The Jacobson et al., 2001 article gave me a positive outlook on the contextual treatment approaches. I was particularly interested in the idea that Behavioral Activation (BA) does not focus on a individual illness / mental illness model whereby unseen, internal pathology is targeted in treatment; rather BA takes into consideration the environmental context of the individual and treatment targets overt behaviors. This seems to be advantageous for several reasons.
Contextual approaches such as BA may reduce number of assumptions (therapists / researchers / clients / others???) need to make. The goal is not to change unseen cognition, which may be difficult to decipher/interpret. Thus the focus on observable behavior reduces the need to interpret the relation between external environmental events and internal cognitions
[however, functional analysis – foundation of treatment – is largely based on assumptions…]
It may also be that, in treatments founded in contextual approaches, it is easier to measure incremental changes in both clinical and research settings. Because we can observe differences in behavior over time, we are not trying to guess whether or not an unobservable cognition has changed (even if that assumption is based on behavior). Important to note that cognitions are not denied; they simply are not the focus of treatment.
However, I question the extent to which cognitions are (or are not) changed by behavioral activation. Does targeting and changing such behaviors as avoidance behavior only change behavior or are there underlying changes to cognition? If cognitions do change, what are these changes and what is the process of change? Do cognitions quickly change such that once positive behavior routines are established we can assume more positive underlying cognitions? Or is the process more slowly such that we may see observable changes in behavior long before there are true changes in cognition?
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I often wonder about the degree to which the behaviors and the cognitions are dissociable, and whether that alone may be an important clinical variable. For example, is the person who's overt behavior changes, but who still has depressogenic automatic cognitions, more at risk for relapse?
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