Status: Strong Research Support


A central assumption of most behavioral therapies for depression is that this disorder is associated with problematic behavior-environmental relationships. These therapies are based on early behavioral social learning theories of depression (e.g., Ferster 1973, 1981; Lewinsohn, 1974). According to these theories, depression is associated with low levels of positive reinforcement and high levels of aversive control, which can be due to problems in the environment or to skill deficits. When people get depressed, they increasingly withdraw from their environment, engage in escape behaviors, and disengage from their routines. Over time, this avoidance exacerbates depressed mood, as individuals lose opportunities to be positively reinforced through experiences, social activity, or experiences of mastery. Behavior therapies focus on increasing the frequency and quality of pleasant activities, increasing one’s sense of mastery, decreasing aversive consequences, and improving mood. Behavior therapies usually involve techniques such as activity scheduling, ongoing monitoring of pleasant activities and feelings of mastery, gradual exposure to more challenging activities, and if needed, social skills and self-control training (e.g., Rehm, 1977).

A number of therapies for depression have grown out of this behavioral tradition. The Coping with Depression Course (Antonuccio, 1998; Lewinsohn, Youngren, & Zeiss, A. Z., 1992) is a psychoeducational group that includes behavioral and cognitive skills training. Muñoz and colleagues have developed programs for low-income and minority populations, such as the Reality Management group (Muñoz, Ippen, Rao, &. Dwyer,2000), which builds on behavioral principles and also includes cognitive and interpersonal components. These manuals are available in Spanish. Behavioral Activation (BA) is the most recent iteration of these early behavioral therapies. BA increases activation systematically with graded exercises to increase the patient’s contact with sources of reward, identify processes that inhibit activation, teach skills to solve life problems, and improve one’s life context (Martell, Addis, & Jacobson, 2001). BA does not include cognitive components. A version of behavioral activation has also been applied to a depressed inpatient sample in an initial pilot study (Hopko, LeJuez, LePage, Hopko, & McNeil, 2003). Cognitive-Behavioral Therapy for Late Life Depression applies behavioral principles to geriatric depression (Thompson, Gallagher-Thompson, & Dick, 1995, Revised, 2005) and also includes some cognitive components.


Key References (in reverse chronological order)

  • Coffman, S. J., Martell, C. R., Dimidjian, S., Gallop, R., & Hollon, S. D. (2007) Extreme nonresponse in cognitive therapy: Can behavioral activation succeed where cognitive therapy fails? Journal of Consulting and Clinical Psychology, 75, 531-541.
  • Cuipers, P., van Straten, A., & Warmerdam, L. (2007). Behavioral activation treatments of depression: A meta-analysis. Clinical Psychology Review, 27, 318-326 (also includes review of Coping with Depression course).
  • Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., et al. (2006). 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, 74, 638-670.
  • Areán, P. A., Gum. A., McCulloch, C. E., Bostrom, A., Gallagher-Thompson, D., & Thompson, L. (2005). Treatment of depression in low-income older adults. Psychology and Aging, 20, 601-609.
  • Kuehner, C. (2005). An evaluation of the “Coping with Depression Course” for relapse prevention with unipolar depressed patients. Psychotherapy and Psychosomatics, 74, 254-259.
  • Miranda, J., Bernal, G., Lau, A., Kohn, L., Hwang, W., & LaFromboise, T. (2005). State of the science on psychosocial interventions for ethnic minorities. Annual Review of Clinical Psychology, 1, 113-142.
  • Scogin, F, Welsh, D., Hanson, A. Stump, J. & Coates, A. (2005). Evidence-based psychotherapies for depression in older adults. Clinical Psychology: Science and Practice, 12, 222-237.
  • Hopko, D. R., Lejuez, C. W., Lepage, J. P., Hopko, S. D., & McNeil, D. W. (2003). A brief behavioral activation treatment for depression: A randomized pilot trial within an inpatient psychiatric hospital. Behavior Modification, 27, 458-469.
  • Hollon, S. D., Thase, M. E., & Markowitz, J. C. (2002). Treatment and prevention of depression. Psychological Science in the Public Interest, 3, 39-77 (review article).
  • Cuijpers, P. (1998). A psychoeducational approach to the treatment of depression: a meta-analysis of Lewinsohn’s “Coping with Depression” course, Behavior Therapy, 29, 521-533.
  • 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., Traux, P.A., Addis, M.E., Koerner, K., Gollan, E., et al. (1996). A component analysis of cognitive-behavioral treatment for depression. Journal of Consulting and Clinical Psychology, 64, 293-304.


Clinical Resources

Coping with Depression and Reality Management
  • Muñoz, R. F., & Mendelson, T. (2005). Toward evidence-based interventions for diverse populations: The San Francisco General Hospital prevention and treatment manuals. Journal of Consulting and Clinical Psychology, 73, 790-799.
  • Manuals available at (these programs include cognitive and behavioral components).
  • Muñoz, R.F., Ippen, C. G., Rao, S. Le, H. Dwyer. E. V. (2000). Manual for group cognitive-behavioral therapy for major depression: A reality management approach. Manuals and clinical resources
  • Antonuccio, D.O. (1998). The coping with depression course: A behavioral treatment for depression. The Clinical Psychologist, 51 (3), 3-5.
  • Lewinsohn, P. M., Youngren, M. A., & Zeiss, A. Z. (1992). Control your depression. New York: Fireside.
Behavioral Activation
  • Martell, C. R., Addis, M. E., & Jacobson, N. S. (2001) Depression in context: Strategies for guided action. NY: Norton
  • Jacobson, N. S., Martell, C. R. & Dimidjian, (2001) Behavioral Activation Treatment for Depression: Returning to contextual roots. Clinical Psychology: Science & Practice, 8, 225-270.
Self-Management Therapy
  • Rehm, L.P. (1984). Self-management therapy for depression. Advances in Behaviour Research and Therapy, 6, 83-98.
Cognitive-Behavioral Therapy for Late Life Depression
  • Thompson, L. W., Gallagher-Thompson, D., & Dick, L. P. (1995, Revised, 2005). Cognitive-Behavioral Therapy for late life depression: A therapist manual. Palo Alto, CA: Older Adult and Familty Center, Veterns Affairs Palo Alto Health Care System.
  • Dick, L. P., Gallagher-Thompson, D., Coon, D. W., Powers, D. V., & Thompson, L. W. (1995, Revised 2005). Cognitive-Behavioral Therapy for late life depression: A client manual. Palo Alto, CA: Older Adult and Family Center, Veterans Affairs Palo Alto Health Care System. (includes behavioral and cognitive components) Manual


Training Opportunities

Coping with Depression and Reality Management

Training in the various versions of the Coping With Depression Course is offered by Dr. Lewinsohn and his current staff at:
Oregon Research Institute
1715 Franklin Blvd.
Eugene, OR 97403-1983
Phone: (503) 484-2123

Manuals and training opportunities for the programs of Muñoz and colleagues can be obtained at:

Behavioral Activation

Online training opportunities can be found at the Behavioral Technology Research, Inc. website.

Cognitive-Behavioral Therapy for Late Life Depression

Please contact: Dr. Dolores Gallagher-Thompson or Dr. Larry W. Thompson
Co-Direcectors, Older Adult Center (mail code: 182C/MP)
VA Palo Alto Health Care System
795 Willow Rd.
Menlo Park, CA 94025