the original pure behavioral approach however focused on training participants in five steps of problem solving: problem orientation, problem orientation and formulation, generation of alternatives, decision making and solution verification.

This source is a bit dated as far as a psych article is concerned, now being fourteen years old. Although since its primary function is to discuss the return to the historical roots of the practice this is not a huge problem. It is very relevant to my topic as it expands upon BA and the authority and accuracy are both there as it was written by professionals in the field and published in a reputable clinical psych journal. The purpose is to explain the history of the BA method and also to claim that it may be just as effective as the combined CBT approach, which has in turn been claimed to be equal (in some cases) to ADM.

As I am attempting to claim the equivocal effectiveness of behavioral approach as a treatment of depression this will be an essential source for my argument. It not only explains the history of the approach but also differentiates it from the commonly combined CT (or CBT) package, further claiming BA to be the main reason why the CT package is shown to be so effective in treating depression.

J.W. Kanter, R.C. Manos, W.M. Bowe, D.E. Baruch, A.M. Busch and L.C. Rusch. “What is Behavioral Activation?: A Review of the Empirical Literature.” Clinical Psychology Review (2010): 608-620. Web. Feb. 23 2015. <>

This article explains the empirical evidence supporting behavioral activation (BA) dating back to the 1970’s and attempts a systematic review of how BA has evolved over the years. It identifies and describes these specific treatment components of BA: activity monitoring, assessment of life goals and values, activity scheduling, skills training, relaxation training, contingency management, procedures targeting verbal behavior and procedures targeting avoidance. These are then reviewed, with their empirical support as both stand-alone treatments as well as components of larger treatment packages. They also discuss the possible future of BA.

This source is more recent than the last analyzation of BA, it was published in 2010. It is relevant to the research because it diseases the empirical evidence behind all of the different BA procedures and future directions the approach may take. Authority and accuracy are strong as it was accepted and published in a reputable psychology review journal. The purpose is to inform professionals of the empirical basis and evidence of the behavioral approach. This something that is difficult for cognitive therapies to prove as they attempts to alter thoughts, which are difficult to measure empirically. Whereas behaviors can be given a definition and accurately measured.

If not evident by now my research is leaning toward the behavioral approach as a potentially viable and equally effective form of therapy as the APA gold standard of antidepressant medication. This source explains the empirical evidence to support BA and also hypothesizes where BA will go in the future.

I. Elkin, R.D. Gibbons, M.T. Shea, S.M. Sotsky, J.T. Watkins, et al. “Initial Severity and Differential Treatment Outcome in the National Institute of Mental Health Treatment of Depression Collaborative Research Program.” Journal of Consulting and Clinical Psychology (October 1995): 841-847. Web. Feb. 23 2015. <>

This article compares initial severity and treatment outcome of a study performed in the mid-nineties (1994) by the National Institute of Mental Health (NIMH) on Treatment of Depression Collaborative Research Program (TDCRP). This study has been cited in a few of the previous articles as a study that disproves the efficacy of cognitive–behavior therapy (CBT) and interpersonal psychotherapy (IPT) versus antidepressant medication (ADM), in this case imipramine plus clinical management (IMI-CM), and the control group of placebo plus clinical management (PLA-CM). This study claims to prove that IMI-CM shows the fastest, most significant and longest lasting reduction of depressive symptoms in the initially severely depressed population.

This study is a bit outdated, being published in 1995, and based on the TDCRP study published by NIMH in 1994 but it is still used as an argument in favor of the efficacy of ADM over the use of behavioral or cognitive forms of depression therapy. The source is very reliable having been based on the findings of a study done by the NIMH and published in a reputable clinical psychology journal. The purpose of the article is to inform clinical psychologists of the most effective treatments for the different severities of depression.

This will mainly be used to show the pro-medication counter-argument and reduce the bias of the research project . The study this article is based on is commonly cited by many psychologist to disprove the equal effectiveness of cognitive-behavioral therapies in the treatment of severely depressed patients.

Annotated Bibliography Peer Review R.F.

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