Abraham (40-year-old male) was referred for treatment for Persistent Depressive Disorder by his GP. The referral letter

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Abraham (40-year-old male) was referred for treatment for Persistent Depressive Disorder by his GP. The referral letter noted that Abraham has been depressed without remission since his divorce from Gloria four years prior. Abraham's GP also noted a history of alcohol abuse during, but not after the divorce. Abraham lives alone, and shares custody of his daughter, Christina who is 8 years old. At the intake session, Abraham reported that he has been depressed most of his life. He recalled his first episode of depression at age 12 when his father left abruptly and severed all contact with the family. Abraham reported that he had believed that his parents were happily married and, at that time, blamed himself for his father's departure. Abraham stated that he feels inadequate. When asked to elaborate, he explained that other people experience stress, get divorced, have crappy jobs, and then move on. But he doesn't move on. He got divorced four years ago and is still depressed. Abraham reported that he has had periods when he functions OK, but that he is never happy. He just stumbles through life and then a switch flips and he's in a dark place again. For the past four years, there hasn't been much that helps him to feel better. Even things that he thinks should help him feel better don't do much. He said he used to cook wonderful dinners with Gloria, but now feels like it is an effort to just order pizza. Everything feels like an effort, even at work in a job that isn't very challenging. He's an accountant and just does the bare minimum to get by. He's exercising less than he has in the past but is watching a lot more TV. He used to shut the TV off at 8 p.m. and play a game or read a book to his daughter, but now he watches TV until he falls asleep. He said that TV helps keep his mind off Gloria and work, but not all that much. He still feels depressed.

Abraham added that sometimes he doesn't talk to another person or even get out of bed all weekend. He knows these things make his depression worse and that they aren't good for his daughter either, but does them anyway. He doesn't understand why. He said the same thing used to happen with alcohol. He knew it made things worse, but because it helped in the moment, he drank to distract himself. He doesn't drink anymore, but he's pulled back from other people, including his daughter. Abraham's social network revolved primarily around his former marriage. He has withdrawn from that network since his divorce and hasn't found a new network. He reported that he has always had trouble fully engaging in relationships. He hides how he really feels about things, fails to express commitment to a relationship, and often ruminates about mistakes he made in the past. When asked about why he engages in these behaviors, Abraham stated that he is trying to avoid re-experiencing the loss of his father. If he always keeps people at bay, it will hurt less when they go. He doesn't feel that he is good enough to sustain a relationship. He also mentioned that his family doesn't discuss their feelings. They don't discuss his father or his father's disappearance. Abraham did not evidence any psychotic behavior during the intake interview and denied a history of mania.

Psychopathology: Mood 293. depressed mood Reinforcement R+ for healthy behavior (TR-and R+ for depressed Then using Manos' behavioral activation (BA) model shown above in thoroughly explain why Abraham's symptoms/diagnosis persist and how the Abrahams current symptoms and history fit with the model and how this understanding helps inform the direction for treatment.