Laura C. Rusch

Depression self-stigma: a new measure and preliminary findings.

It is widely recognized that stigmatization of mental disorders leads stigmatized individuals to avoid treatment altogether or discontinue treatment prematurely. Literature suggests that the impact of stigma may differ by diagnosis; however, previous attempts to measure self-stigma have not been disorder specific. This study sought to develop the Depression Self-Stigma Scale (DSSS) and identify distinct constructs associated with depression self-stigma. Items for the initial administration of the DSSS were developed through careful review of existing measures and the literature on stigma and depression. Items were administered to undergraduates and community members with self-reported depression (N = 391). Results indicated 5 factors (general self-stigma, secrecy, public stigma, treatment stigma, and stigmatizing experiences) with good factor structure, internal consistency, and evidence for construct validity.

Initial Outcomes of a Culturally Adapted Behavioral Activation for Latinas Diagnosed With Depression at a Community Clinic

Latinos demonstrate high rates of depression, often do not seek treatment, and terminate prematurely for a variety of reasons, including lack of sensitivity to contextual and cultural factors in treatment approaches. For decades researchers have suggested a behavioral approach to Latinos diagnosed with depression because such an approach targets the complex environmental stressors experienced by these populations with a simple, pragmatic approach. Recently, behavioral activation has been culturally and linguistically adapted for Latinos/Latinas diagnosed with depression (BA-Latino or BAL). The current study consists of a pilot evaluation of BAL at a bilingual (Spanish—English) community mental health clinic (N = 10 Latinas). Results provide preliminary support for the feasibility and effectiveness of BAL for Latinas in a community setting in terms of treatment adherence, retention, and outcomes. Implications and future directions are discussed.

The Impact of In Our Own Voice on Stigma

The stigma of mental disorders is a major public health concern and the development of effective stigma reduction programs has become a priority. This study examined the effectiveness of In Our Own Voice (IOOV), a stigma reduction program offered by the National Alliance on Mental Illness (NAMI), compared to psychoeducation. The presentations focused on bipolar disorder and to evaluate the specificity of effects, measures of stigma related to bipolar disorder, unipolar depression, schizophrenia, and general mental illness were included. Participants were 43 undergraduates exposed to both IOOV and psychoeducation in a randomly assigned, crossover design reversing the order of exposure. The IOOV presentation significantly decreased stigma for bipolar disorder compared to psychoeducation regardless of order of exposure. Also, IOOV led to significant stigma reduction associated with unipolar depression and approached significant for general mental illness, but not schizophrenia. Possible mechanisms behind IOOVs effect include positive contact with individuals with mental disorders and greater stigma associated with biomedical models of mental disorders emphasized in the psychoeducation condition. Suggestions for future research include evaluating IOOV for other disorders and examining the stability of effects over time.

Making Behavioral Activation More Behavioral.

Behavioral Activation, an efficacious treatment for depression, presents a behavioral theory of depression—emphasizing the need for clients to contact positive reinforcement—and a set of therapeutic techniques—emphasizing provision of instructions rather than therapeutic provision of reinforcement. An integration of Behavioral Activation with another behavioral treatment, Functional Analytic Psychotherapy, addresses this mismatch. Functional Analytic Psychotherapy provides a process for the therapeutic provision of immediate and natural reinforcement. This article presents this integration and offers theoretical and practical therapist guidelines on its application. Although the integration is largely theoretical, empirical data are presented in its support when available. The article ends with a discussion of future research directions.

A comparison of contextual and biomedical models of stigma reduction for depression with a nonclinical undergraduate sample.

Stigma reduction programs are dominated by a biomedical model that presents depression as a medical illness. Alternately, a contextual model emphasizes that one should not be blamed for environmental influences. This study compared biomedical, contextual, and control stigma reduction programs to each other and to a no-program control. The main hypotheses were that the contextual program would have the greatest impact and that a match between participants’ beliefs about depression and the model presented would moderate this effect. Seventy-four participants were randomized to the 3 programs and 12 participants served as a no-program control. The contextual and control programs reduced stigma significantly compared with the no-program control, whereas the biomedical program did not. Beliefs about depression moderated this effect only for the biomedical condition. Contextual and control programs seem to be effective but a biomedical model may be risky for those who disagree with the model. Theoretical implications are discussed.

Lines of Evidence in Support of FAP

What empirical evidence supports FAP? On the one hand, FAP is based on a handful of basic behavioral principles that were theoretically and empirically derived from decades of laboratory experimentation. On the other, FAP has yet to be tested in a randomized controlled trial. Our belief is that the basic tenets of FAP—namely the importance of the therapeutic relationship and the use of natural reinforcement to shape client problems when they occur naturally in the therapeutic relationship—are robust, and lines of evidence in support of these principles converge from multiple and diverse areas of research. In this chapter we review these lines of evidence. It should be clear from the outset, however, that this review by no means seeks to justify the paucity of direct empirical evidence in support of FAP. Rather, we believe that the findings of this review strongly suggest that additional empirical research specifically investigating the efficacy of FAP is warranted, as it was developed from a solid foundation of principles and evidence and represents a convergence of some of the most robust findings in psychological research. While FAP is a therapy based on behavior analytic principles, at its heart it is an interpersonal therapy. FAP is based on the assumption that both the causes of, and treatment for, psychopathology are intimately related to interpersonal relationships. This assumption has substantial support in the literature with respect to depressive disorders. It is well established that interpersonal problems, troubled relationships, and lack of social support predict the onset (Stice, Ragan, & Randall, 2004), course (Lara, Leader, & Klein, 1997; Miller et al., 1992), duration (Brown & Moran, 1994) and relapse of depression (Hooley & Teasdale, 1989). Conversely, the presence of social support has protective effects (Peirce, Frone, Russell, Cooper, M Sherboume, Hays, & Wells, 1995). While several alternative therapies focus on the therapeutic relationship and associated processes, FAP utilizes basic learning principles to harness the therapist-client relationship, focusing on the establishment of a more effective

Integrating Functional Analytic Psychotherapy and Behavioral Activation for the Treatment of Relationship Distress

The following case study demonstrates the potential for an integrated behavioral treatment to improve interpersonal functioning, specifically within a romantic relationship. This integrated treatment utilizes strategies from both Functional Analytic Psychotherapy (FAP) and Behavioral Activation (BA), and thus is termed FAP-Enhanced BA (FEBA). This case study represents an initial attempt to apply FEBA to a 22-year-old female undergraduate, Megan, presenting with relationship distress. Megan and her partner both completed a pretreatment and posttreatment assessment that included self-report questionnaires in addition to a conflict-interaction task that was later coded for the presence of specific emotions. After the pretreatment assessment, Megan participated in 8 sessions of FEBA. Session-by-session descriptions and data will be presented, as well as data from the pretreatment and posttreatment assessments.

Behavioral Activation for Latinos With Depression

Latinos are the fastest-growing ethnic minority group in the United States and face great environmental challenges (e.g., unemployment, loss of social support networks, displacement, and disruption of the family) as well as prejudice and discrimination. These contextual factors are significant risk factors for Latino depression. A behavioral treatment for depression, behavioral activation (BA), may be particularly relevant in treating Latino depression because of its emphasis on contextual factors. This case study presents a cultural modification of BA for Latinos with depression. The treatment of a 25-year-old Latina illustrates a successful application. It suggests that, with some modifications, BA may be a suitable treatment for this population.

FAP and Behavioral Activation

Depression is at the same time extremely common and extremely serious. In fact, depression is one of the most frequent presenting problems in outpatient psychotherapy, was listed as the single most burdensome disease in the world by the World Health Organization (Murray & Lopez, 1996 ), creates significant economic costs at the societal level, and results in major functional impairment and distress for depressed persons and those close to them. Suicide, of course, is the ultimate cost. How may FAP be used specifically with clients who present with depression? On the one hand, Tsai et al. (2008) present a working FAP model for the clinician to use with clients exhibiting diverse diagnoses, including depression, and it is our hope and belief that such a model will be useful.