Behavioral Activation For Depression Research Articles

Behavioural activation for people in custody with depression: A protocol for a feasibility randomised controlled study.

People in custody are at high risk of developing depression. Accessing psychological treatments in a prison setting is a particular challenge, in part, due to difficulties accessing specialist mental health workers. Behavioural Activation (BA) may be helpful in improving health outcomes for people in custody experiencing depressive symptoms. The aim of this study is to establish the feasibility and acceptability of custodial health nurses delivering BA to improve depressive symptoms of people in custody. We will conduct a pilot randomised controlled trial with process observation examining the feasibility and acceptability of BA in treating people in custody with depressive symptoms. 60 people in custody presenting with depressive symptoms will be randomised to receive BA plus treatment as usual (TAU) or TAU provided by custodial health nurses. Eight custodial health nurses will be recruited, trained, and deliver BA. BA will be delivered twice a week for six weeks, with sessions lasting up to 30 minutes. Changes in depression and quality of life (QoL) will be assessed at baseline, 6 weeks, and 3 months post-intervention. Participants will be interviewed to understand feasibility and acceptability of BA in prison settings. The findings will inform the design of a randomised controlled trial to test the efficacy of BA for people in custody with depression. Findings will help determine whether BA for depression is suited to prison health care system and services. Improving depressive symptoms in people in custody has benefits beyond prison settings. The Central Adelaide Local Health Network Human Research Ethics Committee and University of South Australia Human Research Ethics Committee have approved the study. The trial results will be disseminated through peer-reviewed journals and scientific conferences and reported to local stakeholders and policy makers. If feasibility and acceptability is demonstrated, we will seek to progress to an effectiveness study. A potential strength of the trial model proposed, is in its scalability, with potential to increase the trial sites and locations. This trial has been prospectively registered with the Australian New Zealand Clinical Trials Registry (reference number: ACTRN12623000346673p). Trial registration ACTRN12623000346673p.

Behavioral activation for depression in patients with advanced cancer: study protocol for a multicenter randomized controlled trial

BackgroundThough behavioral activation (BA) has been shown to be effective for depression, evidence in patients with advanced cancer has not been established. This study aimed to examine the effectiveness of a BA program on depression in this population.MethodsA randomized controlled trial with a wait-list control group (waiting group) of 38 patients with advanced cancer and depression will be conducted at three sites in Japan. The BA program consists of seven sessions. Outcome measures will be evaluated at three times in the intervention group; at the entry, at the end of the intervention and 4 months after the end of the intervention and four times in the waiting group: at the entry, before the intervention, at the end of the intervention, and 4 months after the end of the intervention. Primary outcome is Beck Depression Inventory-II (BDI-II) score. To examine the main effect of the intervention, two-way repeated measures analysis of variance (ANOVA) will be conducted, with timing and intervention status as the independent variables and BDI-II score as the dependent variable. One-way repeated measures ANOVA will be conducted to combine data from the intervention and control groups and examine changes in BDI-II scores by timing in both groups. Secondary endpoints (anxiety, quality of life, spirituality, degree of behavioral activation, value, and pain) will be evaluated with rating scales. Two-way repeated measures ANOVA will be conducted to examine whether there are differences between the groups before and after the intervention, with timing and intervention status as the independent variables and scores on each rating scale as the dependent variables.DiscussionThis multicenter randomized controlled trial is the first study to assess the effectiveness of BA on depression in patients with advanced cancer. Our findings will provide evidence about the effectiveness of BA on depression and provide an intervention option that is acceptable and feasible for the treatment of depression in this population. The results of this study will lead to improved mood and rebuilding to regain life purpose and value in this vulnerable population.Trial Registration NumberjRCT, jRCT1030210687, Registered 22 March 2022, https://jrct.niph.go.jp/en-latest-detail/jRCT1030210687.

The Full Spectrum of Behavioral Activation in Older Adults: A Scoping Review

<h3>Introduction</h3> Mental health concerns are common in older adults, and include many symptoms that may not meet criteria for specific DSM-5 diagnoses but which nevertheless affect patients' overall functioning and quality of life. However, timely access to quality mental health care remains inadequate in many communities. Behavioral activation (BA) is a brief psychotherapeutic treatment modality that is gaining momentum as a readily deployable intervention for addressing mental health needs in older adults. Early in its development, BA was primarily conceptualized as a treatment for patients with depression. Since its inception, the intervention has found utility in a broad range of patient populations and conditions beyond what most clinicians and researchers originally imagined. BA has the advantage of being able to be implemented by a range of provider types—e.g., health educators, physicians, mental health providers, family caregivers and community volunteers. Although several reviews have summarized the literature on BA for depression in older adults, there has not been a comprehensive scoping review that has looked broadly at the full spectrum of BA in older adults (i.e., beyond its use for depression). Therefore, the primary objective of this scoping review is to provide a comprehensive overview of the literature on the use of behavioral activation with older adults. This overview includes a categorization of the target conditions (e.g., depression, anxiety), specific populations studied (e.g., caregivers, ethnic minorities, veterans), context or setting (e.g., outpatient vs. inpatient), modality of BA use (i.e., stand-alone vs. incorporated into a larger treatment protocol), and type of individuals delivering the intervention. The aim of this full spectrum review is to provide a comprehensive snapshot of the work done to-date while also highlighting areas of growth for targeted dissemination and knowledge gaps for future study. <h3>Methods</h3> In order to conduct a comprehensive, scoping review of the literature on BA, we utilized both a wide date range as well as broad search criteria. We searched for manuscripts published from 1980 to 2020 in PubMed, PsycInfo, Cochrane, and EMBASE. All types of literature were eligible for inclusion (e.g., reviews, randomized clinical trials, case studies, book chapters). The search strategy consisted of selected keywords and combinations of keywords, which were selected to be inclusive of most scholarly work in the field (e.g., behavio(u)ral activation, older adult, geriatric, depression, anxiety). We did not exclude any specific diagnoses or conditions, as we sought to paint as comprehensive a picture as possible of the landscape related to BA. <h3>Results</h3> The database search strategy yielded 3953 articles; after removing duplicates, 1335 unique publications remained (see attached Figure, PRISMA diagram). Selection of publications for the final scoping review consists of two stages of screening. Initial inclusion criteria were: 1) title or abstract included specific and clear reference to behavioral activation; AND 2) clear focus of article or mean age of participants ≥ 50, OR unclear age of participants (leading to a need for additional screening). These initial inclusion criteria resulted in 640 records which were identified as either: 1) meeting inclusion criteria; OR 2) in need of additional screening in the second stage. Our team is currently conducting the second stage of screening for final inclusion, by retrieving identified manuscripts and reviewing the full text to determine age of participants. The final number, scope, and nature of records/publications included in the scoping review will be presented in the poster. <h3>Conclusions</h3> By casting a very wide net with our search strategy, we have uncovered a collection of articles whose breadth and depth were eye-opening—even to the seasoned BA provider. This broad spectrum of work to date with older adults, as well as their caregivers, underscores the transdiagnostic applicability of BA; targets of intervention or study included mental health conditions (e.g., depression, anxiety, substance use, PTSD, OCD, complicated bereavement, eating and sleep disorders), physical conditions (e.g. high blood pressure, diabetes, obesity, frailty) and psychosocial issues (e.g. loneliness, isolation, grief and loss, spiritual connectedness). This broad search revealed a diverse and surprisingly extensive range of life challenges addressed, in an array of contexts (e.g., in-home, community based, outpatient and inpatient settings), and with adaptations to render BA appropriate for a multitude of languages and cultures. It is hoped that this scoping review will not only identify areas in need of further study, but will thoroughly document the state of the field, giving a boost to dissemination efforts aimed at addressing the growing mental health needs of older adults. <h3>This research was funded by</h3> N/A. Chart: https://apps.aagponline.org/abstracts/uploads/2022/08n7lpw0gg4oebo.pdf

Feasibility trial of an integrated treatment "Activate for Life" for physical and mental well-being in older adults

Professional caregivers rely on formal training when managing pain among patients with dementia, but family caregivers (FCGs) lack this foundation. Instead, FCGs use informal sources that may reflect a values-driven decision-making process. Few studies have examined how FGCs’ personal values impact pain management for dementia patients. We sought to examine the influence of personal values on pain management among FCGs for community-dwelling older adults with dementia using qualitative descriptive methods. Twenty-five adult FCGs, aged from 29 to 95, were recruited in central Virginia. Participants were predominantly white, married, female, and high school graduates. We conducted semi-structured interviews that were audio recorded and analyzed using constant comparative analysis. Four themes emerged: 1) Priority for pain management: when quality of life is valued over other factors (i.e., length of life), priorities focused on no pain, leading to better pain management; 2) Moral perspectives: negative views toward drugs, especially opioids, led to less use and greater report of pain; 3) Beliefs about alternative therapy: negative views led to less likely use of non-traditional approaches and reports of more pain, and 4) Personal experience of pain: past personal experiences of pain (negative or positive) influenced the priority placed on pain management and the FCG’s ability to provide effective pain management. The diverse views held by FCGs demonstrate a value-based process and suggest a modifiable factor in pain management. Helping FCGs reflect biases while reinforcing values that improve pain management would lead to improve pain and quality of life for older adults with dementia.

An evaluation of a combined psychological and parenting intervention for HIV-positive women depressed in the perinatal period, to enhance child development and reduce maternal depression: study protocol for the Insika Yomama cluster randomised controlled trial

BackgroundThe combination of poverty, HIV and depression in the perinatal period represents a major public health challenge in many Southern African countries. In some areas, up to a third of HIV-positive women experience perinatal depression. Perinatal depression is associated with negative effects on parenting and key domains of child development including cognitive, behavioural and growth, especially in socio-economically disadvantaged communities. Several studies have documented the benefits of psychological interventions for perinatal depression in low- and middle-income countries, but none have evaluated an integrated psychological and parenting intervention for HIV-positive women using task-sharing. This randomised controlled trial aims to evaluate the effect of a home-based intervention, combining a psychological treatment for depression and a parenting programme for perinatally depressed HIV-positive women.MethodsThis study is a cluster randomised controlled trial, consisting of 48–60 geospatial clusters. A total of 528 pregnant HIV-positive women aged ≥ 16 years who meet the criteria for depression on the Edinburgh Postnatal Depression Scale (EPDS, score ≥ 9)) are recruited from antenatal clinics in rural KwaZulu-Natal, South Africa. The geospatial clusters are randomised on an allocation ratio of 1:1 to either the intervention or Enhanced Standard of Care (ESoC). The intervention group receives 10 home-based counselling sessions by a lay counsellor (4 antenatal and 6 postnatal sessions) and a booster session at 16 months. The intervention combines behavioural activation for depression with a parenting programme, adapted from the UNICEF/WHO Care for Child Development programme. The ESoC group receives two antenatal and two postnatal counselling support and advice telephone calls.In addition, measures have been taken to enhance the routine standard of care.The co-primary outcomes are child cognitive development at 24 months assessed on the cognitive subscale of the Bayley Scales of Infant Development-Third Edition and maternal depression at 12 months measured by the EPDS.AnalysisThe primary analysis will be a modified intention-to-treat analysis. The primary outcomes will be analysed using mixed-effects linear regression.DiscussionIf this treatment is successful, policymakers could use this model of mental healthcare delivered by lay counsellors within HIV treatment programmes to provide more comprehensive services for families affected by HIV.Trial registrationISRCTN registry #11284870 (14/11/2017) and SANCTR DOH-27-102020-9097 (17/11/2017).

Behavioral Activation as an \u2018active ingredient\u2019 of interventions addressing depression and anxiety among young people: a systematic review and evidence synthesis

BackgroundPsychological interventions such as behavioral activation (BA) that focus on overt behaviors rather than complex cognitive skills may be developmentally well-suited to address youth mental health problems. The current systematic review synthesized evidence on the characteristics, effectiveness and acceptability of behavioral activation (BA) to examine its role as a potential ‘active ingredient’ for alleviating depression and anxiety among young people aged 14 to 24 years.MethodsEvidence across the following sources were synthesized: (i) randomized control trials (RCT) evaluating interventions where BA has been used as a standalone intervention or as part of a multicomponent intervention, (ii) qualitative studies examining the acceptability of BA as an intervention or as a coping strategy among young people with lived experiences. Consultations with a youth advisory group (YAG) from India were used to draw inferences from existing evidence and identify future research priorities.ResultsAs part of the review, 23 RCTs were identified; three studies examined BA as a standalone intervention, and the remaining studies examined multicomponent intervention where BA was a constituent element. The intervention protocols varied in composition, with the number of intervention elements ranging between 5 to 18. There was promising but limited evidence in standalone interventions for thse effectiveness of BA for depression. The impact of BA in multicomponent interventions was difficult to evaluate in the absence of focal assessment of activation outcomes. Evidence from 37 additional qualitative studies of youth lived experience literature, corroborated by the YAG inputs, indicated that young people preferred using behavioral strategies similar to BA to cope with depression in their own life. Themes indicated that the activities that are important to an individual and their socio-contextual factors need to be considered in the planning and implementing BA intervention. Evidence for the use of BA in anxiety was limited across data sources.ConclusionsOverall, there was preliminary empirical evidence for the effectiveness and acceptability of BA for youth depression. Further research is needed to examine the components and mechanisms that contribute to its effectiveness as an active intervention ingredient for depression and anxiety.

Behavioural activation for depression in rural Australia: Challenges and opportunities.

Behavioural activation for depression in rural Australia: Challenges and opportunities.

Activation level as a mediator between behavioral activation, sex, and depression among treatment-seeking smokers

IntroductionBehavioral activation (BA) has gained interest when combined with tobacco interventions as it relates to improved depression and cessation rates. However, no prior efforts have examined mediators of BA effectiveness and sex-dependent effects. This secondary analysis assesses the main and interactive effects of sex and type of smoking cessation intervention [a cognitive behavioral treatment (CBT) only, or CBT + BA] on depressive symptoms among treatment-seeking patients with depression. It also examines the activation level as a mediator between BA, BA by sex, and depression. Method120 smokers were assigned to an 8-week CBT or to CBT + BA. They completed the Beck Depression Inventory-II (BDI-II) and the Behavioral Activation for Depression scale-short-form (BADS-SF). A two-way ANOVA assessed the effects of sex and treatment condition on participants’ BDI-II scores. A moderated mediational analysis tested whether the indirect effect of treatment condition on BDI-II through BADS-SF differed by sex. ResultsAfter controlling for end-of-treatment smoking status and baseline BDI-II, there were no significant effects of treatment condition, sex, and their interaction on end-of-treatment BDI-II. Being a male was indirectly associated with higher BDI-II scores through lower BADS-SF score (point estimate = −3.440; SE = 1.637; BC 95% CI [−7.105, −0.749]). This effect was not found for women. ConclusionsThere is a need to tailor interventions by sex when treating smokers with depression. It is recommended to assess symptoms such as mental rumination or self-consciousness, which tend to be more pronounced in women.

A qualitative study exploring adolescents' experience of brief behavioural activation for depression and its impact on the symptom of anhedonia.

Anhedonia, the loss of interest and pleasure, is a core symptom of depression and is associated with deficits in reward processing. Behavioural Activation for depression may address this symptom due to its focus on identifying and increasing intrinsically rewarding activities. This was a qualitative study employing reflexive thematic analysis (TA). Participants were eight treatment-seeking adolescents with a recent primary diagnosis of depression who had received eight sessions of Brief Behavioural Activation. Qualitative semi-structured interviews were conducted after treatment was completed. Three main themes emerged: (1) connecting, reviewing, and taking action: 'focus on getting better rather than what you're feeling'; (2) struggles, restrictors, and motivators: 'it seemed really unachievable'; and (3) feeling, acting, or seeing things differently: 'looking forwards in a more healthy way'. Both specific Brief Behavioural Activation strategies (e.g., connecting with values) and more generic therapeutic strategies (e.g., self-monitoring) may be helpful in treating the symptom of anhedonia in adolescent depression. Motivational aspects of anhedonia, as well as anxiety, fatigue, and academic pressures act as potential barriers to recovery. This highlights the need for psychological treatments for adolescent depression to include explicit and targeted strategies to enhance motivation. Young people reported that specific Brief Behavioural Activation strategies (e.g., connecting with values) and more generic therapeutic techniques (e.g., self-monitoring) had a role in treating anhedonia. Barriers to engaging in Brief BA included: motivational anhedonia, fatigue, and academic demands.

ENGAGEMENT IN SOCIALLY REWARDING ACTIVITIES AS A PREDICTOR OF OUTCOME IN BEHAVIORAL ACTIVATION THERAPY FOR LATE LIFE DEPRESSION

Introduction Late life depression has detrimental effects on older adults’ functioning and well-being. Depressed older adults often experience loneliness and social isolation, which are risk factors for incident depression, increased depression severity, and medical illness. Neurobiological studies suggest that depressed individuals of all ages exhibit impairments in the reward systems and recent studies suggest that socially rewarding experiences may be especially important for depressed older adults. Results of a pilot study conducted by our group has shown that “Engage”, a neurobiologically informed, streamlined brief behavioral activation for depression, led to significant reduction in depressive symptoms. “Engage” targets impairments in positive valence system function through “reward exposure” (i.e. engagement in rewarding and meaningful activities). However, it is unknown whether engagement in certain types of rewarding activities is more beneficial than others. We predicted that given the centrality of social isolation in late life depression, social (versus non-social) rewarding activities would predict greater improvement in depression severity. Methods Forty-eight older adults with unipolar depression without cognitive impairment received 9 sessions of “Engage” psychotherapy. Depression severity was assessed using the Montgomery–Asberg Depression Rating Scale (MADRS) and behavioral activation was measured using the Behavioral Activation for Depression Scale (BADS) at baseline, weeks 6 and 9. We also assessed depression severity on a weekly basis using the Patient Health Questionnaire (PHQ-9). Patients’ weekly behavioral plans were categorized into three groups: a) solitary activities; b) social-group activities (attending a social gathering or going to a social setting such as church or a senior center); c) social-individual activities (engaging in an interpersonal interaction with a specific friend and/or family member). Results Logistic regression analyses showed that higher percentage of social-individual activities (compared to solitary and social-group activities) predicted subsequent improvement in depressive symptoms and increase in behavioral activation, when controlling for baseline scores on MADRS and BADS respectively. Preliminary analysis suggests that patients who selected social individual activities, in addition to solitary and social group activities, had a steeper reduction of depression by the third session compared to patients lacking social individual activities in their reward exposure plans. This observation suggests that engagement in social individual activities is associated with early response of depression to Engage. Conclusions Our preliminary results suggest that exposure to socially rewarding experiences could contribute to the efficacy of psychotherapy for late-life depression. Additionally, these findings highlight the importance of studying the effects of engagement in specific types of rewarding activities in behavioral activation treatment for late-life depression. This research was funded by P50 MH113838 R01 MH102252 T32 MH019132

Supplemental Material for A Randomized Controlled Trial of an Online, Modular, Active Learning Training Program for Behavioral Activation for Depression

Supplemental Material for A Randomized Controlled Trial of an Online, Modular, Active Learning Training Program for Behavioral Activation for Depression

A behavioural approach to helping an older adult with a learning disability and mild cognitive impairment overcome depression

Accessible summary Older people with learning disabilities who develop memory problems are likely to feel sad. There is much information showing how people with learning disabilities can learn new behaviours which help them to think differently and feel better. This is the story of how I helped one older man with learning disabilities and memory problems to change how he was behaving and feel happier. AbstractBackground: There is a considerable body of evidence to suggest that behavioural activation for depression is an equally effective but less complex treatment than cognitive behavioural therapy. It may therefore be more suitable for those who are cognitively impaired (i.e. early‐stage dementia or mild cognitive impairment) or have a learning disability.Materials and Methods: A case study is presented that outlines how a behavioural approach was used to support an older adult with a learning disability and mild cognitive impairment who was depressed. It was delivered by the carer liaison practitioner employed by a memory service.Results: The client's score on the GDS‐LD reduced from 23 to 5 and on the GAS‐ID from 19 to 11 indicating a clinically significant improvement in his symptoms of depression and anxiety at post‐treatment. Mood ratings on the Ottawa Mood Scales rose from 2/10 to 7/10. Increased engagement in activities and an improvement in the client's problem‐solving abilities were evident.Conclusions: The case study demonstrates the clinical utility of behavioural activation as a treatment for depression in an older adult with a learning disability and mild cognitive impairment. This matches the findings of other studies of behavioural activation as an intervention to treat depression in older adults. However, the client did not have a formal diagnosis of learning disability and may therefore be atypical. More comprehensive studies, including randomised controlled trials, are needed to confirm these findings and more thoroughly test the effectiveness of behavioural interventions with this client group.

Adapting brief Behavioural Activation (BA) for adolescent depression: a case example

AbstractThere is an increasing evidence base for the effectiveness of Behavioural Activation in treating adult depression; however, there has been little investigation of using this approach with adolescents. This article reports on the adaptation of brief Behavioural Activation for Depression (BATD) for adolescents (BATD-A). A case study is reported to illustrate the brief structured approach, treatment response as indicated by routine outcome measures, and the family's view of the intervention. The adaptations made to the adult BATD manual are discussed including parental input, adapted values and activities, and engagement issues. It is hoped that following further evaluation, BATD-A could be successfully delivered as a low-intensity intervention for depression.

Sudden gains in behavioural activation for depression

Sudden gains have been linked to improved outcomes in cognitive behaviour therapy for depression. The relationship between sudden gains and outcome is less clear in other treatment modalities, including interpersonal psychotherapy and supportive expressive therapy, which may indicate different mechanisms of change between treatment modalities. The current study examined sudden gains in adults meeting diagnostic criteria for depression (N = 40) offered up to 12 sessions of behavioural activation treatment. Sudden gains were found in 42.5% of the sample. Sudden gains occurred early (median pre-gain session 2) and were related to outcome: those who experienced a sudden gain had significantly lower post-treatment scores on the PHQ-9. Furthermore, the proportion meeting the reliable and clinically significant change criteria at end of treatment was higher in the sudden gain group. These findings highlight the importance of understanding the mechanisms by which sudden gains relate to therapy outcome in behavioural activation.

Design and methodology of a randomized clinical trial of home-based telemental health treatment for U.S. military personnel and veterans with depression

Home-based telemental health (TMH) treatments have the potential to address current and future health needs of military service members, veterans, and their families, especially for those who live in rural or underserved areas. The use of home-based TMH treatments to address the behavioral health care needs of U.S. military healthcare beneficiaries is not presently considered standard of care in the Military Health System. The feasibility, safety, and clinical efficacy of home-based TMH treatments must be established before broad dissemination of home-based treatment programs can be implemented. This paper describes the design, methodology, and protocol of a clinical trial that compares in-office to home-based Behavioral Activation for Depression (BATD) treatment delivered via web-based video technology for service members and veterans with depression. This grant funded three-year randomized clinical trial is being conducted at the National Center for Telehealth and Technology at Joint-base Lewis-McChord and at the Portland VA Medical Center. Best practice recommendations regarding the implementation of in-home telehealth in the military setting as well as the cultural and contextual factors of providing in-home care to active duty and veteran military populations are also discussed.

Assessing depression in obese women: An examination of two commonly-used measures

ObjectiveObesity and depression are associated with somatic complaints that may complicate the measurement of depression in obese individuals. The Beck Depression Inventory-II (BDI-II) and the Hamilton Rating Scale for Depression (HRSD) are frequently used to measure depression severity. The BDI-II and HRSD's ability to measure depression severity may be compromised in those with obesity, to the extent that scores on their somatic items stem more from obesity than from depression. This study examined the: 1) internal consistency of the BDI-II and HRSD among obese women who varied in depressive symptomatology and 2) total and item-level change in the measures among participants who met the criteria for depression remission at 6-months. MethodsData were from a randomized controlled trial of obese women with depression who received either behavioral activation for depression followed by a lifestyle intervention or a lifestyle intervention with attention control. ResultsAt screening (n=355), internal consistency was strong for the BDI-II (α=0.89), but moderate for the HRSD (α=0.67). Among the participants who met the criteria for depression remission following treatment (n=115), every BDI-II item showed significant change at 6-months. In contrast, three HRSD items did not significantly change: the anxiety—somatic (p=0.063), somatic symptoms—gastrointestinal (p=1.000) and loss of weight (p=0.319) items. ConclusionThe BDI-II may be more reliable and sensitive to change than the HRSD in obese women with comorbid depression. Intervention studies involving obese, depressed women should consider these findings in selecting depression outcome measures.

Behavioral activation for depression in older adults: theoretical and practical considerations.

Late-life depression (LLD) is a major public health concern that can have devastating effects on older individuals and their families. Behavioral theories predict that decreases in response-contingent positive reinforcement and increases in negatively reinforced avoidance behaviors, often accompanied by aversive life events, result in the selection and maintenance of depression. Based on these theories, behavioral activation treatments for depression are designed to facilitate structured increases in enjoyable activities that increase opportunities for contact with positive reinforcement. We discuss the applicability of behavioral models for LLD, and we briefly review current behavioral activation interventions for LLD with an emphasis on implications for future behavior-analytic research. Behavioral activation has been demonstrated to be effective in reducing depression and increasing healthy behavior in older adults. Potential challenges and considerations for future research are discussed. We suggest that applied behavior analysts and clinical behavior analysts are particularly well suited to improve and expand on the knowledge base and practical application of behavioral activation interventions with this population.

Behavioral Activation for Depression: A Clinician's GuideBehavioral Activation for Depression: A Clinician's Guide MartellChristopher R.Ph.D., A.B.P.P. DimidjianSonaPh.D. and Herman-DunnRuthPh.D.; New York, Guilford Press, 2010, 220 pages, $35

Introduction: The Development of Behavioral Activation. The Core Principles of Behavioral Activation. The Structure and Style of Therapy. Identifying the Ingredients of the Behavioral Antidepressant. Activity Scheduling and Structuring. Solving Problems and Countering Avoidance. How Thinking Can Be Problematic Behavior. Troubleshooting Problems with Activation. Tying it All Together: Relapse Prevention and Beyond. Appendix 1: Charts and Worksheets for Depressed Clients. Appendix 2: Notebook and Weekly Therapy Plan. Appendix 3: Notebook and Posttherapy Plan. Appendix 4: ACTIVATE Reference Sheet for Therapists.

Treatment failure in behavior therapy: focus on behavioral activation for depression

Behavioral activation (BA) has come to be recognized as an empirically supported treatment for depression. Despite the general success of the approach, many patients experience treatment failure. Based on behavioral models of depression, we present several reasons for treatment failure in BA, including patient inability to understand and adopt the treatment rationale, lack of awareness or ability to articulate and behave according to life values, behavioral noncompliance, and ineffectiveness of contingency management to increase exposure to environmental rewards and reduce contact with both aversive environmental events and reinforcement of depressed behavior. A case study of treatment failure with a depressed breast cancer patient is presented, along with recommendations to reduce failure rates in BA.

Book Review: Cognitive-Behavioural Therapy for Depression: Behavioral Activation for Depression: A Clinician's Guide

Book Review: Cognitive-Behavioural Therapy for Depression: Behavioral Activation for Depression: A Clinician's Guide