Journal ol Abnormal Psychology 1975, Vol. 84, No. 6, 729-731
Engagement in Pleasant Activities and Depression Level Peter M, Lewinsohn University of Oregon Previous studies have shown a low rate of engagement in pleasant activities to be a concomitant of depression. The crucial question addressed by the Hammen and Glass study is whether an increase in pleasant-activity level will produce a decrease in depression level. Positive results would constitute strong evidence that low rate of engagement in pleasant activities is an antecedent of depression. The results of the Hammen and Glass study should not be considered conclusive because neither an initial low pleasant-activities level nor a significant association between mood and pleasant-activity level was demonstrated for the subjects prior to the introduction of the experimental treatment. It is a well-established clinical and empirical fact (Lewinsohn & Graf, 1973; MacPhillamy & Lewinsohn, 1974) that depressed individuals as a group engage in a smaller number of pleasant activities (i.e., activities which they consider to be pleasant or rewarding). Furthermore, a consistent relation between rate of engagement in pleasant activities and mood has been found (Lewinsohn, 1974; Lewinsohn & Graf, 1973; Lewinsohn & Libet, 1972). It was thus eminently reasonable for Hammen and Glass (1975) to hypothesize that an increase in pleasant activities (those patient behaviors which are likely to be reinforced by others or those which can act as reinforcers for other behaviors) would result in a decrease in depression level. From the results obtained by Hammen and Glass, the tentative answer seems to be negative; inducing subjects to increase their rate of engagement in pleasant activities did not produce systematic changes in the depression level of their subjects. There are several ways in which the methodology of the Hammen and Glass (197S) study differs from ours: (a) Subjects in our studies are always instructed in a daily frequency check to count an activity as having occurred only if it was "at least a little pleasant." For example, if watching television is on a subject's activity schedule and if watching television was not experienced as enjoyable (a common occurrence), the subject does not check that particular activity on that day. Thus, the total activity score in our studies takes into consideration the fact that depressed individuals do not enjoy many of the activities they engage in (MacPhillamy & Lewinsohn, 1974), which is not true of the total activity score generated by Hammen and Glass. Requests for reprints should be sent to Peter M. Lewinsohn, Department of Psychology, University of Oregon, Eugene, Oregon 97403.
This fact may account for the considerably lower correlation between mood ratings and pleasantactivity scores found by Hammen and Glass (Note 1). In our studies we have consistently obtained average correlations which range between .3 and .4, based on base-level observations extending over 30 days, (b) Our criteria for the inclusion of a subject as depressed have relied on a two-step classification procedure consisting of the Minnesota Multiphasic Personality Inventory (MMPI) Depression (D) and other scales and a set of ratings based on an individual interview with the subject. The purpose of these rather rigid criteria is not only to ensure a minimum level of depression but also to eliminate subjects who may be depressed but for whom anxiety or other neurotic symptoms constitute major problems. There are several methodological issues in the Hammen and Glass (1975) study that need to be raised. The major data set used for the conclusion that depressed subjects who were told to increase their activity level did not show a subsequent decrease in depression level is based on the Depression Adjective Check List (DACL, Lubin, 1965) ratings, which were filled out by the subjects on a daily basis and then averaged over the 2-wk period (as opposed to the experiment that ran for 1 wk). In our experience, although the DACL ratings provide an excellent measure for the day-to-day mood fluctuations which are shown by most depressed subjects, they are not very sensitive to pre- and postchanges as inferred from the MMPI or interview ratings. In other words, many patients who manifest considerable clinical change in depression level as measured by the MMPI or by interview ratings show relatively little systematic change in their mean DACL ratings. This is a problem that deserves investigation in its own
729
730
SHORT REPORTS
right. Future studies of this sort clearly need to wrestle with the criterion problem. Depression is not a unidimensional phenomenon. The dependent variable clearly deserves more attention in studies designed to test the efficacy of specific treatment procedures intended to alleviate depression. In our studies, the correlations between rate of engagement in pleasant activities and mood ratings for individual subjects range in magnitude from 0 to —.75. There are thus large individual differences in the extent to which the variance in mood ratings can be accounted for by differences in daily activity level. The prediction that an increase in pleasant activity level will produce a reduction in depression level probably should be restricted to individuals (a) in whom there is a significant association between activity level and mood (e.g., r > ,30) and (b) whose baselevel pleasant-activity level is. low (e.g., 1 or 2 standard deviations below the mean). In regard to the first point, it is important to note that the correlation between number of pleasant activities in the critical increase-activities groups was even lower than that obtained for the other three groups (Hammen & Glass, 1975, Experiment 1). Regarding the second point, the mean daily activities scores for the expectancy-control and self-monitor control depressed groups in Experiment 1 and for the depressed groups in Experiment 2 are at a level comparable to that found by us in nondepressed control populations. It thus appears that two critical preconditions (association between mood and activity level and a low base-level rate of engagement in pleasant activities) for the subjects were not met in the present study. Although the author's procedure of instructing subjects to increase their rate of engagement in pleasant activities was successful in Experiment 1, it was considerably less successful in Experiment 2 in that the increase for the depressed increase-activities group was relatively small and the activities score for the nondepressed increaseactivities group decreased. Furthermore, the instruction to increase activities apparently produced a negative effect on the subjects, as suggested by the elevated DACL scores of both increase-activities groups. The subjects may have been reacting to the experimental instructions and this may have affected the results. Different results might have been obtained if a reward had been made contingent on an increase in activities. For a given subject there typically exists a relatively small number of activities (10-20)
which are associated with that subject's mood. In our earlier publication (Lewinsohn & Libet, 1972) we suggested that, "It may be possible for a therapist and his patient to identify a small number of activities which are related to the patient's mood state" (p. 295). The hypothesis that an increase in these mood-related activities would result in a decrease in depression level was not tested by the present experiment. Finally, we will comment on the statement that the results are "contrary to an operant hypothesis of depression" (Hammen & Glass, 1975, p. 718). The so-called major approaches to depression undoubtedly differ in the degree to which they emphasize biochemical, psychodynamic, behavioral, and cognitive measures as independent and as dependent variables in the development and maintenance of that fairly wide and heterogeneous group of phenomena which are encompassed by the term "depression." Behavioral studies have tended to focus on the patient's overt behavior and have been concerned with the consequences of behavior as possibly providing explanations for the behavioral deficits (e.g., low rate of engagement in social behaviors). Behavioral deficits are hypothesized to be the result of extinction, that is, the repertoire of depressed individuals is unsuccessful in eliciting positive reinforcement to a sufficient degree to maintain the behaviors. Behavioral studies may also provide possible explanations for the behavioral excesses (e.g., obsessive ruminating and verbal statements of inadequacy), which are hypothesized to be learned behaviors that are maintained by their consequences. In addition, a low rate of response-contingent positive reinforcement has been hypothesized to act as an eliciting (unconditioned) stimulus for some depressive behaviors, such as the feeling of dysphoria, fatigue, and other somatic symptoms (Lewinsohn, Weinstein, & Shaw, 1969). Such a behavioral focus is, but need not be, incompatible with a methodological framework in which all properly operationalized independent variables may be examined and their relation to all those behaviors (overt and covert) which are generally considered as aspects of depression may be clarified. Such a methodological framework is distinguishable from a specific theoretical position which specifies a particular subset of independent variables as having a central or causal effect on aspects of depression. Hammen and Glass's (1975) results may be inconsistent with the hypothesis that a low rate of engagement in pleasant activities is causally related to depression,
731
SHORT REPORTS but they are not "contrary to an operant hypothesis of depression" (p. 718). REFERENCE NOTE I. Hammen, C. L., & Glass, D. R. Unpublished data, 1975. (Available from Constance L, Hammen, Department of Psychology, University of California, Los Angeles, California 90024.) REFERENCES Hammen, C. L., & Glass, D. R. Depression, activity, and evaluation of reinforcement. Journal of Abnormal Psychology, 1975, 84, 718-721. Lewinsohn, P. M. Clinical and theoretical aspects of depression. In K. S. Calhoun, H. E. Adams, & K. M. Mitchell (Eds,), Innovative treatment
methods in psychopathology. New York: Wiley, 1974. Lewinsohn, P. M., & Graf, M. Pleasant activities and depression. Journal of Consulting and Clinical Psychology, 1973, 41, 261-268. Lewinsohn, P. M., Weinstein, M. S., & Shaw, D. Depression: A clinical research approach. In R. D. Rubin & C. M. Franks (Eds.), Advances in behavior therapy, 1968. New York: Academic Press, 1969. Lubin, B. Adjective checklists for the measurement of depression. Archives of General Psychiatry, 1965, 12, 57-62. MacPhillamy, D. J., & Lewinsohn, P. M. Depress:on as a function of levels of desired and obtained pleasure. Journal of Abnormal Psychology, 1974, 83, 651-657. (Received June 12, 1975)
STATEMENT OF OWNERSHIP, MANAGEMENT AND CIRCU LATH
Member ( T O i N m b r $21
>£SI!i^fou'oBE™,'.^S^..,°f
FBVeh
P* oq y-f-UaiJg" ri ^ t y^ IlUnois. Chicago,
pushing Support Dapartmant
I icrlily lhal llie ilaieins
Engagement in Pleasant Activities and Depression Level Peter M, Lewinsohn University of Oregon Previous studies have shown a low rate of engagement in pleasant activities to be a concomitant of depression. The crucial question addressed by the Hammen and Glass study is whether an increase in pleasant-activity level will produce a decrease in depression level. Positive results would constitute strong evidence that low rate of engagement in pleasant activities is an antecedent of depression. The results of the Hammen and Glass study should not be considered conclusive because neither an initial low pleasant-activities level nor a significant association between mood and pleasant-activity level was demonstrated for the subjects prior to the introduction of the experimental treatment. It is a well-established clinical and empirical fact (Lewinsohn & Graf, 1973; MacPhillamy & Lewinsohn, 1974) that depressed individuals as a group engage in a smaller number of pleasant activities (i.e., activities which they consider to be pleasant or rewarding). Furthermore, a consistent relation between rate of engagement in pleasant activities and mood has been found (Lewinsohn, 1974; Lewinsohn & Graf, 1973; Lewinsohn & Libet, 1972). It was thus eminently reasonable for Hammen and Glass (1975) to hypothesize that an increase in pleasant activities (those patient behaviors which are likely to be reinforced by others or those which can act as reinforcers for other behaviors) would result in a decrease in depression level. From the results obtained by Hammen and Glass, the tentative answer seems to be negative; inducing subjects to increase their rate of engagement in pleasant activities did not produce systematic changes in the depression level of their subjects. There are several ways in which the methodology of the Hammen and Glass (197S) study differs from ours: (a) Subjects in our studies are always instructed in a daily frequency check to count an activity as having occurred only if it was "at least a little pleasant." For example, if watching television is on a subject's activity schedule and if watching television was not experienced as enjoyable (a common occurrence), the subject does not check that particular activity on that day. Thus, the total activity score in our studies takes into consideration the fact that depressed individuals do not enjoy many of the activities they engage in (MacPhillamy & Lewinsohn, 1974), which is not true of the total activity score generated by Hammen and Glass. Requests for reprints should be sent to Peter M. Lewinsohn, Department of Psychology, University of Oregon, Eugene, Oregon 97403.
This fact may account for the considerably lower correlation between mood ratings and pleasantactivity scores found by Hammen and Glass (Note 1). In our studies we have consistently obtained average correlations which range between .3 and .4, based on base-level observations extending over 30 days, (b) Our criteria for the inclusion of a subject as depressed have relied on a two-step classification procedure consisting of the Minnesota Multiphasic Personality Inventory (MMPI) Depression (D) and other scales and a set of ratings based on an individual interview with the subject. The purpose of these rather rigid criteria is not only to ensure a minimum level of depression but also to eliminate subjects who may be depressed but for whom anxiety or other neurotic symptoms constitute major problems. There are several methodological issues in the Hammen and Glass (1975) study that need to be raised. The major data set used for the conclusion that depressed subjects who were told to increase their activity level did not show a subsequent decrease in depression level is based on the Depression Adjective Check List (DACL, Lubin, 1965) ratings, which were filled out by the subjects on a daily basis and then averaged over the 2-wk period (as opposed to the experiment that ran for 1 wk). In our experience, although the DACL ratings provide an excellent measure for the day-to-day mood fluctuations which are shown by most depressed subjects, they are not very sensitive to pre- and postchanges as inferred from the MMPI or interview ratings. In other words, many patients who manifest considerable clinical change in depression level as measured by the MMPI or by interview ratings show relatively little systematic change in their mean DACL ratings. This is a problem that deserves investigation in its own
729
730
SHORT REPORTS
right. Future studies of this sort clearly need to wrestle with the criterion problem. Depression is not a unidimensional phenomenon. The dependent variable clearly deserves more attention in studies designed to test the efficacy of specific treatment procedures intended to alleviate depression. In our studies, the correlations between rate of engagement in pleasant activities and mood ratings for individual subjects range in magnitude from 0 to —.75. There are thus large individual differences in the extent to which the variance in mood ratings can be accounted for by differences in daily activity level. The prediction that an increase in pleasant activity level will produce a reduction in depression level probably should be restricted to individuals (a) in whom there is a significant association between activity level and mood (e.g., r > ,30) and (b) whose baselevel pleasant-activity level is. low (e.g., 1 or 2 standard deviations below the mean). In regard to the first point, it is important to note that the correlation between number of pleasant activities in the critical increase-activities groups was even lower than that obtained for the other three groups (Hammen & Glass, 1975, Experiment 1). Regarding the second point, the mean daily activities scores for the expectancy-control and self-monitor control depressed groups in Experiment 1 and for the depressed groups in Experiment 2 are at a level comparable to that found by us in nondepressed control populations. It thus appears that two critical preconditions (association between mood and activity level and a low base-level rate of engagement in pleasant activities) for the subjects were not met in the present study. Although the author's procedure of instructing subjects to increase their rate of engagement in pleasant activities was successful in Experiment 1, it was considerably less successful in Experiment 2 in that the increase for the depressed increase-activities group was relatively small and the activities score for the nondepressed increaseactivities group decreased. Furthermore, the instruction to increase activities apparently produced a negative effect on the subjects, as suggested by the elevated DACL scores of both increase-activities groups. The subjects may have been reacting to the experimental instructions and this may have affected the results. Different results might have been obtained if a reward had been made contingent on an increase in activities. For a given subject there typically exists a relatively small number of activities (10-20)
which are associated with that subject's mood. In our earlier publication (Lewinsohn & Libet, 1972) we suggested that, "It may be possible for a therapist and his patient to identify a small number of activities which are related to the patient's mood state" (p. 295). The hypothesis that an increase in these mood-related activities would result in a decrease in depression level was not tested by the present experiment. Finally, we will comment on the statement that the results are "contrary to an operant hypothesis of depression" (Hammen & Glass, 1975, p. 718). The so-called major approaches to depression undoubtedly differ in the degree to which they emphasize biochemical, psychodynamic, behavioral, and cognitive measures as independent and as dependent variables in the development and maintenance of that fairly wide and heterogeneous group of phenomena which are encompassed by the term "depression." Behavioral studies have tended to focus on the patient's overt behavior and have been concerned with the consequences of behavior as possibly providing explanations for the behavioral deficits (e.g., low rate of engagement in social behaviors). Behavioral deficits are hypothesized to be the result of extinction, that is, the repertoire of depressed individuals is unsuccessful in eliciting positive reinforcement to a sufficient degree to maintain the behaviors. Behavioral studies may also provide possible explanations for the behavioral excesses (e.g., obsessive ruminating and verbal statements of inadequacy), which are hypothesized to be learned behaviors that are maintained by their consequences. In addition, a low rate of response-contingent positive reinforcement has been hypothesized to act as an eliciting (unconditioned) stimulus for some depressive behaviors, such as the feeling of dysphoria, fatigue, and other somatic symptoms (Lewinsohn, Weinstein, & Shaw, 1969). Such a behavioral focus is, but need not be, incompatible with a methodological framework in which all properly operationalized independent variables may be examined and their relation to all those behaviors (overt and covert) which are generally considered as aspects of depression may be clarified. Such a methodological framework is distinguishable from a specific theoretical position which specifies a particular subset of independent variables as having a central or causal effect on aspects of depression. Hammen and Glass's (1975) results may be inconsistent with the hypothesis that a low rate of engagement in pleasant activities is causally related to depression,
731
SHORT REPORTS but they are not "contrary to an operant hypothesis of depression" (p. 718). REFERENCE NOTE I. Hammen, C. L., & Glass, D. R. Unpublished data, 1975. (Available from Constance L, Hammen, Department of Psychology, University of California, Los Angeles, California 90024.) REFERENCES Hammen, C. L., & Glass, D. R. Depression, activity, and evaluation of reinforcement. Journal of Abnormal Psychology, 1975, 84, 718-721. Lewinsohn, P. M. Clinical and theoretical aspects of depression. In K. S. Calhoun, H. E. Adams, & K. M. Mitchell (Eds,), Innovative treatment
methods in psychopathology. New York: Wiley, 1974. Lewinsohn, P. M., & Graf, M. Pleasant activities and depression. Journal of Consulting and Clinical Psychology, 1973, 41, 261-268. Lewinsohn, P. M., Weinstein, M. S., & Shaw, D. Depression: A clinical research approach. In R. D. Rubin & C. M. Franks (Eds.), Advances in behavior therapy, 1968. New York: Academic Press, 1969. Lubin, B. Adjective checklists for the measurement of depression. Archives of General Psychiatry, 1965, 12, 57-62. MacPhillamy, D. J., & Lewinsohn, P. M. Depress:on as a function of levels of desired and obtained pleasure. Journal of Abnormal Psychology, 1974, 83, 651-657. (Received June 12, 1975)
STATEMENT OF OWNERSHIP, MANAGEMENT AND CIRCU LATH
Member ( T O i N m b r $21
>£SI!i^fou'oBE™,'.^S^..,°f
FBVeh
P* oq y-f-UaiJg" ri ^ t y^ IlUnois. Chicago,
pushing Support Dapartmant
I icrlily lhal llie ilaieins
