title: Understanding the functionality of depression among Australian breast cancer patients: implications for cognitive and behavioural interventions.
abstract: BACKGROUND
  Depression in breast cancer (BCa) patients can reduce quality of life, relationships and treatment compliance, thus constituting a major target for cognitive behavioural (CBT) interventions. Although CBT treatments, which are built upon consideration of the roles of antecedents and consequences for depressive behaviour, are effective, the nature of those antecedents which trigger depression among BCa patients has received relatively little attention.
  
  
  OBJECTIVE
  Hypotheses were (1) to determine if BCa patients were experiencing either or both of punishment type I and II and (2) to identify if these aspects of punishment were related to overall depression.
  
  
  METHODS
  Two hundred fifty-three BCa patients completed a standardised depression scale, and data were factor analysed. Components were interpreted for their relationship to punishment type I or II.
  
  
  RESULTS
  Two major components emerged: (1) loss of previously available sources of personal or social reinforcement (i.e. punishment type II or negative punishment) and (2) behavioural, emotional and cognitive responses to those losses. These two components represent the total symptomatology of major depressive episode from DSM-IV-TR.
  
  
  CONCLUSIONS
  These findings support the application of a functional analytic model of depression within CBT assessment and treatment procedures with BCa patients.
authors.affiliation: Brain-Behaviour Research Group, University of New England, Armidale, NSW, Australia. csharpley@onthenet.com.au
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Sharpley
authors.forename: Vicki
authors.initials: V
authors.lastname: Bitsika
authors.forename: David R H
authors.initials: DR
authors.lastname: Christie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000150:complications / Q000523:psychology*; D015928:Cognitive Behavioral Therapy; D003866:Depressive Disorder / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D004644:Emotions; D005163:Factor Analysis, Statistical; D005260:Female; D015438:Health Behavior; D006801:Humans; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011793:Queensland
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