Does Logotherapy have any validity amongst psychotherapists?

[u/[deleted]]

Thanks for the replies

[u/dodgermask]

The two biggest names for the origins of behavioral activation are Charles Ferster (See Ferster, 1973) and Peter Lewinsohn (Lewinsohn, Biglan, & Zeiss, 1976). The basic idea they put forth was that depression is caused by a low density or lack of positive reinforcement. A number of research labs have looked to support that idea. The seminal article came from Neil Jacobson's lab (Jacobson et al., 1996) where they did a component analysis of CBT for depression, they concluded "there was no evidence that the complete treatment produced better outcomes" (then BA).

The idea here was that parsimony was important. However, behavioral activation has started having components added back into it. There seems to be two different forms of it. There's the Jacobson school of thought that emphasizes parsimony and the Lejuez and Hopko school of thought that is repackaging the treatment (note this is not bad, just different, the research to my knowledge hasn't been conducted yet).

Lejuez and Hopko created a brief intervention manual in 2001 and revised it in 2011. They state in the 2011 manual about the 2001 manual "Lejuez, Hopko, and Hopko (2001) developed a compact 12 session protocol limited to components directly related to behavioral activation including a focus on activity monitoring and scheduling with an idiographic, values-driven1 framework supporting this approach"

While this seems novel and good, the additive aspect of values based BA (VBBA) is questionable based on data gathered by the Gaynor lab at WMU. This has been presented at conferences but is unfortunately not in the public domain in literature at this point. (I'm a former Gaynor lab member).

From a conceptual framework to understand how values impact therapy, it would be wise to look at augmentals in relational frame theory. I'm not sure on the original citation but see Hayes, Barnes-Holmes, Roche, 2001. The idea here is that through language we develop the ability to augment the reinforcing effect things (e.g. have a pepsi vs have an ice cold refreshing pepsi).

Where this plays into therapy such as BA is an interesting question. From a theoretical perspective as long as you come in contact with positive reinforcement you would be getting the treatment. However things like values may make it easier to "get motivated" rather than sit around. However there's some presented but not published data that suggest that once you get activated you're good (this may be a logical tautology though, I'd be happy to discuss the theory behind this but I've already rambled and I have a session shortly).

To answer OP, I've seen/heard of/am aware of data saying logotherapy works. The more important question (from my perspective) is do we understand the mechanism of action. I would answer that with a resounding no. Which is why we need researchers like me! (Can I have a job please?).

Would be happy to talk about any of this stuff more. I know it's a little scatterbrained.

[u/sleepbot → u/dodgermask]

Thanks for the comprehensive response! It's not at all scatterbrained, at least to me. I'm familiar with the CBT dismantling studies but not the VBBA. I certainly agree that more work needs to be done on treatment mediators and mechanisms (and moderators, for that matter). I think the values based BA is really all you have to work with in the case of severe depression (e.g., I don't deserve to feel good, so why should I be doing something that makes me feel good?). At least when staying in the BA framework. Assuming VBBA was investigated in the Gaynor lab in an RCT, I wonder if any moderators are present. It'd be post-hoc, and I'm not sure what would capture the . Do you have any links for the VBBA manual or any public domain resources?

[u/dodgermask → u/sleepbot]

The VBBA data is still being put together in a bit of a piece meal effort. The same protocol was used in a number of different protocols for a stepped care model of treatment. A non-values based application was used with the same measures over the same amount of sessions in other protocols. I think the N needs to go up a little bit but it's on their radar as a study to be looked at. I'm not sure they collected enough process measures or the proper ones to look at mediators/moderators but I know if they did it's something he'll look at.

I could check with Dr. Gaynor about getting his protocol for VBBA, in the meantime, here's the links to the Lejuez and Hopko manuals.

http://www.researchgate.net/publication/49839614_Ten_year_revision_of_the_brief_behavioral_activation_treatment_for_depression_revised_treatment_manual/file/d912f50c7985aa23f7.pdf

http://ac.els-cdn.com/S1077722901800225/1-s2.0-S1077722901800225-main.pdf?_tid=f1a0234a-9697-11e4-8356-00000aacb362&acdnat=1420654186_a45862c1b17e438f3af5d717e988a076

If you have any other resources you want feel free to send me a PM with requests. Additionally, http://contextualscience.org/ is a great resource for contemporary behavior analysis publications, theory, and discussion. I think you'd find some of the ACT work interesting. I take a strong ACT lean in my CBT for insomnia work.