Behavioral Activation Program Research Articles

Effects of behavioral activation program without psychotropic medication treatment for depression in late adolescence: case report

BackgroundA Japanese study revealed that 20.7% of first-year undergraduate students had a major depressive episode during the previous 12 months: first-year undergraduate students with depression need early support. Reportedly, antidepressant medication use during adolescence is associated with modestly increased risk of suicidality. This case study of a late-adolescent woman with depression illustrates the effects of behavioral activation without psychotropic medication.Case presentationA first-year undergraduate student was diagnosed as having major depressive disorder. From earlier studies, we developed a behavioral activation program for late-adolescent people with major depressive disorder. Behavioral activation administered in 10 weekly 60-minute sessions decreased depressive symptoms, avoidant behaviors, and rumination. Moreover, the Beck Depression Inventory, second version score was 1 at 1-year follow-up.ConclusionResults of this case study show that behavioral activation is effective without psychotropic medication. Future studies of large samples must be conducted to assess the effectiveness of behavioral activation without psychotropic medication for depression in late adolescence.

Behavioral Activation Intervention Delivered by a Community Physician to Treat Depressed Female Patients Resident at King Faisal National Guard Residential City in Jeddah, from 18 Years Old and More, Randomized Control Trial, 2017

Background: Depression becomes one of the commonest mental illness that needs early screening and intervention. Behavioral activation is one of the treatment modalities that can be conducted by trained health care professional. The patient learned how to cope with depression using the behavioral activation technique and that can lead to prevent future relapse. Aim: To apply behavioral activation intervention in the primary health care centers and to be delivered by trained nurses. Objectives: This Randomize controlled trial (RCT) conducted to study the effectiveness of behavioral activation intervention among depressed patients. Methodology: Depressed patients were recruited through a community screening using the Beck Depression Inventory II (BDI-II) questionnaire, 16 participants volunteered and randomize for the RCT stage in a ratio of intervention to control (1:1). Post intervention assessment conducted by (BDI-II). Behavioral activation working sheets used during the intervention. Result: The behavioral activation is effective and simple intervention with significant P value among the interventional group (P=0.017). Conclusion: The behavioral activation intervention is effective to manage the depression among the study population. A nationwide survey to accurately determine the cost-effectiveness of behavioral activation program to reduce the burden on health care system is required.

Creating change: implementation of an inpatient behavioural activation programme on a psychiatric intensive care unit

Creating change: implementation of an inpatient behavioural activation programme on a psychiatric intensive care unit

The effect of a behavioral activation program on improving mental and physical health complaints associated with radiation stress among mothers in Fukushima: a randomized controlled trial.

BackgroundMothers living with small children in Fukushima prefecture may experience radiation anxiety and related symptoms after the Fukushima Dai’ich Nuclear Power Plant Accident. A behavioral activation (BA) program was developed to improve their psychosomatic symptoms. The purpose of this randomized controlled trial was to examine the effectiveness of a BA program for improving psychological distress and physical symptoms among mothers with preschool children in Fukushima-prefecture 3 years after the Fukushima Daiichi Nuclear Power Plant accident.MethodsParticipants were recruited from mothers living with a preschool child(ren) in Fukushima city and surrounding areas though a newspaper advertisement, posters, and flyers. Participants allocated to the intervention group received a newly developed group-based BA program, which consisted of two 90- min lessons with a 1-week interval. Psychological distress and physical symptoms as a primary outcome, and radiation anxiety and positive well-being (liveliness and life satisfaction) as a secondary outcome, were measured at baseline, 1- and 3-month follow-ups.ResultsParticipants were randomly allocated to either an intervention or a control group (18 and 19, respectively). The BA program showed a marginally significant intervention effect on psychological distress (p = 0.051) and physical symptoms (p = 0.07) at 1-month follow-up, while the effect became smaller at 3-month follow-up. The effect sizes at 1-month were medium to large (-0.72 and -0.56, respectively). There was a significant intervention effect on increasing liveliness at 3-month follow-up (p = 0.02); and there were marginally significant effects on life satisfaction at 1- and 3-month follow-ups (both p = 0.09).ConclusionsThis BA program may be effective for improving psychological distress, physical symptoms, and well-being, at least for a short duration, among mothers with preschool children after the nuclear power plant accident in Fukushima, while a further large-scale study is needed.Trial registrationThe UMIN Clinical Trials Registry (UMIN-CTR; ID = UMIN000014081). Registered 27 May 2014.

Behavioral activation group therapy for reducing depressive symptoms and improving quality of life: a feasibility study.

BackgroundDepression 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.MethodsThis 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.ResultsDifferences 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.ConclusionsDiscussions 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 registrationClinical Trials registration number NCT02045771

Behavioral activation for late adolescents with subthreshold depression: a randomized controlled trial.

The main behavioral characteristic of subthreshold depression that is observed in adolescents is the low frequency of exposure to environmental rewards. Therefore, it was considered that a simple intervention conducted in short sessions, focusing on increasing access to positively reinforcing activities, would be efficacious in increasing the availability of rewards. We conduct a randomized controlled trial to examine the efficacy of such a behavioral activation program that was conducted weekly for 5weeks in 60-min sessions. Late adolescent university students aged 18-19years with subthreshold depression were randomly allocated to a treatment (n=62) or a control group (n=56). The primary outcome of the study was the Beck Depression Inventory-II score. Results indicated that late adolescent students in the treatment group showed significant improvements in their depressive symptoms (effect size -0.90, 95% CI -1.28 to -0.51) compared to the control group. Students in the treatment group also showed significant improvements in self-reported rating of quality of life and in behavioral characteristics. It is concluded that this intervention had a large and significant effect despite being short and simple and that this low-intensity cognitive behavioral therapy program could be conducted in many different types of institutions. It is suggested that the long-term effects of the treatment program should be targeted for investigation in future studies.

Development and Initial Evaluation of a Telephone-Delivered, Behavioral Activation, and Problem-Solving Treatment Program to Address Functional Goals of Breast Cancer Survivors

The purpose of this research was to develop and pilot test an intervention to optimize functional recovery for breast cancer survivors. Over two studies, 31 women enrolled in a goal-setting program via telephone. All eligible women enrolled (37% of those screened) and 66% completed all study activities. Completers were highly satisfied with the intervention, using it to address, on average, four different challenging activities. The longitudinal analysis showed a main effect of time for overall quality of life (F(5, 43.1) = 5.1, p = 0.001) and improvements in active coping (F (3, 31.7) = 4.9, p = 0.007), planning (F (3, 36.0) = 4.1, p = 0.01), reframing (F (3, 29.3) = 8.5, p < 0.001), and decreases in self-blame (F (3,31.6) = 4.3, p = 0.01). The intervention is feasible and warrants further study to determine its efficacy in fostering recovery and maximizing activity engagement after cancer treatment.

The Adolescent Behavioral Activation Program: Adapting Behavioral Activation as a Treatment for Depression in Adolescence

This study aimed to examine implementation feasibility and initial treatment outcomes of a behavioral activation (BA) based treatment for adolescent depression, the Adolescent Behavioral Activation Program (A-BAP). A randomized, controlled trial was conducted with 60 clinically referred adolescents with a depressive disorder who were randomized to receive either 14 sessions of A-BAP or uncontrolled evidenced-based practice for depression. The urban sample was 64% female, predominantly Non-Hispanic White (67%), and had an average age of 14.9 years. Measures of depression, global functioning, activation, and avoidance were obtained through clinical interviews and/or through parent and adolescent self-report at preintervention and end of intervention. Intent-to-treat linear mixed effects modeling and logistic regression analysis revealed that both conditions produced statistically significant improvement from pretreatment to end of treatment in depression, global functioning, and activation and avoidance. There were no significant differences across treatment conditions. These findings provide the first step in establishing the efficacy of BA as a treatment for adolescent depression and support the need for ongoing research on BA as a way to enhance the strategies available for treatment of depression in this population.

Transdiagnostic Behavior Therapy for Bullying-Related Anxiety and Depression: Initial Development and Pilot Study

The majority of school-age youth experience some form of bullying, and the consequences can have significant impact on a child’s or adolescent’s social, emotional, and academic functioning. The majority of anti-bullying initiatives have focused on schoolwide prevention programs aimed to enhance school climate and a school’s response to bullying incidences. Few programs address the socio-emotional functioning of youth who are experiencing significant anxiety and mood problems following exposure to bullying. The current paper describes the development of a transdiagnostic behavioral activation and exposure program (Group Behavior Activation Therapy for Bullying) designed to address internalizing problems secondary to bullying. Case descriptions and clinical outcomes are reported from a pilot group of 5 youth (ages 12 to 13). Video clips of group demonstrations are included for illustrative purposes. Attendance was strong and group satisfaction ratings indicated the program was feasible and acceptable to conduct in school settings. Initial outcomes suggest that youth experienced benefits in anxiety and depression diagnoses, symptom outcomes, and functional impairment related to bullying. However, larger controlled evaluations are required to support any conclusions about treatment efficacy.

Netmums: a phase II randomized controlled trial of a guided Internet behavioural activation treatment for postpartum depression

Despite the high prevalence of postnatal depression (PND), few women seek help. Internet interventions may overcome many of the barriers to PND treatment use. We report a phase II evaluation of a 12-session, modular, guided Internet behavioural activation (BA) treatment modified to address postnatal-specific concerns [Netmums Helping With Depression (NetmumsHWD)]. To assess feasibility, we measured recruitment and attrition to the trial and examined telephone session support and treatment adherence. We investigated sociodemographic and psychological predictors of treatment adherence. Effectiveness outcomes were estimated with the Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder-7, Work and Social Adjustment Scale, Postnatal Bonding Questionnaire, and Social Provisions Scale. A total of 249 women were recruited via a UK parenting site, Netmums.com. A total of 83 women meeting DSM-IV criteria for major depressive disorder were randomized to NetmumsHWD (n = 41) or treatment-as-usual (TAU; n = 42). Of the 83 women, 71 (86%) completed the EPDS at post-treatment, and 71% (59/83) at the 6-month follow-up. Women completed an average of eight out of 12 telephone support sessions and five out of 12 modules. Working women and those with less support completed fewer modules. There was a large effect size favouring women who received NetmumsHWD on depression, work and social impairment, and anxiety scores at post-treatment compared with women in the TAU group, and a large effect size on depression at 6 months post-treatment. There were small effect sizes for postnatal bonding and perceived social support. A supported, modular, Internet BA programme can be feasibly delivered to postpartum women, offering promise to improve depression, anxiety and functioning.

An Initial Evaluation of the Clinical and Fitness for Work Outcomes of a Military Group Behavioural Activation Programme

Behavioural Activation (BA) is an evidence-based psychological treatment for depression based on behavioural theory. However, in common with other talking therapies, there is limited evidence about occupational factors related to treatment. This is an important gap in the research given the emphasis placed on employment considerations in recent service initiatives. A service evaluation to investigate the clinical and fitness to work outcomes of a group BA programme for serving military personnel. 46 patients experiencing moderate to severe depression attended a 12-session Military Behavioural Activation and Rehabilitation Course (MBARC). The primary outcomes were the Patient Health Questionnaire-9 (PHQ-9), a self-report measure of depression and the patient's medical employability category. Clinical and statistically significant changes were found on the PHQ-9 between pre-course and 3-month follow-up. Pretreatment 3 patients (6.5%) were psychologically fit to deploy on full operational duties in their primary role; this increased to 25 (56.8%) and 29 (65.9%) at 3 and 6-months respectively. Preliminary findings suggest that MBARC is a clinically and occupationally effective treatment for depression in military personnel. Further research is required to identify if BA delivered in a group setting would be effective in non-military settings and whether treatment benefits are maintained in the longer term.

Internet-based behavioral activation—Treatment for postnatal depression (Netmums): A randomized controlled trial

BackgroundDespite the high prevalence of postnatal depression (PND), few women seek help. The internet may increase timely access to treatment. We report a randomized controlled trial of a minimal intervention internet Behavioral Activation (iBA) treatment modified to address postnatal specific concerns (Postnatal-iBA). MethodsWomen (n=910) recruited via a popular UK parenting site, Netmums.com, scoring above 12 on the Edinburgh Postnatal Depression Scale (EPDS) were randomly assigned to receive either Postnatal-iBA delivered or treatment-as-usual (TAU). We investigated the feasibility (recruitment, trial and treatment adherence) and effectiveness (depression status EPDS >12) of the intervention. ResultsRecruitment was excellent; 1261 women, 961 of whom met inclusion criteria, signed up to the trial within two 2-week recruitment periods. Thirty-eight percent (343/910) of women completed the 15-week outcome assessment. Of those who completed 15-week assessment, fewer exceeded the depression cutoff in the Postnatal-iBA group (n=66/181) compared to TAU (n=91/162). Assuming all non-respondents remained depressed, the Postnatal-iBA effect was reduced. LimitationsThe study suffered from high attrition and future trials need to consider strategies for improving outcome completion. Some women reported struggles “keeping up” with the treatment. ConclusionsA minimal support, widely accessible internet Behavioral Activation program for PND is feasible to deliver to community populations when embedded within popular parenting sites. For women who provide outcome data, postnatal-iBA offers promise as an effective treatment for PND. The addition of support may reduce women’s struggles to keep pace with the treatment.

Trial of a behavioral intervention to increase dilated fundus examinations in African–Americans aged over 65 years with diabetes

This article describes a randomized clinical trial to test the impact of a home-based behavioral activation program to improve rates of dilated fundus examinations in older African–Americans with diabetes. This trial is enrolling subjects who have not met the recommendations for annual eye examinations. The intervention being testing is novel, culturally relevant and has the potential to reduce a significant health disparity regarding vision impairment. Subjects are randomized to behavioral activation or a placebo condition to control for the effects of attention. Both the active and control interventions are delivered in subjects’ homes by a community healthcare worker. The primary outcome is whether a subject had a dilated fundus examination by an ophthalmologist by 6 months.

Open Trial of Brief Behavioral Activation Psychotherapy for Depression in an Integrated Veterans Affairs Primary Care Setting

Major depressive disorder (MDD) is highly prevalent and impairing and highly likely to present in primary care settings. Recent efforts by the Department of Veterans Affairs (VA) have sought to integrate mental health services into primary care settings, leading to new specialty pharmacotherapy and psychotherapy treatment options for primary care patients. However, little is known about the effectiveness of these new services in primary care patients with MDD. The present study investigated the effectiveness of a brief, easy-to-administer, evidence-based psychotherapy behavioral activation in an integrated mental health/primary care setting in a southeastern VA medical center during the first year of the program. Thirty-five veterans with MDD (DSM-IV criteria) completed an initial clinical intake, were given the Mini International Neuropsychiatric Interview, and began a 4-week behavioral activation program. Patients also completed the Hospital Anxiety and Depression Scale (HADS) at intake, posttreatment, and at 1-month follow-up. The study was conducted from November 2009 to November 2010. Sixty percent (n = 21) of patients completed the brief behavioral activation. Treatment completers demonstrated significant reductions in symptoms of both anxiety and depression on the HADS at posttreatment (t values > 5.2, P values < .001, d values > 1.16, g values > 1.02) and follow-up (t values > 4.0, P values < .01, d values > 1.74, g values > 1.67) when compared to pretreatment levels. The present findings support the use of behavioral activation as an effective treatment for patients with MDD in a primary care setting. These findings suggest that new integrated primary care settings should incorporate behavioral activation to offer brief, evidence-based treatments that provide reliable symptom reductions in addition to possible reductions in treatment needs and better management of related physical health conditions.