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Saracino RM, Park EY, Demirjian C, Jutagir DR, McConnell KM, Schofield E, Raue PJ, Lejuez CW, Nelson CJ. Protocol for a randomized controlled trial of brief behavioral activation among older adult cancer survivors. J Geriatr Oncol 2024; 15:101719. [PMID: 38342735 DOI: 10.1016/j.jgo.2024.101719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/13/2024]
Abstract
INTRODUCTION As many as 35% of older adult cancer survivors (OACS; i.e., ≥65 years old) have clinically significant depression. OACS often experience fatigue, mild cognitive impairment, and increased medical comorbidities post-cancer that make them susceptible to depression. Behavioral activation (BA) is an empirically supported depression treatment in geriatric psychiatry that guides individuals to reengage in pleasurable and rewarding activities and has great potential for addressing the needs of OACS. This manuscript presents the protocol for a pilot randomized controlled trial (RCT) testing the efficacy of a brief BA intervention adapted to address the needs of OACS (BBA-OACS) by telephone and videoconference delivery. MATERIALS AND METHODS An RCT will be conducted at Memorial Sloan Kettering Cancer Center (MSK) in New York City. Participants will be randomized to either BA as a target intervention or supportive psychotherapy (SP) as a standard of care control intervention for outpatient oncology. The target intervention includes 10 weekly sessions of BA consisting of psychoeducation about depression and the rationale for BA, life areas and values assessment, compilation of a list of enjoyable and important activities across values, activity scheduling, and self-monitoring of satisfaction and mood. The standard of care control intervention includes 10 weekly sessions of SP consisting of reassurance, guidance, encouragement, and support for patients with cancer. OACS who have a history of cancer, report elevated depressive symptoms, are fluent in English, and can communicate via telephone or videoconference will be recruited from the MSK Survivorship Clinics across all disease types. Seventy participants will be recruited for the study (10 training cases, 30 in each RCT arm). The primary aim is to evaluate implementation outcomes (i.e., acceptability, feasibility, and fidelity) of BA, relative to SP, for cancer survivorship. The secondary aim is to determine the preliminary effects of BA on depressive symptoms (primary outcome), anxiety, coping, and increased activity level (secondary outcomes) compared to SP. Participants will be asked to complete a set of three surveys pre- and post-intervention. DISCUSSION If successful, BBA-OACS would provide frontline clinicians with an accessible, evidence-based treatment for OACS. Future research will evaluate the efficacy of BA in a larger trial and its impact on depression and other healthcare outcomes. TRIAL REGISTRATION This study is registered under ClinicalTrials.gov (ID NCT05574127).
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Affiliation(s)
- Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Avenue, 4(th) Floor, New York, NY 10017, USA.
| | - Ellen Y Park
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Avenue, 4(th) Floor, New York, NY 10017, USA
| | - Caraline Demirjian
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Avenue, 4(th) Floor, New York, NY 10017, USA
| | - Devika R Jutagir
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Avenue, 4(th) Floor, New York, NY 10017, USA
| | - Kelly M McConnell
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Avenue, 4(th) Floor, New York, NY 10017, USA
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Avenue, 4(th) Floor, New York, NY 10017, USA
| | - Patrick J Raue
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195, USA
| | - Carl W Lejuez
- Department of Psychology, Stony Brook University, 407 Administration Building, New York, NY 11794, USA
| | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Avenue, 4(th) Floor, New York, NY 10017, USA
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Reeb RN, Elvers G, Hunt CA, Turner TN, Ballas TN, Farmer CN, Gibbins K, Glendening ZS, Kinsey R, Latuch BD, Parker CN, Snow-Hill NL, Zicka JL, Bohardt D, Andrews R. Participatory community action research in homeless shelters: Outcomes for shelter residents and service-learning research assistants. J Prev Interv Community 2024; 52:173-197. [PMID: 38470612 DOI: 10.1080/10852352.2024.2317671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
The article reports empirical outcomes of an ongoing transdisciplinary participatory community action research project that implements behavioral activation in homeless shelters. The overall goal of this Project is twofold: (1) to improve psychosocial functioning of shelter residents and enhance their opportunities to overcome homelessness; and (2) to enhance civic development of service-learning students who assist in Project implementation. Two studies are reported, representing these goals. Study 1 found that residents of a men's shelter (n = 892), women's shelter (n = 433), and transitional housing (n = 40) perceived behavioral activation sessions as immediately beneficial (i.e., important, meaningful, worthy of repeating, and enjoyable), and over the course of shelter stay, they perceived behavioral activation as contributing to their hope, empowerment/self-sufficiency, quality of life, purpose/meaning in life, wellbeing, social support, shelter social climate, and relationships with staff. Quantitative findings are supported by qualitative data (comments by residents on forms). Study 2, which replicates and extends past research on civic-development in service-learning students, used a new quasi-experimental design to compare service-learning students (n = 41) in an interdisciplinary course on homelessness versus non-service-learning students (n = 16) in a psychology course. Service-learning students showed pre- to post-semester improvements in community service self-efficacy, decreases in stigmatizing attitudes, and increases in awareness of privilege and oppression, but students not engaged in service-learning did not show these civic-related changes. These quantitative results are supported by qualitative data (written reflections by students). Results and implications are discussed within the context of the concept of psychopolitical validity.
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Affiliation(s)
- Roger N Reeb
- Department of Psychology, University of Dayton, Dayton, OH, USA
| | - Greg Elvers
- Department of Psychology, University of Dayton, Dayton, OH, USA
| | - Charles A Hunt
- Department of Psychology, University of Dayton, Dayton, OH, USA
| | - Tia N Turner
- Department of Psychology, University of Dayton, Dayton, OH, USA
| | - Thomas N Ballas
- Department of Psychology, University of Dayton, Dayton, OH, USA
| | | | - Katey Gibbins
- Department of Psychology, University of Dayton, Dayton, OH, USA
| | | | - Rebecca Kinsey
- Department of Psychology, University of Dayton, Dayton, OH, USA
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Oh J, Lee E, Cha EJ, Seo HJ, Choi KH. Community-based multi-site randomized controlled trial of behavioral activation for patients with negative symptoms of schizophrenia. Schizophr Res 2023; 252:118-126. [PMID: 36640745 DOI: 10.1016/j.schres.2022.12.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/13/2022] [Accepted: 12/30/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Negative symptoms are closely related to the poor prognosis of schizophrenia, for which there is no effective treatment to date. Behavioral activation (BA), which is an effective treatment for depression, is a behavioral approach that targets low levels of response-contingent positive reinforcement. This study aimed to explore BA as an effective intervention for relieving the negative symptoms of schizophrenia. METHODS This was a randomized single-blind controlled trial. Eighty-four patients with schizophrenia were enrolled in community mental health settings. Excluding 14 patients who opted out of the study, 70 were randomly assigned to receive BA in addition to treatment-as-usual (BA + TAU) or treatment-as-usual (TAU) only. Negative symptoms were assessed using the Clinical Assessment Interview for Negative Symptoms (CAINS) and Brief Negative Symptom Scale (BNSS) at baseline, post-treatment, and 6-months follow-up. RESULTS Significant differences between the BA + TAU and TAU only groups were observed in the measures of negative symptoms post-treatment. The total score of CAINS was significantly decreased after BA treatment (η2 = 0.13). The tendency of the BA + TAU treatment effect was also observed for the BNSS total score and PANSS negative symptom subscale (η2 = 0.10 and η2 = 0.11, respectively). However, the difference between the two groups was not sustained at the six-month follow-up. CONCLUSIONS Our findings suggest that BA could be a promising time-limited and structured psychosocial intervention for schizophrenia-associated negative symptoms with the merit of easy dissemination. Further studies are needed to examine the factors involved in sustaining improvement.
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Affiliation(s)
- Jihye Oh
- Department of Psychiatry, Catholic University of Korea, College of Medicine, Republic of Korea
| | - Eunbyeol Lee
- Department of Psychology, Korea University, Republic of Korea
| | - Eun Ji Cha
- Department of Psychology, Korea University, Republic of Korea
| | - Ho-Jun Seo
- Department of Psychiatry, St. Vincent's Hospital, Catholic University of Korea, College of Medicine, Republic of Korea.
| | - Kee-Hong Choi
- Department of Psychology, Korea University, Republic of Korea.
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Raue PJ, Hawrilenko M, Corey M, Lin J, Chen S, Mosser BA. "Do More, Feel Better": Pilot RCT of Lay-Delivered Behavioral Activation for Depressed Senior Center Clients. Behav Ther 2022; 53:458-468. [PMID: 35473649 PMCID: PMC9046684 DOI: 10.1016/j.beth.2021.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 10/26/2021] [Accepted: 11/18/2021] [Indexed: 11/02/2022]
Abstract
This pilot randomized control trial (RCT) tested "Do More, Feel Better" (DMFB), a lay-delivered Behavioral Activation intervention for depressed senior center clients. The study examined: (1) the feasibility of training older lay volunteers to fidelity; and (2) the acceptability, safety, and impact of the intervention. Twenty-one lay volunteers at four senior centers were trained in DMFB. Fifty-six depressed clients were randomized to receive 9 sessions of DMFB or Behavioral Activation delivered by social workers (MSW BA). Research assessments of overall client activity level (BADS) and depression severity (HAM-D) were conducted at baseline and Weeks 3, 6, and 9. Eighty-one percent of lay volunteers who underwent training were formally certified in DMFB. Depressed clients receiving each intervention reported high levels of satisfaction and showed large and clinically significant changes in 9-week activity level (d ≥ 1.35) and depression severity (d ≥ 3.34). Differences between treatment groups were very small for both activity level (dMSW = 0.16; 95% CI, -0.70 to 1.02) and depression (dMSW = 0.14; 95% CI, -0.63 to 0.91). Increases in activity level were associated with decreases in depression (β = -0.42; 95% CI, -0.55 to -0.30). Both interventions appeared to work as intended by increasing activity level and reducing depression severity. "Do More, Feel Better" shows the potential of evidence-based behavioral interventions delivered by supervised lay volunteers, and can help address the insufficient workforce available to meet the mental health needs of community-dwelling older adults.
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Weaver A, Zhang A, Landry C, Hahn J, McQuown L, O’Donnell LA, Harrington MM, Buys T, Tucker KM, Pfeiffer P, Kilbourne AM, Grogan-Kaylor A, Himle JA. Technology-Assisted, Group-Based CBT for Rural Adults' Depression: Open Pilot Trial Results. RESEARCH ON SOCIAL WORK PRACTICE 2022; 32:131-145. [PMID: 35665316 PMCID: PMC9165685 DOI: 10.1177/10497315211044835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE This pilot study assesses the association of Raising Our Spirits Together (ROST), a technology-assisted, group-based cognitive behavioral therapy for depression, with rural adults' depressive symptoms and anxiety. METHOD Nine adults from rural Michigan participated in an open pilot of ROST. Clergy facilitated pilot groups. The pilot began in February 2020 in-person. Due to COVID-19, the pilot was completed virtually. RESULTS Mean depressive symptom scores, based on the PHQ-9, significantly decreased from pre-treatment (M = 14.4) to post-treatment (M = 6.33; t (8) = 6.79; P < .001). Symptom reduction was maintained at 3-month follow-up (M = 8.00), with a significant pattern of difference in depressive symptoms over time (F(2) = 17.7; P < .001; eta-squared = .689). Similar patterns occurred for anxiety based on the GAD-7. Participants attended an average of 7.33 of 8 sessions. Fidelity ratings were excellent. DISCUSSION ROST is a potentially feasible intervention for rural adults' depressive symptoms. ROST offers a promising model for increasing treatment access and building capacity in rural areas.
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Affiliation(s)
- Addie Weaver
- University of Michigan School of Social Work, Ann Arbor, MI, USA
| | - Anao Zhang
- University of Michigan School of Social Work, Ann Arbor, MI, USA
| | - Caroline Landry
- University of Michigan School of Social Work, Ann Arbor, MI, USA
| | | | - Lynne McQuown
- Jonesville First Presbyterian Church, Jonesville, MI, USA
| | | | | | - Trevor Buys
- University of Michigan School of Social Work, Ann Arbor, MI, USA
| | | | - Paul Pfeiffer
- Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI, USA
- Department of Veterans Affairs, Ann Arbor, MI, USA
| | - Amy M. Kilbourne
- Department of Veterans Affairs, Ann Arbor, MI, USA
- Department of Learning Health Sciences, University of Michigan School of Medicine, Ann Arbor, MI, USA
- Quality Enhancement Research Initiative, U.S. Department of Veterans Affairs, Washington, DC, USA
| | | | - Joseph A. Himle
- University of Michigan School of Social Work, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI, USA
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Crits-Christoph P, Goldstein E, King C, Jordan M, Thompson D, Fisher J, Gibbons MBC. A Feasibility Study of Behavioral Activation for Major Depressive Disorder in a Community Mental Health Setting. Behav Ther 2021; 52:39-52. [PMID: 33483123 PMCID: PMC7826447 DOI: 10.1016/j.beth.2020.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 11/28/2022]
Abstract
Behavioral activation (BA) is a well-supported treatment approach, but little research has been conducted on the effectiveness of this treatment within publicly funded community mental health settings. We examined the feasibility of conducting a randomized trial examining the effectiveness of nine sessions of BA as a treatment for major depressive disorder (MDD) in a community mental health clinic (CMHC) setting. Following adaptation of a BA manual and training of BA therapists, 80 patients seeking treatment at a CMHC were randomized, with a 3:1 randomization rate of BA to nine sessions of treatment as usual (TAU). Feasibility assessments indicated that only one eligible patient refused randomization and, of patients who attended at least one session, the median number of sessions was six for the BA group and eight for the TAU group. Of three postbaseline monthly assessments, 71.3% (171/240) were successfully obtained. On average, patients in the BA condition completed homework assignments 83.9% of the time. Treatment fidelity ratings indicated that substantially more BA techniques were delivered in the BA group compared to the TAU group (d = 2.11). Measures of BA mechanisms improved significantly over time and these changes were significantly associated with change in depressive symptoms. These results indicate that it is feasible to conduct a randomized study of BA for MDD in a CMHC setting. In addition, the study reconfirmed the potential importance of theory-relevant BA mechanism variables. Following these findings, further investigation into the effectiveness of BA in this setting is needed.
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Affiliation(s)
| | | | | | | | | | - Jena Fisher
- Sharon Hill and Lafayette Hill, Pennsylvania
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Spates CR, Padalino R, Hale AC, Germain CS, Nimmo K, Kohler R. A review of web‐based technology in behavioural activation. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Andrew C. Hale
- Department of Psychology, Western Michigan University, Kalamazoo, Michigan, USA,
| | - Chelsea Sage Germain
- Department of Psychology, Western Michigan University, Kalamazoo, Michigan, USA,
| | - Kelsey Nimmo
- Department of Psychology, Western Michigan University, Kalamazoo, Michigan, USA,
| | - Robert Kohler
- Department of Psychology, Western Michigan University, Kalamazoo, Michigan, USA,
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Blanchet V, Provencher MD. Évaluation des effets de l’activation comportementale de groupe pour le traitement de la dépression sévère en milieu clinique. SANTE MENTALE AU QUEBEC 2020. [DOI: 10.7202/1070239ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bien que l’efficacité de la thérapie d’activation comportementale (AC) pour le traitement de la dépression ait été établie à travers de nombreux essais aléatoires et contrôlés, les études ayant évalué l’efficacité de l’AC, lorsqu’implantée dans les établissements du réseau de la santé, sont rares et les données la supportant sont insuffisantes. Cette étude s’intéresse à l’AC appliquée de manière à tenir compte de la réalité clinique des milieux et des patients. Elle évalue les effets de l’AC de groupe pour le traitement de la dépression sévère en milieu clinique auprès d’une population hétérogène en termes de diagnostic (dépression unipolaire et bipolaire) et de comorbidité (Axes I et II). Les 45 participants souffrant de dépression sévère ont été recrutés en milieu hospitalier et ont reçu une intervention de groupe d’AC de 10 séances. Des questionnaires ont été administrés afin d’obtenir des données prétraitement, posttraitement et 4 semaines suivant la fin du traitement. Les résultats soutiennent les effets de l’AC de groupe pour le traitement de la dépression sévère en milieu clinique auprès d’une population hétérogène, de même que pour le maintien des acquis à court terme. Les effets de l’AC ont également été observés sur l’ensemble des mesures d’activation comportementale, de renforcement, d’anxiété, d’adaptation sociale et de qualité de vie ainsi que sur les symptômes de dépression bipolaire.
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Affiliation(s)
| | - Martin D. Provencher
- Ph. D., Professeur titulaire, École de psychologie, Université Laval ; Chercheur régulier, Centre de recherche sur les soins et les services de première ligne de l’Université Laval et Centre de recherche CERVO
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Raue PJ, Sirey JA, Dawson A, Berman J, Bruce ML. Lay-delivered behavioral activation for depressed senior center clients: Pilot RCT. Int J Geriatr Psychiatry 2019; 34:1715-1723. [PMID: 31368583 PMCID: PMC6803033 DOI: 10.1002/gps.5186] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/28/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We describe the development of a lay-delivered behavioral intervention ("Do More, Feel Better") for depressed senior center clients, and we present preliminary data from a pilot randomized controlled trial (RCT) on (a) the feasibility of training lay volunteers to fidelity and (b) the acceptability, impact, and safety of the intervention. METHODS We trained 11 volunteers at two aging service settings in "Do More, Feel Better" and randomized 18 depressed clients to receive the intervention or referral to mental health services. RESULTS Pilot data indicated that we can successfully train and certify 64% of older volunteers and that depressed clients receiving the intervention reported high levels of session attendance and satisfaction. While there were no significant differences in 12-week reduction in Hamilton Depression Rating Scale scores between groups, intervention clients showed an 8-point reduction in comparison with a 0-point reduction among referral clients. CONCLUSIONS "Do More, Feel Better" has the potential of transferring evidence-based behavioral interventions to the hands of supervised lay volunteers and can address the insufficient workforce providing geriatric mental health services.
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Trajectories of Change in a Group Behavioral Activation Treatment for Severe, Recurrent Depression. Behav Ther 2019; 50:504-514. [PMID: 31030869 DOI: 10.1016/j.beth.2018.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 08/21/2018] [Accepted: 08/28/2018] [Indexed: 11/20/2022]
Abstract
Depression is a common and costly problem. Behavioral Activation (BA) is an effective treatment for depression when delivered 1:1, but group treatments often do not perform as well as 1:1 treatments. One way to begin to understand how group treatments perform is to assess the process of change during treatment. This study examined trajectories of change across 10-session group BA for individuals with severe, chronic, or recurrent forms of depression. We also tested whether individuals who had associated sudden gains or depression spikes had better outcomes than those who did not have these change patterns. We examined psychological and sociodemographic predictors of the patterns of change. Participants were 104 individuals who met diagnostic criteria for major depressive disorder and participated in one of 10 BA groups, provided over a 2-year period. A linear, but not quadratic or cubic, rate of change fit the data and the effect size for the change in mood symptoms from baseline to posttreatment was large, Cohen's d = 1.25. Although 34% (26 of the 77 who provided outcome data) of individuals had a sudden gain and 10% (7/77) had a depression spike, neither sudden gains nor depression spikes predicted posttreatment outcomes. None of the demographic or psychological factors (rumination, behavioral activation) predicted the pattern of change. These results suggest that although group BA may help to reduce depressive symptoms in individuals with severe, recurrent, and/or chronic forms of depression, the overall linear pattern of change is different from quadratic patterns of change reported for 1:1 BA.
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Yang JP, Simoni JM, Cheryan S, Shiu CS, Chen W, Zhao H, Lu H. The Development of a Brief Distress Reduction Intervention for Individuals Recently Diagnosed With HIV in China. COGNITIVE AND BEHAVIORAL PRACTICE 2018; 25:319-334. [PMID: 30853776 PMCID: PMC6405229 DOI: 10.1016/j.cbpra.2017.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In China, where there are few mental health resources, the majority of HIV-related efforts have focused on medical treatment and transmission prevention rather than psychosocial support. Yet people living with HIV/AIDS (PLWHA) report high levels of psychological distress, especially upon first receiving their HIV diagnosis. We conducted mixed methods research of a qualitative study with (N = 31) individual interviews and 3 focus groups (n = 6 in each group) of HIV-affected participants, and a quantitative survey (N = 200) with individuals living with HIV in Shanghai and Beijing, China. Our qualitative data revealed themes of forms of distress experienced and types of psychosocial support that our participants wished they could have accessed upon diagnosis as well as suggestions for intervention structure that would be most feasible and acceptable. Our quantitative surveys provided further evidence of the high degree of psychosocial distress among recently diagnosed PLWHA. Our findings informed the development of the Psychology Toolbox intervention, a brief CBT skills-based intervention comprising cognitive restructuring, behavioral activation, and paced breathing, designed to be integrated into primary care for recently diagnosed PLWHA. This study describes the intervention development process and contents of each session. Future research should evaluate the intervention for efficacy as well as examine best strategies for eventual implementation and dissemination.
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Affiliation(s)
| | | | | | | | | | | | - Hongzhou Lu
- Shanghai Public Health Clinical Center, Fudan University
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12
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Effectiveness of Group Behavioural Activation for Depression: A Pilot Study. Behav Cogn Psychother 2017; 45:401-418. [DOI: 10.1017/s1352465816000540] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: The evidence base for behavioural activation (BA) is mainly grounded in the individual delivery method, with much less known about the impact of group delivery. Aims: To conduct a pilot study of behavioural activation in groups (BAG) for depression delivered in a routine service setting, in order to explore acceptability, effectiveness and predictors of outcome. Methods: The manualized group treatment format was delivered in a Primary Care mental health setting, at step three of an Improving Access to Psychological Therapies (IAPT) service. BAG was facilitated by cognitive behavioural psychotherapists, and outcome measures (depression, anxiety and functional impairment) were taken at each session. Seventy-three participants were referred and treated within nine groups. Results: BAG was an acceptable treatment generating a low drop-out rate (7%). Significant pre–post differences were found across all measures. There was a moderate to large depression effect size (d+ = 0.74), and 20% met the criteria for a reliable recovery in depression. Greater severity of initial depression and attendance of at least four BAG sessions predicted better outcomes. Conclusions: BAG appears to be an effective depression treatment option that shows some clinical promise. Further larger and more controlled studies are nevertheless required.
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Samaan Z, Dennis BB, Kalbfleisch L, Bami H, Zielinski L, Bawor M, Litke K, McCabe K, Whattam J, Garrick L, O'Neill L, Tabak TA, Simons S, Chalmers S, Key B, Vanstone M, Xie F, Guyatt G, Thabane L. Behavioral activation group therapy for reducing depressive symptoms and improving quality of life: a feasibility study. Pilot Feasibility Stud 2016; 2:22. [PMID: 27965841 PMCID: PMC5154036 DOI: 10.1186/s40814-016-0064-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 04/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression is associated with a loss of productivity and noticeable personal, social, and economic decline; it affects more than 350 million people worldwide. Behavioral activation (BA), derived from cognitive behavioral therapy, has drawn increasingly more interest as a means of treatment for major depressive disorder due to its relative cost-effectiveness and efficacy. In this study, we disseminate findings from a feasibility study evaluating barriers to implementing a group BA program for major depressive disorder. The purpose of this feasibility study is to assess both patient and clinician perceptions on components of a group-based behavioral activation (BA) program. In particular, this feasibility study provides in-depth evaluation of the acceptability of BA prior to the design and implementation of a randomized trial to investigate BA effectiveness. Findings from this study directly informed decisions regarding the design and implementation of BA during the pilot trial. Specific components of BA were assessed and modified based on the results of this study. METHODS This qualitative study was completed through the Mood Disorders Program at St. Joseph's Healthcare Hamilton. The authors of this study used data from two focus group sessions, one consisting of an interdisciplinary group of clinicians working in the Mood Disorders Program, and the other of registered outpatients of the Mood Disorders Program with a confirmed clinical diagnosis of depression. The benefits of offering this program in a group format, mainly social skill development opportunities and the use of technology such as activity tracking device, smart phones, and tablets during the therapy sessions, are a major focus of both the clinician and patient groups. Both groups emphasized the importance of offering sustainable activation. RESULTS Differences in opinions existed between staff and patient groups regarding the use of technology in the program, though ultimately it was agreed upon that technology could be useful as a therapeutic aid. All participants agreed that behavioral activation was essential to the development of positive habits and routines necessary for recovery from depression. Patients agreed the program looked sustainable and stressed the potential benefit for improving depressive symptoms. CONCLUSIONS Discussions from clinician and patient-centered focus groups directly informed decisions regarding the design and implementation of BA during the pilot trial. Specific components of BA were assessed and modified based on the results of this study. These findings provide insight for clinicians providing behavioral activation programming, and will serve as a framework for the development of the Out of the Blues program, a group-based BA program to be piloted in the Mood Disorders Program at St. Joseph's Healthcare Hamilton. TRIAL REGISTRATION Clinical Trials registration number NCT02045771.
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Affiliation(s)
- Zainab Samaan
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada
| | - Brittany B Dennis
- St. George's University of London, Cranmer Terrace, London, UK ; Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W, Hamilton, ON Canada
| | - Lindsay Kalbfleisch
- Recreational Therapy Program, McMaster University, 1280 Main St. W, Hamilton, ON Canada
| | - Herman Bami
- Faculty of Health Science, McMaster University, 1280 Main St. W, Hamilton, ON Canada
| | - Laura Zielinski
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W, Hamilton, ON Canada
| | - Monica Bawor
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; St. George's University of London, Cranmer Terrace, London, UK
| | - Kathryn Litke
- Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada
| | - Kathleen McCabe
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada
| | - Jeff Whattam
- Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada
| | - Laura Garrick
- Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Laura O'Neill
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada
| | - Terri Ann Tabak
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada
| | - Scott Simons
- Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada
| | - Sandra Chalmers
- Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada
| | - Brenda Key
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada
| | - Meredith Vanstone
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W, Hamilton, ON Canada
| | - Feng Xie
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W, Hamilton, ON Canada
| | - Gordon Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Department of Medicine, McMaster University, 1280 Main St. W, Hamilton, ON Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Biostatistics Unit, Centre for Evaluation of Medicine, ON, Canada ; System-Linked Research Unit, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Department of Anaesthesia, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Department of Paediatrics, McMaster University, 1280 Main St. W, Hamilton, ON Canada
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Choi KH, Jaekal E, Lee GY. Motivational and Behavioral Activation as an Adjunct to Psychiatric Rehabilitation for Mild to Moderate Negative Symptoms in Individuals with Schizophrenia: A Proof-of-Concept Pilot Study. Front Psychol 2016; 7:1759. [PMID: 27895602 PMCID: PMC5107574 DOI: 10.3389/fpsyg.2016.01759] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/26/2016] [Indexed: 12/31/2022] Open
Abstract
Few psychosocial approaches address the negative symptoms of schizophrenia, which shares common features with depression and anxiety. Behavioral activation (BA) is effective for addressing depression and anxiety in adults with various mental disorders. Motivational interviewing (MI) has been successfully applied to address ambivalence or lack of motivation toward treatment. Motivational and behavioral activation (mBA) has been developed by incorporating the core principles from BA and MI with recent findings on the negative symptoms of schizophrenia. In this study, we aimed to examine the feasibility and preliminary efficacy of mBA in a non-randomized controlled pilot study that included individuals with schizophrenia with mild to moderate negative symptoms receiving psychiatric rehabilitation. A total of 73 individuals with schizophrenia were recruited. Forty-seven of the participants who met the study inclusion and exclusion criteria were assigned to either an mBA + usual psychiatric rehabilitation group (mBA) or a usual psychiatric rehabilitation only group (treatment as usual, TAU). Administering mBA to individuals with schizophrenia with mild to moderate negative symptoms was feasible in a community mental health setting. Relative to TAU, mBA was associated with large effects in reducing negative symptoms measured using the Positive and Negative Syndrome Scale (PANSS) and the Brief Negative Symptom Scale (BNSS). However, after considering PANSS cognitive deficits and marital status as covariates due to significant differences in their baseline levels, the treatment effects on the BNSS were partially observed. In addition, participants in the mBA group showed improved verbal learning and memory compared with those in the TAU group. In individuals with schizophrenia receiving the usual forms of psychiatric rehabilitation in a community mental health setting, mBA appears to offer a promising adjunctive approach for addressing mild to moderate negative symptoms. Further investigations are needed to replicate the current findings in a randomized controlled trial.
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Affiliation(s)
- Kee-Hong Choi
- Department of Psychology, Korea University Seoul, Republic of Korea
| | - Eunju Jaekal
- Department of Psychology, Korea University Seoul, Republic of Korea
| | - Ga-Young Lee
- Department of Psychology, Korea University Seoul, Republic of Korea
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15
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Ramnerö J, Folke F, Kanter JW. A learning theory account of depression. Scand J Psychol 2015; 57:73-82. [DOI: 10.1111/sjop.12233] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 04/13/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Jonas Ramnerö
- Department of Psychology; Stockholm University; Stockholm Sweden
| | - Fredrik Folke
- Department of Neuroscience, Psychiatry; Uppsala University; Uppsala University Hospital; Uppsala Sweden
- Center for Clinical Research; Dalarna Sweden
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16
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Magidson JF, Seitz-Brown CJ, Safren SA, Daughters SB. Implementing Behavioral Activation and Life-Steps for Depression and HIV Medication Adherence in a Community Health Center. COGNITIVE AND BEHAVIORAL PRACTICE 2014; 21:386-403. [PMID: 25419102 DOI: 10.1016/j.cbpra.2013.10.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Antiretroviral therapy to treat HIV/AIDS has substantially improved clinical outcomes among patients living with HIV/AIDS, but only in the presence of very consistent adherence. One of the most prevalent and impactful individual-level predictors of poor adherence is depressive symptoms, even at subthreshold levels. Evidence-based cognitive behavioral interventions exist to address improvements in depressive symptoms and adherence in this population, yet these techniques have largely been designed and tested as individual treatments for delivery in mental health settings. This presents a significant challenge when transporting these techniques to medical settings where other formats for delivery may be more appropriate (i.e., groups, less frequent visits) and few hands-on resources exist to guide this process. As such, primary aims of this study were to adapt and implement evidence-based cognitive behavioral techniques for depression (behavioral activation; BA) and HIV medication adherence (Life-Steps) that have potential for dissemination in an outpatient community health center. The intervention incorporated feedback from health center staff and utilized a modular, group format that did not rely on sequential session attendance. Feasibility was examined over 8 weeks (n = 13). Preliminary effects on depression, health-related quality of life, and medication adherence were examined and exit interviews were conducted with a subset of participants (n = 4) to inform future modifications. Treatment descriptions and recommendations for effective clinical implementation based on patient and clinician feedback are provided along with case material of two individual patients and an example group session. Current efforts are an important next step for disseminating evidence-based techniques for depression and HIV medication adherence to community health center or AIDS service organization settings.
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Affiliation(s)
- Jessica F Magidson
- Massachusetts General Hospital/Harvard Medical School and University of Maryland, College Park
| | | | | | - Stacey B Daughters
- University of Maryland, College Park, and University of North Carolina, Chapel Hill
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17
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Adapting manualized Behavioural Activation treatment for older adults with depression. COGNITIVE BEHAVIOUR THERAPIST 2014. [DOI: 10.1017/s1754470x14000038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThere is growing evidence that Behavioural Activation is an effective treatment for older adults with depression. However, there is a lack of detail given in studies about any adaptations made to interventions or efforts made to remove treatment barriers. Factors such as co-morbid physical health problems, cognitive impairment and problems with social support suggest there may be specific treatment considerations when developing interventions for this group. This article aims to describe adaptations made to a general adult Behavioural Activation manual using literature on treatment factors for older adults as an organizational framework. This information may be of use to mental health workers delivering behavioural interventions to older adults with depression and documents the initial phase of developing a complex intervention.
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18
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Pagoto S, Schneider KL, Whited MC, Oleski JL, Merriam P, Appelhans B, Ma Y, Olendzki B, Waring ME, Busch AM, Lemon S, Ockene I, Crawford S. Randomized controlled trial of behavioral treatment for comorbid obesity and depression in women: the Be Active Trial. Int J Obes (Lond) 2013; 37:1427-34. [PMID: 23459323 PMCID: PMC3675166 DOI: 10.1038/ijo.2013.25] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 01/04/2013] [Accepted: 01/13/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Depression is associated with increased risk for obesity and worse weight loss treatment outcomes. The purpose of the present study was to test the hypothesis that delivering evidence-based behavior therapy for depression before a lifestyle weight loss intervention improves both weight loss and depression. DESIGN In a randomized controlled trial, obese women with major depressive disorder (N=161, mean age=45.9 (s.d.: 10.8) years) were randomized to brief behavior therapy for depression treatment followed by a lifestyle intervention (BA) or a lifestyle intervention only (LI). Follow-up occurred at 6 and 12 months. Main outcome measures included weight loss and depression symptoms. RESULTS Intention-to-treat analyses revealed both conditions lost significant weight, but no differences between conditions in weight change at 6 months (BA=-3.0%, s.e.=-0.65%; LI=-3.7%, s.e.=0.63%; P=0.48) or 12 months (BA=-2.6%, s.e.=0.77%; LI=-3.1%, s.e.=0.74%; P=0.72). However, the BA condition evidenced significantly greater improvement in Beck Depression Inventory-II scores relative to the LI condition at both 6 months (BA mean change=-12.5, s.d.=0.85; LI mean change=-9.2, s.d.=0.80, P=0.005) and 12 months (BA mean change=-12.6, s.d.=0.97; LI mean change=-9.9, s.d.=0.93; P=0.045). Participants who experienced depression remission by 6 months (61.2%) lost greater weight (mean=-4.31%; s.e.=0.052) than those who did not (39.7%; mean=-2.47%, s.e.=0.53; P=.001). CONCLUSION Adding behavior therapy to a lifestyle intervention results in greater depression remission but does not improve weight loss within 1 year. Improvement in depression is associated with greater weight loss.
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Affiliation(s)
- S Pagoto
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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Braun SR, Gregor B, Tran US. Comparing bona fide psychotherapies of depression in adults with two meta-analytical approaches. PLoS One 2013; 8:e68135. [PMID: 23840824 PMCID: PMC3695954 DOI: 10.1371/journal.pone.0068135] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 05/25/2013] [Indexed: 01/20/2023] Open
Abstract
Objective Despite numerous investigations, the question whether all bona fide treatments of depression are equally efficacious in adults has not been sufficiently answered. Method We applied two different meta-analytical techniques (conventional meta-analysis and mixed treatment comparisons). Overall, 53 studies with 3,965 patients, which directly compared two or more bona fide psychotherapies in a randomized trial, were included. Meta-analyses were conducted regarding five different types of outcome measures. Additionally, the influence of possible moderators was examined. Results Direct comparisons of cognitive behavior therapy, behavior activation therapy, psychodynamic therapy, interpersonal therapy, and supportive therapies versus all other respective treatments indicated that at the end of treatment all treatments but supportive therapies were equally efficacious whereas there was some evidence that supportive therapies were somewhat less efficacious than all other treatments according to patient self-ratings and clinical significance. At follow-up no significant differences were present. Age, gender, comorbid mental disorders, and length of therapy session were found to moderate efficacy. Cognitive behavior therapy was superior in studies where therapy sessions lasted 90 minutes or longer, behavior activation therapy was more efficacious when therapy sessions lasted less than 90 minutes. Mixed treatment comparisons indicated no statistically significant differences in treatment efficacy but some interesting trends. Conclusions This study suggests that there might be differential effects of bona fide psychotherapies which should be examined in detail.
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Barraca J, Pérez-Álvarez M, Bleda JHL. Avoidance and Activation as Keys to Depression: Adaptation of the Behavioral Activation for Depression Scale in a Spanish Sample. SPANISH JOURNAL OF PSYCHOLOGY 2013; 14:998-1009. [DOI: 10.5209/rev_sjop.2011.v14.n2.45] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In this paper we present the adaptation of the Behavioral Activation for Depression Scale (BADS), developed by Kanter, Mulick, Busch, Berlin, and Martell (2007), in a Spanish sample. The psychometric properties were tested in a sample of 263 participants (124 clinical and 139 non-clinical). The results show that, just as in the original English version, the Spanish BADS is a valid and internally consistent scale. Construct validity was examined by correlation with the BDI-II, AAQ, ATQ, MCQ-30, STAI and EROS. Factor analysis justified the four-dimensions of the original instrument (Activation, Avoidance/Rumination, Work/School Impairment and Social Impairment), although with some differences in the factor loadings of the items. Further considerations about the usefulness of the BADS in the clinical treatment of depressed patients are also suggested.
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Moss K, Scogin F, Di Napoli E, Presnell A. A self-help behavioral activation treatment for geriatric depressive symptoms. Aging Ment Health 2012; 16:625-35. [PMID: 22304676 DOI: 10.1080/13607863.2011.651435] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This study investigated behavioral activation (BA) bibliotherapy as a treatment for late-life depressive symptoms. BA bibliotherapy was administered using Addis and Martell's Overcoming depression one step at a time as a stand-alone treatment that was completed by participants (N=26) over a 4-week period [Addis, M.E., & Martell, C.R. (2004). Overcoming depression one step at a time. Oakland, CA: New Harbinger Publications, Inc.]. Results of an immediate intervention group were compared with those of a delayed treatment control group and treatment response for both groups was evaluated at 1-month follow-up. Primary outcome results showed that symptoms on a clinician-rated measure of depressive symptoms, Hamilton Rating Scale for Depression, were significantly lower at post-treatment for those who received immediate BA bibliotherapy compared with those who were in the delayed treatment control condition. However, self-reported depressive symptoms (a secondary outcome measured via the Geriatric Depression Scale), were not significantly different at this period. Because study control was lost after the delayed treatment group received the intervention, within-subjects analyses examining both treatment groups combined showed that clinician-rated depressive symptoms significantly decreased from pre-treatment to both post-treatment and 1-month follow-up. Self-reported depressive symptoms were significantly lower from pre-treatment to 1-month follow-up. These findings suggest that BA may be useful in treating mild or subthreshold depressive symptoms in an older adult population.
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Affiliation(s)
- Kathryn Moss
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
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22
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Spates CR, Kalata AH, Ozeki S, Stanton CE, Peters S. Initial open trial of a computerized behavioral activation treatment for depression. Behav Modif 2012; 37:259-97. [PMID: 22987916 DOI: 10.1177/0145445512455051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article presents preliminary findings from use of a novel computer program that implements an evidence-based psychological intervention to treat depression based on behavioral activation (BA) therapy. The program is titled "Building a Meaningful Life Through Behavioral Activation". The findings derive from an open trial with moderate to severely depressed individuals (N = 15) in an Intention to Treat sample. Hierarchical linear modeling (HLM) analyses revealed significant change over time on Beck Depression Inventory-Second Edition (BDI-II) scores, Revised Hamilton Depression Rating Scale scores, and significant contribution to BDI-II score variance by participant age over time, change over time in negative automatic thoughts, and change over time in BA scores. Piecewise HLM analyses revealed that significant change over time was associated uniquely with active treatment and not during 3 weeks of baseline measurement. In addition to treatment-associated significant change on all dependent measures over time, effect sizes were in the moderate to large range. Limitations are small sample size, nonrandomized control, research-recruited patients instead of purely treatment-seeking patients, possible rating bias by independent assessors who had knowledge that participants had received active treatment in this open trial, and the influence of additional services received in the post acute-treatment phase by some participants could have contributed to maintenance of gains reported for that period.
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23
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Bailey DL, Arco L. Effects of a Brief Behavioural Activation Treatment on Activities of Various Difficulty and Depression. BEHAVIOUR CHANGE 2012. [DOI: 10.1375/bech.27.3.184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThis study examined, first, effectiveness of a brief behavioural activation treatment for depression, in which participants engaged concurrently in activities of various difficulty instead of a standard least-to-most difficult sequence; and second, the relationship between behavioural self-observations of changes in activity levels and depressive symptomatology. Two adults with mild to moderate BDI-II depressive symptoms participated in a with-in participant multiple baseline study that contained 8 weekly conjoint sessions. Results showed that depression decreased to minimal levels at posttreatment and 1-month follow-up as a function of increases in activities of various difficulty. Results suggest early initiation of more difficult activities, and corroborate the relationship between increased activities and decreased depressive symptoms.
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Samad Z, Brealey S, Gilbody S. The effectiveness of behavioural therapy for the treatment of depression in older adults: a meta-analysis. Int J Geriatr Psychiatry 2011; 26:1211-20. [PMID: 21308789 DOI: 10.1002/gps.2680] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 11/29/2010] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To systematically review the effectiveness of behavioural therapy in depressed older adults. METHODS Electronic databases were searched to July 2009. Reference lists of systematic reviews and identified studies from the search strategy were also screened. Randomised controlled trials (RCTs) of behavioural therapy compared with waiting list controls or other psychotherapies in older adults (aged ≥55 years) with clinical depression were included. One author independently identified studies for inclusion. Two authors extracted data and assessed the included studies for risk of bias. Estimates of depression were combined using a random effects model and the I(2) statistic to examine heterogeneity. RESULTS Four RCTs were included in the meta-analysis. For post-treatment self-rated depression symptoms, behavioural therapy was not significantly more effective than a waiting list control [standardised mean difference (SMD) of -0.52, 95% confidence interval (CI) -1.35 to 0.30, p = 0.21, n = 117], cognitive therapy (SMD of 0.23, 95% CI -0.24 to 0.70, p = 0.33, n = 134) or brief psychodynamic therapy (SMD of -0.37, 95% CI -0.84 to 0.11, p = 0.13, n = 69). For post-treatment clinician-rated depression, behavioural therapy was not significantly more effective than cognitive therapy or brief psychodynamic therapy but was significantly more effective than a waiting list control (weighted mean difference (WMD) of -5.68, 95% CI -7.71 to -3.66, p < 0.001, n = 117). CONCLUSIONS Behavioural therapy in depressed older adults appears to have comparable effectiveness with alternative psychotherapies. Further research is recommended with the need for larger sample sizes, more clarity on trial design and the intervention, longer term follow-up and concomitant economic evaluations.
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Affiliation(s)
- Zara Samad
- Humber Mental Health Trust, Trust Headquarters, Willerby Hill, Willerby, East Yorkshire, UK
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25
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Mairs H, Lovell K, Campbell M, Keeley P. Development and pilot investigation of behavioral activation for negative symptoms. Behav Modif 2011; 35:486-506. [PMID: 21746764 DOI: 10.1177/0145445511411706] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Negative symptoms cause functional impairment and impede recovery from psychosis, not least, because of limited developments in empirically validated treatments. This article details a pilot evaluation of a behavioral activation (BA) treatment with eight people presenting with psychosis and marked negative symptoms. The rationale for this development was that BA is effective in treating depression, a condition that shares overlapping features with negative symptoms. Results provide preliminary support for feasibility and effectiveness of BA for negative symptoms in terms of treatment adherence, retention, and initial outcomes. However, additional advantages may accrue from revisions to the BA treatment.
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Baruch DE, Kanter JW, Bowe WM, Pfennig SL. Improving Homework Compliance in Career Counseling With a Behavioral Activation Functional Assessment Procedure: A Pilot Study. COGNITIVE AND BEHAVIORAL PRACTICE 2011. [DOI: 10.1016/j.cbpra.2010.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dimidjian S, Barrera M, Martell C, Muñoz RF, Lewinsohn PM. The Origins and Current Status of Behavioral Activation Treatments for Depression. Annu Rev Clin Psychol 2011; 7:1-38. [DOI: 10.1146/annurev-clinpsy-032210-104535] [Citation(s) in RCA: 416] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Sona Dimidjian
- Department of Psychology and Neuroscience, University of Colorado, Boulder, Colorado 80309
| | - Manuel Barrera
- Department of Psychology, Arizona State University, Tempe, Arizona 85287
| | - Christopher Martell
- Department of Psychology, University of Washington, Seattle, Washington 98195
| | - Ricardo F. Muñoz
- Department of Psychiatry, University of California, San Francisco, and San Francisco General Hospital, San Francisco, California 94110
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Kanter JW, Santiago-Rivera AL, Rusch LC, Busch AM, West P. Initial Outcomes of a Culturally Adapted Behavioral Activation for Latinas Diagnosed With Depression at a Community Clinic. Behav Modif 2010; 34:120-44. [DOI: 10.1177/0145445509359682] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Latinos demonstrate high rates of depression, often do not seek treatment, and terminate prematurely for a variety of reasons, including lack of sensitivity to contextual and cultural factors in treatment approaches. For decades researchers have suggested a behavioral approach to Latinos diagnosed with depression because such an approach targets the complex environmental stressors experienced by these populations with a simple, pragmatic approach. Recently, behavioral activation has been culturally and linguistically adapted for Latinos/Latinas diagnosed with depression (BA-Latino or BAL). The current study consists of a pilot evaluation of BAL at a bilingual (Spanish—English) community mental health clinic ( N = 10 Latinas). Results provide preliminary support for the feasibility and effectiveness of BAL for Latinas in a community setting in terms of treatment adherence, retention, and outcomes. Implications and future directions are discussed.
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Affiliation(s)
| | | | | | | | - Paul West
- Sixteenth Street Community Health Center, Milwaukee, Wisconsin
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29
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Schneider KL, Bodenlos JS, Ma Y, Olendzki B, Oleski J, Merriam P, Crawford S, Ockene IS, Pagoto SL. Design and methods for a randomized clinical trial treating comorbid obesity and major depressive disorder. BMC Psychiatry 2008; 8:77. [PMID: 18793398 PMCID: PMC2556322 DOI: 10.1186/1471-244x-8-77] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 09/15/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity is often comorbid with depression and individuals with this comorbidity fare worse in behavioral weight loss treatment. Treating depression directly prior to behavioral weight loss treatment might bolster weight loss outcomes in this population, but this has not yet been tested in a randomized clinical trial. METHODS AND DESIGN This randomized clinical trial will examine whether behavior therapy for depression administered prior to standard weight loss treatment produces greater weight loss than standard weight loss treatment alone. Obese women with major depressive disorder (N = 174) will be recruited from primary care clinics and the community and randomly assigned to one of the two treatment conditions. Treatment will last 2 years, and will include a 6-month intensive treatment phase followed by an 18-month maintenance phase. Follow-up assessment will occur at 6-months and 1- and 2 years following randomization. The primary outcome is weight loss. The study was designed to provide 90% power for detecting a weight change difference between conditions of 3.1 kg (standard deviation of 5.5 kg) at 1-year assuming a 25% rate of loss to follow-up. Secondary outcomes include depression, physical activity, dietary intake, psychosocial variables and cardiovascular risk factors. Potential mediators (e.g., adherence, depression, physical activity and caloric intake) of the intervention effect on weight change will also be examined. DISCUSSION Treating depression before administering intensive health behavior interventions could potentially boost the impact on both mental and physical health outcomes. TRIAL REGISTRATION NCT00572520.
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Affiliation(s)
- Kristin L Schneider
- Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, USA.
| | - Jamie S Bodenlos
- Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, USA
| | - Yunsheng Ma
- Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, USA
| | - Barbara Olendzki
- Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, USA
| | - Jessica Oleski
- Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, USA
| | - Philip Merriam
- Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, USA
| | - Sybil Crawford
- Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, USA
| | - Ira S Ockene
- Department of Cardiovascular Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, USA
| | - Sherry L Pagoto
- Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, USA
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Validation of the Behavioral Activation for Depression Scale (BADS) in a Community Sample with Elevated Depressive Symptoms. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2008. [DOI: 10.1007/s10862-008-9088-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hopko DR, Bell JL, Armento M, Robertson S, Mullane C, Wolf N, Lejuez CW. Cognitive-behavior therapy for depressed cancer patients in a medical care setting. Behav Ther 2008; 39:126-36. [PMID: 18502246 DOI: 10.1016/j.beth.2007.05.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Revised: 04/17/2007] [Accepted: 05/24/2007] [Indexed: 01/17/2023]
Abstract
Major depression is the most common psychiatric disorder among cancer patients and is associated with decreased quality of life, significant deterioration in recreational and physical activities, relationship difficulties, sleep problems, more rapidly progressing cancer symptoms, and more metastasis and pain relative to nondepressed cancer patients. Although some research has explored the utility of psychological interventions with cancer patients, only one study to date has explored the potential benefits of cognitive-behavior therapy among cancer patients with well-diagnosed depression. Addressing this gap in the literature, this study represents an open clinical trial to assess the effectiveness of a brief Cognitive-Behavioral Treatment for Depression (CBTD) among depressed cancer patients in a medical care setting. Results revealed strong treatment integrity, good patient compliance, excellent patient satisfaction with the CBTD protocol, and significant pre-post treatment gains across a breadth of outcome measures assessing depression, anxiety, quality of life, and medical outcomes. These gains also were associated with strong effect sizes and generally maintained at 3-month follow-up. Behavioral activation interventions, especially when paired with cognitive techniques, may represent a practical medical care treatment that may improve psychological outcomes and quality of life among cancer patients. Study limitations and future research directions are discussed.
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Affiliation(s)
- Derek R Hopko
- University of Tennessee, Knoxville, Department of Psychology, Knoxville, TN 37996-0900, USA.
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The Behavioral Activation for Depression Scale (BADS): Psychometric Properties and Factor Structure. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2006. [DOI: 10.1007/s10862-006-9038-5] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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