1. Outline

Gray (1987) proposed the ‘Behavioral Inhibition System (BIS)’ and the ‘Behavioral Activation System (BAS)’ which are concepts that explain an individual’s natural temperamental characteristics.

• AS is a system that makes individuals sensitive to clues related to compensation and makes individuals act in pursuit of the positive results they want.

  This system has been reported to be deeply related to the catecholamine system of the brain, especially the dopamine pathway (Garver & White, 1994).

• On the other hand, BIS is a system that inhibits behavior to avoid negative or painful consequences by making people sensitive to clues related to punishment.

  This system is deeply related to the brain’s shock hippocampal system and the centripetal monoamine system from the brainstem, especially the serotonin pathway involved in this system (Gyohyeon Kim et al., 2001; Carver & White, 1994).

2. Depression and Behavior Activation

Recently, the multi-level theory of depression has been proposed, breaking away from the basic model that depression is simply caused by negative perception.

This theory is a concept that the core belief we used to talk about, in other words, contains not only just recognition but also sensory, physical, emotional, and situational conditional information.

Teasdale is called a schematic model, and Beck is called a mode.

This means that a depression mode is latent inside an individual, and when it is activated, the depression mode works and dysfunctionally responds to the surrounding situation.

The theory is that the activation of this mode of depression creates hot effect-laden cognition, and the individual’s coping method reinforces it again, forming a solid ring of a vicious cycle.

(1) Behavior Activation

• The term “Behavior Activation” first appeared in a paper by Hollon and Garber (1990), defined as “a series of clinical procedures used in cognitive therapy for depression.“

  Subsequently, Jacobson et al. (1996) presented the concept of Behavior Activation by explaining the behavioral intervention that was the focus of the cognitive therapy factor analysis study, while Lejuez, Hopko, Lepage, Hopko and McNeil (2001) explained Behavior Activation as a sole treatment of depression.

• Behavioral Activation (BA) is a structural and short-term psychological approach that has recently been suggested as a strong therapeutic alternative to depression (Dobson et al., 2008).

  In addition to the evidence for the effectiveness of Behavioral Activation, the cost-efficiency strengths of applying them to local communities or clinical practice have been revealed (Ekers, Dawson, & Bailey, 2013).

  In foreign countries, a number of studies have been conducted to verify the effectiveness of behavioral activation of depression, including large-scale studies (e.g. Dimidjian et al., 2006; Dobson et al., 2008; Kawrisak, Nicholas, & Hopko, 2009; Jacobson et al., 1996).

  A study that meta-analyzed the accumulated research results reported that behavioral activation treatment has a moderate or higher effect size (e. Cuijpers, Van Straten, & Warmerdam, 2007; Eker et al., 2014; Mazzucchelli, Kane, & Rees, 2009)

• Martell proposes a TRAP/TRAC model to explain the context in which depressed people exhibit avoidance behavior and their involvement in behavior activation.

  Avoidance behavior and depression form a feedback loop.

  When a trigger triggers a aversive response in the client’s life, the client will lose the opportunity to solve the problem or contact the available reinforcement if the client shows an avoidance pattern.

  Avoidance behavior increases the intensity and frequency of depressing reactions, which leads to missing opportunities to cope with subsequent negative events (contextual triggers).

  However, if the client does something constructive with Alternative Coping, the cycle of avoidance behavior and depression will not appear.

  Martell overcomes the deficiency of static reinforcement through basic activity plans and at the same time prevents avoidance behavior, the need to activate competitive behavior was emphasized, and based on this, he developed a behavioral activation treatment manual (Martell et al., 2012).

(2) The core treatment factors of depression behavior activation

• Kanter et al. (2010) analyzed the studies to verify the effectiveness of behavior activation treatment, confirmed six manuals as a result, and extracted eight behavior activation treatment techniques from these manuals.

  In eight treatment techniques, activity monitoring, contingency management, values and goals assessment, activity scheduling, procedures targeting verbal behavior, procedures targeting avoidance, skills training, relaxation are included.

• Activity monitoring : In treatment, the client records daily activities every hour in the daily activity log.

• Contingency management : Help depressed clients find and increase behaviors that are most likely to participate in interactions with the environment.

  It is premised that all actions occur in a specific context and are reinforced according to the outcome of the action.

• Values and goals assessment : The client creates personal values and goals for a total of 10 areas, including family relationships, social relationships, education/training, physical/health issues, and spiritual life.

  To identify the broad yet unique positive reinforcement used by the client.

• Activity scheduling : Plan behaviors that are alternative to avoidance and rumination or plan activities that are in line with the client’s values. (The task consists of rules and instructions that require a specific action, specifically specifying what, when, where, and how to do it.)

  It has the function of increasing contact with positive reinforcement available in the client’s surrounding environment.

  The role of a catalyst that allows the client to achieve more of the target behavior.

• Procedures targeting verbal behavior : Examine the context in which the rumination occurs and is maintained with the therapist.

  Procedures targeting avoidance : The client (1) directly aims at the avoidance behavior and performs the activation task, and (2) allows them to functionally evaluate avoidance and activate alternative coping behavior.

• Skills training : The Technical Training Intervention Act is used when the client does not know how to activate effective behavior despite being strengthened in the environment.

  Social skills training for behavior activation typically includes modeling, role acting, self-assertive training, interpersonal relationship and communication skills training, etc.

• Relaxation