Behavioral Activation Treatment Research Articles

FC11: Guided low-intensity behavioural activation intervention delivery preferences among people with dementia, informal caregivers, and professional stakeholders: a qualitative study (the INVOLVERA Study)

Background:Despite a need to provide support to people with dementia and informal caregivers to live well with dementia, the availability of psychological interventions to enhance wellbeing and support mental health problems such as depression for people with dementia are limited. A potential solution is behavioural activation, an evidence-based intervention for depression that seeks to target behavioural avoidance. Behavioural activation can be delivered in a written self-help format, with support provided by an informal caregiver, who in turn receives guidance from a healthcare professional. However, it is necessary to develop and tailor self-help interventions to the needs and preferences of specific populations.Objective:To explore the needs and preferences of people with dementia, informal caregivers, and professional stakeholders to ensure cultural appropriateness, relevancy, and acceptability of the intervention.Methods:Participatory action research with co-design principles using semi-structured interviews and focus groups. People with dementia (n=8), informal caregivers (n=19), healthcare professionals (n=18), and community stakeholders (n=7) were provided with draft versions of the behavioral activation written self-help intervention and a proposed intervention delivery model. Open-ended questions explored preferences concerning preferred intervention delivery setting, type of support and guidance provided, perceived relevance of the intervention content and language, and ways to enhance relevancy, cultural appropriateness, and acceptability.Results:Analysis resulted in an overarching theme: Tailoring and flexibility, and three categories: Intervention process, material and context; Support and guidance; and Time. Results informed adaptations to the intervention content and delivery model, including: (1) reducing the amount of material to minimise treatment burden; (2) increasing the relevance of case stories and illustrations to Swedish society and culture; (3) modernising the design and illustrations; (4) including a case story of a person with young onset-dementia; (5) increasing the flexibility of the delivery model (e.g., delivery outside of traditional health care settings); and (6) providing additional guidance to informal caregivers.Conclusion:Stakeholders expressed a need for tailoring and flexibility throughout intervention delivery, and for cultural adaptations to intervention content to improve perceived appropriateness and relevance. A planned feasibility study will examine the feasibility, acceptability, relevancy and cultural appropriateness of the intervention and delivery model.

Perceptions of a comprehensive physical activity behavior intervention among endometrial cancer survivors with obesity. A qualitative study

PurposeEvaluate perceptions of a 12-week in-person physical activity intervention for endometrial cancer survivors with obesity. MethodsSixteen endometrial cancer survivors (Age: 64 ± 8 yrs) with obesity (BMI: 34 ± 8 kg·m−2) who completed a 12-week comprehensive physical activity program completed semi-structured interviews regarding perceptions of physical activity participation. Transcripts were analyzed using thematic analysis and were confirmed by multiple authors. ResultsEmergent themes (and subthemes) were: 1) Routine physical activity (Walking, Chores), 2) Motivations for physical activity (Social, Independence, Health, Family, Weight), 3) Barriers to physical activity (Weather, Pain, Fatigue, Family Stress), 4) Motivation to 12-week program adherence (Social, Fun, Caring, Structure, Shared Experiences), 5) Perceived benefits of the program (Social, Self-efficacy, Activities of Daily Living, Body Composition, Well-being, Health), and 6) Feedback about the 12-week program (Timing, Setting, Exercise Modes, Incentives, Instructor, Learning). ConclusionsSocioculturally diverse cancer survivors with obesity who were able to complete a 12-week physical activity program emphasized the importance of maintaining independence, and being part of a fun, caring, and social environment for their ability to overcome fatigue, pain, and family stresses to adhere to the program. Participants discussed myriad health and wellness benefits, and wished the program were more robust. Implications for Cancer SurvivorsLow-burden exercise programs can confer meaningful health and wellness benefits for cancer survivors. To maintain adherence, programs should emphasize social cohesion and exercises to help maintain independence. Instructors should express caring support while also making classes fun, while emphasizing body composition instead of weight loss.

Behavioral Activation for Comorbid Depression in People With Noncommunicable Disease in India: Protocol for a Randomized Controlled Feasibility Trial.

The increasing burden of depression and noncommunicable disease (NCD) is a global challenge, especially in low- and middle-income countries, considering the resource constraints and lack of trained human resources in these settings. Effective treatment of depression in people with NCDs has the potential to enhance both the mental and physical well-being of this population. It will also result in the effective use of the available health care resources. Brief psychological therapies, such as behavioral activation (BA), are effective for the treatment of depression. BA has not been adapted in the community health care services of India, and the feasibility of using BA as an intervention for depression in NCD and its effectiveness in these settings have not been systematically evaluated. Our objective is to adapt BA for the Indian NCD context and test the acceptability, feasibility, and implementation of the adapted BA intervention (BEACON intervention package [BIP]). Additionally, we aim to test the feasibility of a randomized controlled trial evaluation of BIP for the treatment of depression compared with enhanced usual care. Following well-established frameworks for intervention adaptation, we first adapted BA (to fit the linguistic, cultural, and resource context) for delivery in India. The intervention was also adapted for potential remote delivery by telephone. In a randomized controlled trial, we will be testing the acceptability, feasibility, and implementation of the adapted BA intervention (BIP). We shall also test if a randomized controlled feasibility trial can be delivered effectively and estimate important parameters (eg, recruitment and retention rates and completeness of follow-up) needed to design a future definitive trial. Following the receipt of approval from all the relevant agencies, the development of the BIP was started on November 28, 2020, and completed on August 18, 2021, and the quantitative data collection was started on August 23, 2021, and completed on December 10, 2021. Process evaluation (qualitative data) collection is ongoing. Both the qualitative and quantitative data analyses are ongoing. This study may offer insights that could help in closing the gap in the treatment of common mental illness, particularly in nations with limited resources, infrastructure, and systems such as India. To close this gap, BEACON tries to provide BA for depression in NCDs through qualified NCD (BA) counselors integrated within the state-run NCD clinics. The results of this study may aid in understanding whether BA as an intervention is acceptable for the population and how feasible it will be to deliver such interventions for depression in NCD in South Asian countries such as India. The BIP may also be used in the future by Indian community clinics as a brief intervention program. Clinical Trials Registry of India CTRI/2020/05/025048; https://tinyurl.com/mpt33jv5. DERR1-10.2196/41127.

Effects of a Web-Based Behavioral Activation Intervention on Depressive Symptoms, Activation, Motivation, and Volition: Results of a Randomized Controlled Trial

Introduction: Behavioral activation (BA) is effective for the treatment of depression. The Health Action Process Approach (HAPA), which is derived from health psychology, can provide a motivational-volitional framework of BA. Objective: This study investigated the efficacy of a HAPA-based internet-delivered BA intervention (iBA; called InterAKTIV) in individuals with depression, also assessing HAPA-based motivational and volitional outcomes. Methods: In a two-arm randomized controlled efficacy trial with a parallel design, 128 participants with a major depressive episode were randomly allocated to the intervention group (IG; TAU + immediate access to iBA) or control group (CG; TAU + access to iBA after follow-up). The primary outcome of clinician-rated depressive symptoms and secondary outcomes were assessed at baseline (T1), 8 weeks (T2), 6-month after randomization (T3). Data were analyzed on an intention-to-treat basis. Results: Linear mixed model analyses revealed a significant group*time interaction effect on clinician-rated depressive symptoms favoring the IG (F_{2, 156.0} = 7.40; p < 0.001, d = 0.79 at T2, d = 0.25 at T3). The IG was also superior regarding self-rated depressive symptoms, BA, most motivational, and all volitional outcomes. Conclusion: This study shows that HAPA-based iBA can significantly improve clinician-rated depressive symptoms, as well as outcomes used in the HAPA model in people with depression. Building on these efficacy results, in the next step, the relationship between BA interventions and activity levels should be investigated, taking into account motivation and volition as potential mediators.

Protocol for an economic evaluation of scalable strategies to improve mental health among perinatal women: non-specialist care delivered via telemedicine vs. specialist care delivered in-person

BackgroundPerinatal depression affects an estimated 1 in 5 women in North America during the perinatal period, with annualized lifetime costs estimated at $20.6 billion CAD in Canada and over $45.9 billion USD in the US. Access to psychological treatments remains limited for most perinatal women suffering from depression and anxiety. Some barriers to effective care can be addressed through task-sharing to non-specialist providers and through telemedicine platforms. The cost-effectiveness of these strategies compared to traditional specialist and in-person models remains unknown. This protocol describes an economic evaluation of non-specialist providers and telemedicine, in comparison to specialist providers and in-person sessions within the ongoing Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) trial.MethodsThe economic evaluation will be undertaken alongside the SUMMIT trial. SUMMIT is a pragmatic, randomized, non-inferiority trial across five North American study sites (N = 1,226) of the comparable effectiveness of two types of providers (specialist vs. non-specialist) and delivery modes (telemedicine vs. in-person) of a behavioural activation treatment for perinatal depressive and anxiety symptoms. The primary economic evaluation will be a cost-utility analysis. The outcome will be the incremental cost-effectiveness ratio, which will be expressed as the additional cost required to achieve an additional quality-adjusted life-year, as assessed by the EuroQol 5-Dimension 5-Level instrument. A secondary cost-effectiveness analysis will use participants’ depressive symptom scores. A micro-costing analysis will be conducted to estimate the resources/costs required to implement and sustain the interventions; healthcare resource utilization will be captured via self-report. Data will be pooled and analysed using uniform price and utility weights to determine cost-utility across all trial sites. Secondary country-specific cost-utility and cost-effectiveness analyses will also be completed. Sensitivity analyses will be conducted, and cost-effectiveness acceptability-curves will be generated, in all instances.DiscussionResults of this study are expected to inform key decisions related to dissemination and scale up of evidence-based psychological interventions in Canada, the US, and possibly worldwide. There is potential impact on real-world practice by informing decision makers of the long-term savings to the larger healthcare setting in services to support perinatal women with common mental health conditions.

A feasibility and pilot additive randomised control trial of attachment security priming during behavioural activation.

There is some initial evidence that attachment security priming may be useful for promoting engagement in therapy and improving clinical outcomes. This study sought to assess whether outcomes for behavioural activation delivered in routine care could be enhanced via the addition of attachment security priming. This was a pragmatic two-arm feasibility and pilot additive randomised control trial. Participants were recruited with depression deemed suitable for a behavioural activation intervention at Step 2 of a Talking Therapies for Anxiety and Depression service. Ten psychological wellbeing practitioners were trained in implementing attachment security priming. Study participants were randomised to either behavioural activation (BA) or BA plus an attachment prime. The diagrammatic prime was integrated into the depression workbook. Feasibility outcomes were training satisfaction, recruitment, willingness to participate and study attrition rates. Pilot outcomes were comparisons of clinical outcomes, attendance, drop-out and stepping-up rates. All practitioners recruited to the study, and training satisfaction was high. Of the 39 patients that were assessed for eligibility, 24 were randomised (61.53%) and there were no study drop-outs. No significant differences were found between the arms with regards to drop-out, attendance, stepping-up or clinical outcomes. Further controlled research regarding the utility of attachment security priming is warranted in larger studies that utilise manipulation checks and monitor intervention adherence.

Physical Activity Behavioral Intervention for type 2 DM Patients: A Literature Review

Various chronic and acute conditions as comorbid diseases are highly influential to the everyday life of type 2 diabetes mellitus patients, including in physical, psychological, economic, family burden, and quality of life aspects. The protocol and evaluation of this literature review used the PRISMA checklist. Using four databases; Pubmed, Science-direct, Scopus/Web of Science, and ProQuest. Five main physical activity behavioral intervention models for diabetes mellitus patients were discovered: 1. empowerment (individual and familial); 2. diabetes self-management education; 3. web-based digital health intervention; 4. motivational interviewing; and 5. SMS-based education. The five models focused on strengthening the importance of physical activity in diabetes mellitus patients’ self-management.

“You rise up and then you start pulling people up with you”: Patient experiences with a peer-delivered behavioral activation intervention to support methadone treatment

BackgroundAlthough medications for opioid use disorder (MOUD) are efficacious treatments for opioid use disorder, retention remains low. Peer recovery specialists (PRSs), individuals with lived substance use and recovery experience, may be particularly well-suited to support patients receiving MOUD. While PRSs are rarely trained in evidence-based behavioral interventions other than motivational interviewing, preliminary evidence suggests that peers can deliver brief behavioral interventions, such as behavioral activation, with efficacy and fidelity. This qualitative study sought to explore patient perspectives on receiving an adapted PRS-delivered behavioral activation intervention (Peer Activate) to support patients receiving methadone treatment. MethodsThe sample (N = 26) included patients recently starting or demonstrating challenges with adherence at a community-based methadone treatment program who received the Peer Activate intervention in a pilot trial. Participants were invited to participate in in-depth, semi-structured interviews at study completion or discontinuation, assessing perceived acceptability and feasibility of Peer Activate, and stigma-related barriers. Interview transcripts were coded using codebook/template thematic analysis. ResultsAnalysis revealed the importance of two areas to promote intervention acceptability: 1) connection with intervention content and skill building, and 2) valued PRS-specific qualities. Intervention flexibility was found to promote feasibility of the intervention in the context of chaotic and challenging life circumstances. Additionally, participants described stigma towards substance use and methadone treatment as potential barriers to engaging in methadone treatment. ConclusionResults support the acceptability and feasibility to patients of this PRS-delivered behavioral activation intervention in the context of outpatient MOUD treatment among a low-income, majority racially minoritized patient population. Future intervention adaptation and implementation should focus on incorporating content related to relationships and interpersonal skills; balancing behavioral intervention content with system navigation support; maintaining flexibility; and further investigation of the impact of individual PRS attributes, including shared lived experiences, on intervention acceptability and shifts in stigma.

Activación conductual para dejar de fumar en universitarios mediante videoconferencia: estudio piloto

Introduction: tobacco use is a public health problem in the world. In Mexico, prevalence rates are higher in young adults. There are different reasons for smoking or quitting in a college environment, but they all overlap since most include positive affect induction and reduction of negative affect, which accounts for positive and negative reinforcement processes in smoking behavior. Behavioral Activation (BA) was originally proposed in the treatment of depression through the reinforcement of incompatible behaviors. Promising results have been reported recently in the use of substances and modification of affective states. Objective: to evaluate the effectiveness of a Behavioral Activation intervention to Smoking cessation (BA-S) in the consumption pattern. Method: BA-S was applied by videoconference to 15 college students, with a single-case design with replication; the effect size was calculated using the non-overlap of all pairs (NAP). Results: The BA-S was effective for smoking cessation and reducing consumption patterns. The effect size ranged between 91.10% and 100%; nine students quit smoking and six reduced their consumption. Discussion and conclusions: BA-S decreased the pattern of tobacco consumption and modified the affective states; these results should be taken with caution due to the limited number of participants. It is suggested to continue with the application of the intervention through videoconference since it is a viable alternative in this population.

Acceptability and Feasibility of a Pain and Depressive Symptoms Management Intervention in Middle-Aged and Older African American Women.

The intersection of race, gender, and age puts older African American women at high risk of experiencing comorbid pain and depressive symptoms. The purpose of this study was to assess the feasibility and acceptability of a 12-week behavioral activation intervention to target self-selected goals related to pain and depressive symptoms in middle-aged and older African American women. This randomized waitlist control study included 34 self-identified African American women, 50 years of age or older, with moderate-to-severe chronic pain and depressive symptoms. The intervention consisted of 8 in-person or virtual 1-hour visits with a nurse. Follow-up acceptability assessments were conducted with 10 participants. The average age of the participants was 64.8 (standard deviation [SD] 10.5). They reported an average pain intensity score of 7.0 (SD 1.9) out of 10 and an average Patient Health Questionnaire-9 depressive symptoms score of 11.9 (SD 4.0) at baseline. Of the 34 participants who consented, 28 (82.4%) women started the intervention and 23 (82.1%) completed the intervention. Participants described the study as useful and beneficial. Participants recommended including a group component in future iterations. Effect sizes at 12 weeks were -0.95 for depressive symptoms indicating a substantial decrease in experienced depressive symptoms, but pain intensity was virtually unchanged (+0.09). The findings of this study demonstrate that the intervention is acceptable among middle-aged and older African American women and their personal goals were met. Including a group component and identifying effective ways to decrease attrition rates will be key in the next steps of development for this intervention. It is crucial to provide tailored, nonpharmacological approaches to pain, and depression symptom management in older adult populations who experience inequities in pain and mental health outcomes. This study emphasizes the importance of participant-driven goal-setting interventions.

Effects of lifestyle physical activity and sedentary behaviour interventions on disease activity and patient- and clinician- important health outcomes in rheumatoid arthritis: a systematic review with meta-analysis

BackgroundLifestyle physical activity (PA) is defined as any type of PA undertaken as part of daily life. It can include engagement in activities of daily living (i.e., household chores, gardening, walking to work), incidental PA, walking and/or reducing sedentary or sitting behaviours (SB). Regular PA is recommended for people with Rheumatoid Arthritis (RA) to reduce disease activity and systemic inflammation, as well as to improve patient- and clinician-important health outcomes. However, there is no summarised evidence of the effectiveness of interventions specifically targeting lifestyle PA and SB in this population. The aims of this systematic review with meta-analysis were to evaluate interventions targeting lifestyle PA and/or SB on 1) disease activity; 2) PA, SB and 3) patient- and clinician-important outcomes in people with RA.MethodsEight databases [Medline, Cochrane Library CENTRAL, Web of Science, PsychINFO, Cumulative Index to Nursing & Allied Health Literature, Scopus, Excerpta Medica database and Physiotherapy Evidence Database] were searched from inception-August 2022. Inclusion criteria required interventions to target lifestyle PA and/or SB, conducted in adults with RA, assessing patient- and/or clinician-important outcomes.ResultsOf 880 relevant articles, 16 interventions met the inclusion criteria. Meta-analyses showed statistically significant effects of interventions on disease activity (standardised mean difference = -0.12 (95% confidence interval = -0.23 to -0.01, I2 = 6%, z = 2.19, p = .03), moderate-to-vigorous PA, light/leisure PA, steps, functional ability, and fatigue. Whereas, no intervention effects were visualised for total PA, pain, anxiety or quality of life.ConclusionsLifestyle PA interventions led to increased PA, reductions in SB and improvements in disease activity and other patient- and/or clinician-important health outcomes in people with RA. Future interventions should be less heterogenous in content, structure, focus and outcome measures used to aid understanding of the most effective intervention components for improving health. More SB interventions are needed to determine their effectiveness at producing clinical benefits.

Community Walks: a cluster randomized controlled trial of a multilevel physical activity intervention for low income public housing residents

BackgroundPhysical activity behavioral interventions to change individual-level drivers of activity, like motivation, attitudes, and self-efficacy, are often not sustained beyond the intervention period. Interventions at both environmental and individual levels might facilitate durable change. This community-based study seeks to test a multilevel, multicomponent intervention to increase moderate intensity physical activity among people with low incomes living in U.S. public housing developments, over a 2 year period.MethodsThe study design is a prospective, cluster randomized controlled trial, with housing developments (n=12) as the units of randomization. In a four-group, factorial trial, we will compare an environmental intervention (E) alone (3 developments), an individual intervention (I) alone (3 developments), an environmental plus individual (E+I) intervention (3 developments), against an assessment only control group (3 developments). The environmental only intervention consists of community health workers leading walking groups and indoor activities, a walking advocacy program for residents, and provision of walking maps/signage. The individual only intervention consists of a 12-week automated telephone program to increase physical activity motivation and self-efficacy. All residents are invited to participate in the intervention activities being delivered at their development. The primary outcome is change in moderate intensity physical activity measured via an accelerometer-based device among an evaluation cohort (n=50 individuals at each of the 12 developments) from baseline to 24-month follow up. Mediation (e.g., neighborhood walkability, motivation) and moderation (e.g., neighborhood stress) of our interventions will be assessed. Lastly, we will interview key informants to assess factors from the Consolidated Framework for Implementation Research domains to inform future implementation.DiscussionWe hypothesize participants living in developments in any of the three intervention groups (E only, I only, and E+I combined) will increase minutes of moderate intensity physical activity more than participants in control group developments. We expect delivery of an intervention package targeting environmental and social factors to become active, combined with the individual level intervention, will improve overall physical activity levels to recommended guidelines at the development level. If effective, this trial has the potential for implementation through other federal and state housing authorities.Trial registrationClinical Trails.gov PRS Protocol Registration and Results System, NCT05147298. Registered 28 November 2021.

Communicative accessibility and prospective acceptability of a digital behavioural activation intervention for people with aphasia

ABSTRACT Background Behavioural Activation (BA) is a mental health treatment that encourages a person to develop or re-engage in activities that are pleasurable and meaningful to them. It is important to consider the ways such interventions can be made accessible and acceptable to individuals with communication disabilities like aphasia after stroke. Digital technologies may provide a scalable approach to increasing dissemination of BA to this population. Aims The aim of this study was to examine the communicative accessibility and prospective acceptability of a digital BA intervention developed for this population. Methods & Procedures A qualitative research design was used, involving semi-structured interviews with 11 people with aphasia caused by stroke. Data were subject to qualitative content analysis. Outcomes & Results The results suggest that participants found the developed intervention to be both overall accessible and acceptable. Participants suggested improvements that highlighted the importance of considering how an individual’s psychosocial and cognitive experience of stroke aphasia may influence their preferences for intervention layout and content. Conclusions Results of our study reiterated the importance of a user-centred design process to ensure the accessibility and acceptability of digital interventions. This work provides the foundation for ongoing design of the intervention. The continued development may also provide a framework for future development of accessible and acceptable digital interventions not only for those living with aphasia after stroke but others living with acquired language or cognitive disabilities.

A Preliminary Examination of the Role of Avoidance in Behavioral Activation Treatment Among Latinx Individuals.

The current study examined the role of avoidance in behavioral activation treatment compared to a supportive counseling condition targeting depressive symptoms in a sample comprised of Latinx individuals. Depressed Latinx individuals with Spanish-speaking preference (LSSP; N = 46) were randomized to receive 10-weekly sessions of Brief Behavioral Activation Treatment for Depression (BATD) or supportive counseling. Participants completed weekly self-report measures of depressive symptoms and avoidance. Avoidance levels decreased over the course of both treatments. However, decreases in depressive symptoms were associated with decreases in avoidance over time only for individuals who were randomized to BATD. Greater change in avoidance levels was related to post-treatment depression score, only for those who received BATD. Finally, greater avoidance prior to commencing treatment predicted lower depressive symptom change over the course of both treatments. This study provides preliminary evidence that avoidance may be a specific proposed mechanism of depression change in BATD among LSSP with depression. Pretreatment avoidance appears to be a useful construct to identify the trajectories of depressive symptoms over the course of psychotherapy among LSSP.

A nurse-led multicomponent behavioral activation intervention for patients with atrial fibrillation: a randomized controlled trial

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Research Grants Committee of Hong Kong through the General Research Fund Introduction Patients with atrial fibrillation (AF) often play a passive role in the treatment decision-making process, rendering jeopardized health-related quality of life, suboptimal medication optimization and self-care. Purpose This study aimed to examine the effects of a Nurse-led Multicomponent Behavioral Activation (N-MBA) intervention on HRQoL, knowledge about AF, medication adherence and psychological distress among patients with AF. Methods This parallel two-arm randomized controlled trial recruited community-dwelling patients aged ≥65 years with a confirmed diagnosis of atrial fibrillation, moderate to high risk of stroke but not receiving oral anticoagulation. Participants were randomized in a 1:1 ratio to receive the N-MBA intervention or standard care. The 13-week intervention adopted a novel behavioral activation approach to equip AF patients as an active agent to manage the disease. It consisted of care components to prepare patients for shared decision-making by using a decision aid, an empowerment-based educational module covering relevant AF self-care topics and continuous support through telephone calls. A set of validated instruments was administered at baseline, immediate and 6 months post-intervention. Results A total of 252 participants were randomized to the intervention (n = 127) or control (n = 125) group. Compared with the control group, the intervention group showed greater improvements in HRQoL [β = 10.617, 95% confidence interval (CI) = 1.285 – 20.501, p = 0.023] and AF knowledge (β = 2.129, 95% CI =1.026 – 5.712, p &amp;lt;0.001) at immediate post-intervention. The effects on both outcomes sustained at 6-month follow-up time point. No significant between-group changes in medication adherence, anxiety and depression were detected. Participants in the intervention group were activated to raise their concerns about AF and its treatment with the attending doctors, and they perceived higher compatibility between patient and physician decisions of OAC use upon completion of the intervention. Conclusion The empowerment-based nurse-led intervention is effective at sustaining improvements in HRQoL, AF knowledge and treatment decision making in AF patients with moderate to high stroke risk. It does not increase their psychological distress.

A protocol for a wait list control trial of an intervention to improve pain and depressive symptoms among middle-aged and older African American women

BackgroundPain and depression frequently co-occur among older adults with comorbidities and can exacerbate one another. The intersection of race, gender and age puts older African American women at high risk of experiencing comorbid pain and depression. The purpose of this study is to test the feasibility and acceptability of a 12-week behavioral activation intervention called DAPPER (Depression and Pain Perseverance through Empowerment and Recovery) that uses non-pharmacological, tailored strategies to target pain and mood symptoms. We will measure pain intensity and depressive symptoms as outcomes, although we are not powered to test differences. MethodsWe describe the protocol for this study that uses a randomized waitlist control design to examine acceptability and feasibility of an intervention. The study population is comprised of self-identified African American women, 50 years of age or older with chronic pain and who self-report of depressive symptoms. Participants must also be pre-frail or frail and have an ADL or IADL limitation. The intervention consists of eight 1–2-h visits with a nurse interventionist via in-person or virtual telecommunication methods and two visits for non-invasive specimen collection. The primary outcomes include goal attainment, pain and depressive symptoms. Secondary outcomes include stress, frailty, and communication with providers. Follow-up qualitative interviews are conducted with participants to assess intervention acceptability. DiscussionFindings from this pilot study will provide further evidence supporting the use of non-pharmacological techniques to intervene in the cycle of pain and depression among an at-risk sub-population.

A Cross-Cultural Conceptual Comparison of Behavioral Activation and Ikigai

Cultural bridging may alleviate and catalyze the therapeutic process and help to match therapeutic interventions and patient preferences. In this article, we propose to enhance Western-originated prevention and treatment of depression (behavioral activation) with an Eastern-originated cultural concept of the purpose of living (ikigai).Behavioral activation (BA) is an effective standard method (within cognitive-behavior therapy) to treat depression, whereas ikigai is a Japanese life philosophy attitude. Both approaches share the fundamental idea that the reflection of personal values guides the individual’s everyday decisions. In the present narrative review, we try to explain and systematically compare both approaches to explore the possibilities of their meaningful integration.While the literature underscored the striking similarity between the fundamental ideas of both concepts, the main difference is that ikigai, as a traditional, non-psychotherapeutic approach, refers more to intuition and metaphorical heuristics. We introduce when and how the practice of ikigai could enhance behavioral activation interventions in psychotherapy and its transfer into everyday life.

Feasibility &amp; Acceptability of a Behavioral Activation Intervention for Depression in Caregivers of People With Dementia

Abstract Date Presented 04/21/2023 This poster describes the delivery of a behavioral activation, reward-based intervention to caregivers of people with dementia. Feasibility of virtual delivery, participant satisfaction, and intervention protocol is illustrated. Primary Author and Speaker: Avital S. Isenberg Contributing Authors: Stephen Smagula, Juleen Rodakowski

Active behavioural physiotherapy intervention for acute non-specific neck pain: a cluster randomised double-blind pilot and feasibility clinical trial

Purpose To evaluate the feasibility of an active behavioural physiotherapy intervention (ABPI) and procedures to prevent the transition to chronicity in patients with acute non-specific neck pain (ANSNP). Materials and methods A cluster-randomised double-blind (assessors and participants), parallel 2-arm (ABPI versus standard physiotherapy intervention [SPI]) pilot and feasibility clinical trial was conducted owing to a pre-specified published protocol. Six public hospitals were recruited and cluster-randomised (computer-generated randomisation with block sampling). Sixty participants (30 in each arm, 10 per hospital) were assessed at baseline and 3 months following baseline for neck disability index, numerical pain rating scale, cervical range-of-motion, fear-avoidance beliefs questionnaire and EuroQol 5-dimension 5-level. Results All procedures worked well. The participants’ median age was 36.5 (range 21–59, interquartile range: 20.75) years. Participants in the ABPI demonstrated better improvement in all outcomes compared to SPI. Furthermore, the number of fully recovered participants following ABPI (27/30, 90.00%) was higher than SPI (16/30, 53.33%) with fewer treatment sessions and lower costs of management. Conclusions The findings suggest that the ABPI is feasible and valuable (e.g. a high number of fully recovered participants, fewer treatment sessions and reduced management costs compared to the SPI) in conducting a future definitive trial to evaluate the effectiveness of the ANSNP management. Trial registration TCTR20180607001

Key Components of Antenatal Lifestyle Interventions to Optimize Gestational Weight Gain

Randomized clinical trials have found that antenatal lifestyle interventions optimize gestational weight gain (GWG) and pregnancy outcomes. However, key components of successful interventions for implementation have not been systematically identified. To evaluate intervention components using the Template for Intervention Description and Replication (TIDieR) framework to inform implementation of antenatal lifestyle interventions in routine antenatal care. Included studies were drawn from a recently published systematic review on the efficacy of antenatal lifestyle interventions for optimizing GWG. The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Health Technology Assessment Database, MEDLINE, and Embase were searched from January 1990 to May 2020. Randomized clinical trials examining efficacy of antenatal lifestyle interventions in optimizing GWG were included. Random effects meta-analyses were used to evaluate the association of intervention characteristics with efficacy of antenatal lifestyle interventions in optimizing GWG. The results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Data extraction was performed by 2 independent reviewers. The main outcome was mean GWG. Measures included characteristics of antenatal lifestyle interventions comprising domains related to theoretical framework, material, procedure, facilitator (allied health staff, medical staff, or researcher), delivery format (individual or group), mode, location, gestational age at commencement (<20 wk or ≥20 wk), number of sessions (low [1-5 sessions], moderate [6-20 sessions], and high [≥21 sessions]), duration (low [1-12 wk], moderate [13-20 wk], and high [≥21 wk]), tailoring, attrition, and adherence. For all mean differences (MDs), the reference group was the control group (ie, usual care). Overall, 99 studies with 34 546 pregnant individuals were included with differential effective intervention components found according to intervention type. Broadly, interventions delivered by an allied health professional were associated with a greater decrease in GWG compared with those delivered by other facilitators (MD, -1.36 kg; 95% CI, -1.71 to -1.02 kg; P < .001). Compared with corresponding subgroups, dietary interventions with an individual delivery format (MD, -3.91 kg; 95% CI -5.82 to -2.01 kg; P = .002) and moderate number of sessions (MD, -4.35 kg; 95% CI -5.80 to -2.89 kg; P < .001) were associated with the greatest decrease in GWG. Physical activity and mixed behavioral interventions had attenuated associations with GWG. These interventions may benefit from an earlier commencement and a longer duration for more effective optimization of GWG. These findings suggest that pragmatic research may be needed to test and evaluate effective intervention components to inform implementation of interventions in routine antenatal care for broad public health benefit.