The belief that a person suffering from depression can behave him- or herself out of it is both appealing and troublesome. The benefits of constructive activity notwithstanding, dependence on others for positive reinforcement could result in depression that waxes and wanes in direct proportion to the presence or absence of external stimuli. The danger inherent is this view is of placing too strong a focus on those external reinforcements.
A patient who places conditions of worth on his or her actions may be convinced that others will never be in a state of approval of those actions. Such a patient may benefit more greatly from a cognitive therapy that addresses his or her maladaptive thinking patterns and self-deprecating automatic thoughts. It is the therapist's responsibility to assess the most effective treatment based on the patient's individual profile. The specific therapeutic approach must be tailored to the patent's needs and capabilities. If the patient requires guidance to change maladaptive thinking, then a plan to simply change behavior is doomed to fail.
The behaviorist perspective can also be interpreted as placing responsibility for depression squarely on the shoulders of the patient. Encouragement (of the patient to take charge of his or her own recovery by changing the nature of his or her personal relationships) can be effective with a strong-willed person who is committed to recovery. By helping to develop a plan of action and monitoring its success and opportunities for improvement, the behavioral therapist maintains at once a reliable presence at a respectful distance.
The patient's relationships are also important factors in depression that must be addressed to treat depression; ergo behavioral therapy must tackle negativity in that facet of the patient's life. The therapist must assess the overall relationship dynamic and any negative patterns of communication between the patient and his or her most significant others.
Ideally, a behavioral therapist has evaluated the patient and hypothesized that he or she will benefit from changing behavioral patterns. The therapist patient will then work closely with the patient to assess the nature of his or her innate behavioral patterns to determine which are constructive and which detract from his or her impression of positive reinforcement. Classical conditioning is not suited for this task but modeling and shaping may be effective. Operant conditioning, by definition, is the order of the day. The patient will receive continuous positive reinforcement for behaviors that combat his or her depression, while those that feed the depression will become extinct.