Behavioral Activation Therapy Research Articles

The effects of fifteen evidence-supported therapies for adult depression: A meta-analytic review

Objective: In the past decades, many different types of psychotherapy for adult depression have been developed. Method: In this meta-analysis we examined the effects of 15 different types of psychotherapy using 385 comparisons between a therapy and a control condition: Acceptance and commitment therapy, mindfulness-based cognitive behavior therapy (CBT), guided self-help using a self-help book from David Burns, Beck’s CBT, the “Coping with Depression” course, two subtypes of behavioral activation, extended and brief problem-solving therapy, self-examination therapy, brief psychodynamic therapy, non-directive counseling, full and brief interpersonal psychotherapy, and life review therapy. Results: The effect sizes ranged from g = 0.38 for the “Coping with Depression” course to g = 1.10 for life review therapy. There was significant publication bias for most therapies. In 70% of the trials there was at least some risk of bias. After adjusting studies with low risk of bias for publication bias, only two types of therapy remained significant (the “Coping with Depression” course, and self-examination therapy). Conclusions: We conclude that the 15 types of psychotherapy may be effective in the treatment of depression. However, the evidence is not conclusive because of high levels of heterogeneity, publication bias, and the risk of bias in the majority of studies.

Development of a Consensus-Based OT Treatment Template for Veterans With Combat-Related Posttraumatic Stress Disorder (PTSD)

Abstract Date Presented 04/04/19 This poster presents a model OT treatment template for veterans with PTSD. Utilizing a modified Delphi method of consensus attainment, the study surveyed Canadian OTs to identify treatment template components. The resulting treatment template is present-focused, occupation-focused, occupation-based, and built upon the Canadian Model of Occupational Performance and Engagement, Behavioral Activation, and Acceptance and Commitment Therapy. Primary Author and Speaker: Steven Gerardi

Behavioral Activation as a Treatment for Posttraumatic Stress Disorder Among Returning Veterans: A Randomized Trial.

Although evidence-based, trauma-processing treatments exist for posttraumatic stress disorder (PTSD), many individuals do not seek out, complete, or fully respond to these treatments, pointing to the need for alternative treatments. In this study, the authors evaluated the effectiveness of behavioral activation therapy modified to address PTSD among veterans. In a randomized trial, behavioral activation was compared with treatment as usual (referral to PTSD "standard care") among a sample of 80 veterans of the wars in Iraq and Afghanistan who were enrolled at the U.S. Department of Veterans Affairs (VA) Portland Health Care System and the VA Puget Sound Health Care System. Levels of PTSD symptoms decreased for both groups across posttreatment and at 3-month follow-up as measured by clinical interview and self-report measures. The behavioral activation group had greater improvement on PTSD as evidenced by the self-report measure of symptom severity. Both groups also showed improvement on self-report measures of depression and overall functioning across time, with greater improvement on depression evidenced by the behavioral activation group. Ratings of treatment satisfaction were high for both groups. Behavioral activation is a promising alternative treatment for PTSD.

Multinutrient supplements found to have no benefit in preventing depression onset

Multinutrient supplementation did not show preventive effects for depression compared with food‐related behavioral activation therapy or no therapy in a group of overweight adults with subsyndromal symptoms of depression, a randomized trial involving more than 1,000 participants has found. Hospitalization rates during the trial's one‐year follow‐up were virtually identical in the three study groups, the researchers reported. Study results were published March 5 in JAMA.

Behavioral activation therapy for depression and anxiety in cancer patients: a case series study

BackgroundBehavioral activation therapy (BAT) directly addresses activities that individuals value most highly, and may be easily applicable to cancer patients. However, there is no established evidence of the use of BAT in this population. In this study, we examined the possibility of a BAT program for depression and anxiety in cancer patients.Case presentationWe retrospectively reviewed the medical records of cancer patients with each of the following characteristics: 1) were outpatients or inpatients visiting the psycho-oncology division of the National Cancer Center Hospital in Japan; 2) met criteria for Major Depressive Disorder or Adjustment Disorders; and 3) participated in a BAT program. The primary outcome was the program completion percentage. Secondary outcomes were self-reported depression severity (Patient Health Questionnaire-9 (PHQ-9) score), anxiety disorder status (Generalized Anxiety Disorder-7 (GAD-7) score), and clinical improvement (Clinical Global Impression-Improvement (CGI-I) score) after the program. We analyzed both depression and anxiety by the matched paired t-test. Ten patients participated in the program, and nine completed it. One dropped out due to cognitive impairment secondary to brain metastasis. Both the PHQ-9 scores (pre: 14.4 (SD, 6.1); post: 5.1 (SD, 5.8)) and the GAD-7 scores (pre: 11.9 (SD, 4.9); post: 4.7 (SD, 5.5)) significantly improved after the program (PHQ-9: P = 0.0014; GAD-7: P = 0.0004). CGI-I scores ranged from 1 to 3, and all subjects except the patient who dropped out improved clinically. Among the ten patients, three distinctive cases could be observed as follows. Case 1; a 45-year-old housewife with breast cancer who did not agree to take antidepressants because of concerns about the side effects achieved remission without antidepressants and began to live an active life. Case 4; a 66-year-old housewife was so shocked after endometrial cancer diagnosis that she was absent-minded and her compliance with the assigned homework was poor, therefore, her depression did not improve much. Case 9; a 62-year-old man with laryngeal cancer who had recurrent anxiety. Increased business activity, on which he put great value, gradually allowed him to be able to live his life actively without concerns.ConclusionsThis study suggests that BAT would be effective for the depression and anxiety of cancer patients.

Effect of Multinutrient Supplementation and Food-Related Behavioral Activation Therapy on Prevention of Major Depressive Disorder Among Overweight or Obese Adults With Subsyndromal Depressive Symptoms

Effects of nutritional interventions on the prevention of major depressive disorder (MDD) in overweight adults are unknown. To examine the effect of 2 nutritional strategies (multinutrient supplementation, food-related behavioral activation therapy) and their combination for prevention of a new MDD episode in overweight adults with subsyndromal depressive symptoms. This multicenter 2 × 2 factorial randomized clinical trial included overweight adults (body mass index, 25-40) with elevated depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] scores ≥5) and no MDD episode in the past 6 months from 4 European countries. A total of 1025 adults were randomized (July 30, 2015-October 12, 2016) and followed up for 1 year (October 13, 2017). Daily multinutrient supplements (1412-mg omega-3 fatty acids, 30-μg selenium, 400-μg folic acid, and 20-μg vitamin D3 plus 100-mg calcium) vs placebo and 21 individual or group therapy sessions vs none (blinded to researchers) for 1 year. Participants were allocated to placebo without therapy (n = 257), placebo with therapy (n = 256), supplements without therapy (n = 256), and supplements with therapy (n = 256). Cumulative 1-year onset of MDD via the Mini International Neuropsychiatric Interview at 3, 6, and 12 months. Logistic regression using effect-coded variables (-1 indicating control, 1 indicating intervention) evaluated intervention effects both individually and in combination (interaction) on MDD onset. Among 1025 participants (mean age, 46.5 years; 772 women [75%]; mean BMI, 31.4), 779 (76%) completed the trial. During the 12-month follow-up, 105 (10%) developed MDD: 25 (9.7%) patients in the placebo without therapy, 26 (10.2%) in the placebo with therapy, 32 (12.5%) in the supplement without therapy, and 22 (8.6%) in the supplement with therapy group. None of the treatment strategies affected MDD onset. The odds ratio (OR) for supplements was 1.06 (95% CI, 0.87-1.29); for therapy, 0.93 (95% CI, 0.76-1.13); and for their combination, 0.93 (95% CI, 0.76-1.14; P for interaction, .48). One person in the supplementation with therapy group, died. Twenty-four patients in each of the placebo groups and 24 patients in the supplementation with therapy group were hospitalized, and 26 patients in the supplementation-only group were hospitalized. Among overweight or obese adults with subsyndromal depressive symptoms, multinutrient supplementation compared with placebo and food-related behavioral activation therapy compared with no therapy did not reduce episodes of major depressive disorder during 1 year. These findings do not support the use of these interventions for prevention of major depressive disorder. ClinicalTrials.gov Identifier: NCT02529423.

Engagement in Socially and Interpersonally Rewarding Activities as a Predictor of Outcome in “Engage” Behavioral Activation Therapy for Late-Life Depression

Loneliness and social isolation are associated with depressive symptoms, cognitive and physical disabilities, and increased risk of mortality among older adults. Socially rewarding activities reduce loneliness, and neurobiological evidence suggests that these activities may activate neural reward systems in older adults to a greater extent than other rewarding experiences. The current study was designed to investigate whether engagement in social and interpersonal activities (i.e., exposure to social rewards) predicts subsequent increase in behavioral activation and reduction in depressive symptoms in reward exposure treatment for late-life depression. Forty-eight older adults without cognitive impairment and with major depression received nine sessions of "Engage" psychotherapy. Behavioral activation and depression severity were assessed by trained raters at baseline and weeks 6 and 9. Patients' weekly behavioral plans were categorized into three groups: 1) solitary activities; 2) social-group activities (attending a social gathering or a social setting such as church or a senior center); and 3) interpersonal-individual activities (engaging in an interpersonal interaction with a specific friend or family member). Mixed-effects models showed reduction in depression severity and increase in behavioral activation over time. In linear regression models, a higher percentage of interpersonal-individual activities (but not solitary or social-group activities) predicted subsequent increase in behavioral activation and improvement of depression. These findings highlight the importance of understanding the effects of engagement in specific types of rewarding activities in behavioral activation treatments for late-life depression. Exposure to socially rewarding interpersonal interactions could contribute to the efficacy of psychotherapy for late-life depression.

The Applicability of Behavioral Activation Therapy in College Students

Behavioral activation therapy; Social anxiety disorder; Case conceptualization

Smartphone problem-solving and behavioural activation therapy to reduce fear of recurrence among patients with breast cancer (SMartphone Intervention to LEssen fear of cancer recurrence: SMILE project): protocol for a randomised controlled trial

IntroductionOne of the most common distressing conditions experienced by breast cancer survivors is fear of cancer recurrence (FCR). There is, however, no standard intervention for ameliorating FCR. Our clinical experience...

Behavioral activation and recreational therapy

Behavioral activation (BA) is an evidence-based brief and effective treatment for depression. This article explains BA, its procedures, and its relationship to recreational therapy (RT). According to BA theory, depression leads to lives reduced in ability to gain rewards from the environment. BA aims to activate clients to engage in activities that increase rewards, reduce negativity, and improve subjective well-being (SWB). This approach is consistent with RT practice, and expressly identified in Austin’s Health Protection/Health Promotion Model. BA has been shown to be effective in clinical depression programs across age groups, as well as in other diagnoses including post-traumatic stress disorder (PTSD), anxiety disorder, and substance use disorder. The basic BA orientation of engaging in activity and resumption of a pleasing and meaningful experiences is highly consistent with RT practice, and BA should be a tool in the RT modalities toolbox.

Pretreatment brain connectivity during positive emotion upregulation predicts decreased anhedonia following behavioral activation therapy for depression

BackgroundNeurobiological predictors of antidepressant response may help guide treatment selection and improve response rates to available treatments for major depressive disorder (MDD). Behavioral activation therapy for depression (BATD) is an evidence-based intervention designed to ameliorate core symptoms of MDD by promoting sustained engagement with value-guided, positively-reinforcing activities. The present study examined pre-treatment task-based functional brain connectivity as a predictor of antidepressant response to BATD. MethodsThirty-three outpatients with MDD and 20 nondepressed controls completed a positive emotion regulation task during fMRI after which participants with MDD received up to 15 sessions of BATD. We used generalized psychophysiological interaction analyses to examine group differences in pre-treatment functional brain connectivity during intentional upregulation of positive emotion to positive images. Hierarchical linear models were used to examine whether group differences in functional connectivity predicted changes in depression and anhedonia over the course of BATD. ResultsCompared to controls, participants with MDD exhibited decreased connectivity between the left middle frontal gyrus and right temporoparietal regions during upregulation of positive emotion. Within the MDD group, decreased connectivity of these regions predicted greater declines in anhedonia symptoms over treatment. LimitationsFuture studies should include comparison treatments and longitudinal follow-up to clarify the unique effects of BATD on neural function and antidepressant response. ConclusionsResults are consistent with previous work showing BATD may be particularly effective for individuals with greater disturbances in brain reward network function, but extend these findings to highlight the importance of frontotemporoparietal connectivity in targeting symptoms of low motivation and engagement.

Applying behavioral activation to sustain and enhance the effects of contingency management for reducing stimulant use among individuals with HIV infection

ABSTRACTThere is a high prevalence of stimulant use among HIV-infected individuals, which is associated with suboptimal antiretroviral therapy (ART) adherence, HIV treatment interruptions, detectable HIV viral load, and transmission of HIV via increased sexual risk behavior. Contingency management (CM) is an initially effective treatment for stimulant use. However, the effects of CM are not sustained after the active intervention has ended. One potential contributor to the intractability of existing treatments may be a lack of attention to replacement activities or the role of depressed mood. Behavioral activation (BA) is an evidence-based approach for depression that involves identifying and participating in pleasurable, goal-directed activities. As a potential approach to address the CM rebound effect – informed by our formative qualitative research with the participant population – we conducted an open pilot trial of an intervention combining CM-BA for HIV-infected individuals with stimulant use disorder. Participants completed weekly BA therapy sessions (10–16 sessions) and thrice-weekly toxicology screenings (12 weeks); contingencies were rewarded for negative toxicology tests to support reengagement into positive life activities. Major assessments were conducted at baseline, 3-, and 6-months. Toxicology screening was repeated prior to the 6-month assessment. Eleven participants with stimulant use disorder enrolled; 7 initiated treatment and completed the full intervention. The mean age was 46 (SD = 5.03) and 14% identified as a racial/ethnic minority. Of the completers, the mean change score in self-reported stimulant use within the past 30 days (within-person change; reduction in self-reported stimulant use) was 4.14 days at 3 months and 5.0 days at 6 months [Cohen’s d = 0.89]. The mean change score in weekly toxicology screens (reduction in positive toxicology screens) was .71 at 3 months and 1 at 6 months [Cohen’s d = 1.05]. Exit interviews indicated that the integrated intervention was well received and acceptable. This study provides preliminary evidence that a combined CM-BA intervention for this population was feasible (100% retention at 6-months), acceptable (100% of intervention sessions attended; participants rated the intervention ‘acceptable’ or ‘very acceptable’), and may be an option to augment the potency and sustained impact of CM for this population. Future pilot testing using a randomized controlled design is warranted.

Preventing Cognitive Decline in Black Individuals With Mild Cognitive Impairment

Mild cognitive impairment (MCI) is a transition state between normal cognitive aging and dementia that increases the risk for progressive cognitive decline. Preventing cognitive decline is a public health priority. To determine whether behavioral activation prevents cognitive and functional decline over 2 years in black individuals with MCI. Single-center, single-masked, attention-controlled randomized clinical trial. Participants were enrolled from June 21, 2011, to October 3, 2014, and follow-up ended December 13, 2016. Community-based recruitment and treatment of black individuals older than 65 years with amnestic MCI. Volunteer sample of 1390 persons with memory complaints were screened. Overall, 536 individuals had baseline assessment, and 315 (58.8%) were ineligible, most often owing to normal cognition (205 of 315 [65%]) or dementia (59 of 315 [18.7%]); 221 fully eligible participants were randomized. Analyses were intention to treat. Participants were randomized to behavioral activation, which aimed to increase cognitive, physical, and social activity (111 [50.2%]), or supportive therapy, an attention control treatment (110 [49.8%]). The prespecified primary outcome was a decline of 6 or more recalled words on the total recall score of the Hopkins Verbal Learning Test-Revised assessed at 6, 12, 18, and 24 months. The secondary outcome was functional decline. Of 221 randomized participants (mean [SD] age, 75.8 [7.0] years, 175 women [79%]), 77 behavioral activation participants (69.4%) and 87 supportive therapy participants (79.1%) had 2-year outcome assessments. After baseline, behavioral activation participants engaged in significantly more cognitive activities than supportive therapy participants. The 2-year incidence of memory decline was 1.2% (95% CI, 0.2-6.4) for behavioral activation vs 9.3% (95% CI, 5.30-16.4) for supportive therapy (relative risk, 0.12; 95% CI, 0.02-0.74; P = .02). Behavioral activation was associated with stable everyday function, whereas supportive therapy was associated with decline (difference in slopes, 2.71; 95% CI, 0.12-5.30; P = .04). Rates of serious adverse events for behavioral activation and supportive therapy, respectively, were: falls (14 [13%] vs 28 [25%]), emergency department visits (24 [22%] vs 24 [22%]), hospitalizations (36 [32%] vs 31 [28%]), and deaths (7 [5%] vs 3 [4%]). Behavioral activation prevented cognitive and functional decline, but this finding requires further investigation. Black individuals have almost twice the rate of dementia as white individuals; behavioral activation may reduce this health disparity. ClinicalTrials.gov Identifier: NCT01299766.

Psychotherapeutic Treatments for Depression During Pregnancy.

Depression during pregnancy is a significant public health problem that is associated with adverse consequences for women and children. Despite the availability of treatment options, depression during pregnancy is often undertreated. Most pregnant women prefer nonpharmacological interventions over antidepressant medications. We review the evidence base for psychotherapeutic treatment approaches to depression during pregnancy. Treatments reviewed include interpersonal therapy, cognitive-behavioral therapy, behavioral activation, and mindfulness-based cognitive therapy. We review both traditional face-to-face delivery and digital interventions. We conclude with recommendations for treatment preferences, collaborative decision-making, and strategies to improve uptake of such services among prenatal women.

Cost-Effectiveness of Behavioral Activation for Depression in Older Adult Veterans: In-Person Care Versus Telehealth.

This study examined whether delivering behavioral activation for depression through telehealth is cost-effective compared to in-person care. This was a randomized, noninferiority trial, with participants assigned to 1 of 2 arms of 8-week behavioral activation therapy: in-person or via telehealth. Primary clinical outcomes included measures of depression (Geriatric Depression Scale, Beck Depression Inventory, and Structured Clinical Interview for DSM-IV) at 12 months follow-up. Quality of life was assessed using the 36-Item Short Form Health Survey. Economic outcomes included the difference in health services utilization costs between 1 year post-intervention and 1 year pre-intervention, as quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios for differences in cost based on mean travel and median travel relative to the 3 primary outcomes and QALYs. 241 participants were enrolled and completed study procedures between April 2007 and July 2012. Post-intervention, veterans treated in-person had a mean of $2,998 higher VA health care utilization costs relative to their pre-intervention utilization costs, while veterans treated via telehealth had a mean of $870.91 higher costs post-intervention relative to pre-intervention. The difference between bootstrap mean and median QALYs was not significantly different from zero. Although the intervention costs for telehealth were higher relative to in-person care, veterans receiving behavioral activation via telehealth had lower health utilization costs 1 year after the intervention than those receiving care in person while QALYs were approximately the same. These results demonstrate the noninferiority of telehealth in treating depression in veterans with respect to QALYs and a large and significant cost benefit of using telehealth in terms of health services utilization post-intervention. ClinicalTrials.gov identifier: NCT00324701.

Acceptability of the Fitbit in behavioural activation therapy for depression: a qualitative study

前言 重度抑郁症的特征是情绪低落和缺乏动力。文献表明，增加身体活动对缓解抑郁症有积极作用。健康追踪设备可以补充行为激活（BA）疗法，以改善抑郁症患者的身体活动和心理健康。 目的 了解患者从Fitbit获得的好处并探索与患者体验相关的主题。比较感知的益处、患者因素、Fitbit使用情况和贝克的抑郁量表（BDI）得分。 方法 对患者（n=36）进行的半结构式访谈，这些患者均已在情绪障碍门诊中完成了为期28周的行为激活项目。所有的患者都被要求携带一个Fitbit One设备。我们对访谈进行了专题分析，并对患者特征、Fitbit使用情况、记录的步数、感知到的好处和BDI评分进行了探索性的定量分析。 结果 23名患者认为Fitbit对他们的身体活动很有帮助。积极经历的主题包括自我意识、同伴激励和目标设定的机会。负面主题包括不便、不准确和不感兴趣。年龄、基线和BDI得分的变化、先前的身体活动目标和对技术的熟悉程度与Fitbit的感知收益或使用度无相关性。感知收益与使用度显著相关（P<0.01）。 结论 总的来说，Fitbit是一个用于补充抑郁症患者的行为激活疗法可以接受的工具。许多积极的主题与当前的文献一致；然而，患者也报告了可能影响使用的负面因素。 临床意义 临床医生和研究者在应用运动追踪器来刺激抑郁症患者时应该同时考虑其优势和局限性。 注册号码 NCT02045771；前期结果。

Integrated Care: Perspectives From A Behavioral Health Consultant

Integrated Care: Perspectives From A Behavioral Health Consultant

Behavioral activation versus treatment as usual in naturalistic sample of psychiatric patients with depressive symptoms: a benchmark controlled trial

BackgroundMore systematic use of evidence-based brief therapies is needed in the treatment of depression within psychiatric care. The aim of this study was to explore the impact of behavioral activation therapy (BA) for patients with depressive symptoms in a routine clinical setting of secondary psychiatric care.MethodsThe BA-treated intervention group (n = 242) comprised patients with depressive symptoms (Beck Depression Inventory (BDI) score ≥ 17 at baseline). The control group (n = 205) patients received treatment as usual in the same catchment area. The groups were matched at baseline using BDI and Alcohol Use Disorders Identification Test scores and inpatient/outpatient status. The groups were compared at 6-, 12- and 24-month follow-up points on functional outcome (Global Assessment of Functioning scale), service use, dropout and deaths. The Montgomery–Åsberg Depression Rating Scale was used to assess depressive symptoms in the intervention group.ResultsThe estimated difference in GAF score between intervention and control group patients was significant at 12- and 24-months follow-up points in favor of intervention group (GAF score difference 4.85 points, p = 0.006 and 5.71 points, p = 0.005, respectively; estimate for patient group 2.26, p = 0.036). The rates of dropout, mortality and service use were similar between the groups. Among the intervention group patients, the estimated improvement in MADRS score compared to baseline was statistically significant throughout the follow-up (p < 0.001 at all follow-up points).ConclusionsThe systematic use of BA among secondary psychiatric care depressive patients provides encouraging results despite the patients had various comorbid non-psychotic disorders.Trial registrationClinicalTrials.gov, Identifier NCT02520271, Release Date: 06/27/2015, retrospectively registered.

A Comparison Between the Effectiveness of Acceptance and Commitment Treatment and Behavioral Activation Treatment for Depression on Symptoms Severity and Rumination Among Patients with Treatment-Resistant Depression

Background: A group of patients with depression do not show proper treatment response to merely biological interventions. Objectives: The aim of this study was to investigate the effectiveness of add on acceptance and commitment treatment (ACT) and brief behavioral activation therapy for depression (BATD) to pharmacotherapy in treatment-resistant depression (TRD). Methods: The study was conducted in Sari and Babol (North of Iran), during year 2016. In this study, the method of multiple baseline was used. Twelve patients, including eight females and four males, having level 2 European staging model, were randomly selected and entered the study after an interview by a psychiatrist and conducting SCID-I -SCID-II and checking the inclusion and exclusion criteria. They were randomly entered in 12 sessions of ACT or BATD. The data obtained were analyzed through the method of visual outline, reliable change index (RCI), effect size, and improvement percentage formula. Results: The results of this study showed that the ACT and BATD were useful for improving treatment targets. These results were statistically significant according to the RCI index. The earned effect size varied from 1 to 3.33. Conclusions: The results of this study provided greater evidence for ACT and BADT. Also, the present study supports the role of trans-diagnostic approaches as an add on to in TRD. Keywords: Acceptance and Commitment Therapy; Behavioral Activation; Treatment-Resistant Depression

Predicting post treatment client satisfaction between behavioural activation for depression delivered either in-person or via home-based telehealth

Introduction Treatment engagement, adherence, cancellations and other patient-centric data are important predictors of treatment outcome. But often these data are only examined retrospectively. In this investigation, we analysed data from a clinical trial focused on innovative delivery of depression treatment to identify which patients are likely to prefer either in-home or in-person treatment based on pre-treatment characteristics. Methods Patient satisfaction was assessed in a trial of individuals with depression treated using identical behavioural activation therapy protocols in person or through videoconferencing to the home (N = 87 at post treatment: 42 in-person and 45 in-home participants). The Client Satisfaction Questionnaire was administered at the end of the treatment. A Tobit regression model was used to assess moderation using treatment assignment. Regression lines were generated to model treatment satisfaction as a function of treatment assignment and to identify whether and where the groups intersected. We examined the distributions of the contributing moderators to the subsets of participants above and below the intersection point to identify differences. Results While no significant differences in patient satisfaction were observed between the two groups, or between patients receiving treatment by different providers, baseline characteristics of the sample could be used to differentiate those with a preference for traditional, in-office care from those preferring in-home care. Discussion Participants who were more likely to prefer in-home care were characterized by larger proportions of veterans and lower-ranked enlisted service members. They also had more severe symptoms at baseline and less formal education. Understanding client reactions when selecting treatment modality may allow for a more satisfying patient experience.