Behavioral Activation Treatment Research Articles

Pilot evaluation on an adapted tele-behavioral activation to increase physical activity in persons with depression: a single-arm pilot study

BackgroundPhysical activity has the potential to improve physical and mental health outcomes of persons with depression. However, feasible and acceptable strategies to integrate physical activity interventions into real-world settings are needed.ObjectiveTo assess the feasibility and acceptability of a manualized Behavioral Activation intervention aimed to increase physical activity in persons with depression (defined as a PHQ-9 score ≥ 10).MethodsA single-arm pilot study was conducted. The intervention consisted of 8 tele-therapy sessions delivered over a 10-week period. Measures of feasibility included screening, enrollment, intervention adherence, outcome data availability, and intervention fidelity. Acceptability was assessed with a post-intervention survey and qualitatively through focus groups and interviews. Preliminary efficacy of the intervention was assessed by evaluating pre-to-post changes in physical activity and depressive symptoms.ResultsAll feasibility metrics exceeded predetermined feasibility goal metrics with the exception of Fitbit wear and screening rate, which was due to a greater than anticipated enrollment rate. Participants (n = 15) reported perceived benefits from the intervention and convenience in attending tele-therapy sessions. Depressive symptoms, as measured by the PHQ-9 improved (16.8 at enrollment to 10.1 post intervention, Cohen’s d = 1.13). Self-reported moderate-to-vigorous physical activity (MVPA) increased from 22.0 min/week at baseline to 36.67 min/week post-intervention (d = 0.58). Physical activity as measured by the Fitbit showed little change (daily step 5543.29 during Week 1 to 6177.48 during Week 10, (d = 0.14); MVPA 21.23 min/week during Week 1 to 19.22 at Week 10 (d = 0.0.06).ConclusionsResults of the pilot study suggest the intervention is feasible to deliver and acceptable to participants. Preliminary results suggest the intervention may be effective in improving depressive symptoms and increasing self-reported physical activity.Trial registrationClinicalTrials.gov NCT04990401, Registered July 21, 2021.

Participatory developed school-based interventions targeting physical activity and sedentary behaviour among children and adolescents: A scoping review.

A significant number of children and adolescents are insufficiently physically active and have a sedentary lifestyle, which is associated with adverse health outcomes, necessitating effective interventions. Using a participatory approach, which engages youth in intervention development, may enhance intervention effectiveness, as such interventions are believed to be more tailored to the needs of the target group. This scoping review aimed to provide an overview of the results of process and effect evaluations of studies that developed school-based physical activity and/or sedentary behaviour interventions using a participatory approach among children and adolescents. Six databases (MEDLINE, Embase, Web of Science, CENTRAL (Cochrane Central Register of Controlled Trials), Scopus and SPORTDiscus) were searched. Studies were included when they evaluated the participatory process, intervention implementation or health-related intervention effects. A quality assessment was completed using two QualSyst checklists. Extracted data included characteristics of studies, interventions, and participatory processes; characteristics of participants from whom data were collected; outcomes measured and measurement methods used; and key findings. Twenty-five papers, covering 18 original studies, were included. Studies suggested that participatory processes were generally perceived positively, resulting in pupils feeling empowered, experiencing ownership and gaining certain skills. Participatory developed interventions also seemed to be generally well received, although the intervention dose delivered and intervention reach seemed to vary between studies. Finally, studies generally tended to report no effects on health. Although a participatory approach could be promising in empowering pupils and promoting intervention acceptance, apparent differences in intervention implementation and limited effectiveness highlight the need to enhance participatory processes and intervention effectiveness.

DepActive: study protocol for a randomised controlled multicentre trial of telephone-delivered behavioural activation for the treatment of depression in older adults in primary care

BackgroundDepression is common in older adults and is related to reduced quality of life and functional ability as well as increased mortality and morbidity. Current guidelines recommend psychological treatments for the treatment of depression in adults. Studies show that about 30% of older adults with depression in Sweden receive pharmacological treatment and about 3% receive psychological treatment. However, a majority receive no treatment at all. There is a need for effective and scalable psychological treatment options for older adults with depression in primary care. Behavioural activation is an extensively evaluated, effective, and relatively simple treatment for depression that can be delivered by health care professionals without comprehensive training in psychological treatment.MethodsWe will conduct a randomised controlled 2-armed parallel group multicentre trial comparing treatment as usual in primary care to a five-session telephone-delivered behavioural activation treatment as add on to treatment as usual. The current trial is open labelled. In all, 250 older adults (≥ 65 years) with depression will be recruited from primary healthcare centres in three Swedish regions. The primary outcome is depressive symptoms measured with the Montgomery Åsberg Depression Rating Scale – Self rating version (MADRS-S) after treatment and at 3- and 6-month follow-up. Secondary outcomes include depression diagnoses, activity level (self-rated and measured with accelerometer), and self-rated anxiety, daily functioning, quality of life, self-efficacy, and loneliness.DiscussionThere is a need for fully powered studies of brief behavioural activation for older adults with depression delivered by telephone in a primary care context. This study has the potential to improve first-line treatment of depression in older adults in primary care, consequently reducing morbidity and mortality within this population. Increasing the availability and accessibility to effective psychological treatment for depression in older adults is needed to meet future demographic changes.Trial registrationClinicalTrials.gov: NCT06284889. Registered February 28, 2024.

Investigating discrepancies in findings between rigorous randomized trials and meta-analyses evaluating pregnancy interventions to limit gestational weight gain.

Robust randomized trials consistently demonstrate little impact from diet and physical activity interventions on gestational weight gain (GWG) and clinical outcomes, although meta-analyses report some benefit. Our aim was to evaluate the effect of trial quality on treatment effect estimates and review conclusions. We conducted a systematic review of dietary and/or physical activity interventions for pregnant women with a body mass index ≥18.5kg/m2. We assessed studies for risk of bias and methodological features impacting reliability. Outcomes included GWG; gestational diabetes mellitus (GDM); pre-eclampsia; caesarean birth; and birth weight measures. For each outcome, a sequence of meta-analyses was performed based on intervention group and level of potential bias in the effect estimate. We identified 128 eligible studies. The most robust estimate from a combined diet and physical activity behavioral intervention, with only studies at negligible risk of bias, was a difference in GWG of 1.10kg (95% CI -1.62 to -0.58; 17,755 women). There was no evidence of an effect on any clinical outcomes. Our findings highlight discrepancies produced by the indiscriminate inclusion of studies with methodological flaws in previous systematic reviews. Regular weighing of pregnant women is futile in the absence of clinical benefit.

Engagement, Acceptability, and Effectiveness of the Self-Care and Coach-Supported Versions of the Vira Digital Behavior Change Platform Among Young Adults at Risk for Depression and Obesity: Pilot Randomized Controlled Trial.

Adolescence and early adulthood are pivotal stages for the onset of mental health disorders and the development of health behaviors. Digital behavioral activation interventions, with or without coaching support, hold promise for addressing risk factors for both mental and physical health problems by offering scalable approaches to expand access to evidence-based mental health support. This 2-arm pilot randomized controlled trial evaluated 2 versions of a digital behavioral health product, Vira (Ksana Health Inc), for their feasibility, acceptability, and preliminary effectiveness in improving mental health in young adults with depressive symptoms and obesity risk factors. A total of 73 participants recruited throughout the United States were randomly assigned to use Vira either as a self-guided product (Vira Self-Care) or with support from a health coach (Vira+Coaching) for 12 weeks. The Vira smartphone app used passive sensing of behavioral data related to mental health and obesity risk factors (ie, activity, sleep, mobility, and language patterns) and offered users personalized insights into patterns of behavior associated with their daily mood. Participants completed self-reported outcome measures at baseline and follow-up (12 weeks). All study procedures were completed via digital communications. Both versions of Vira showed strong user engagement, acceptability, and evidence of effectiveness in improving mental health and stress. However, users receiving coaching exhibited more sustained engagement with the platform and reported greater reductions in depression (Cohen d=0.45, 95% CI 0.10-0.82) and anxiety (Cohen d=0.50, 95% CI 0.13-0.86) compared to self-care users. Both interventions also resulted in reduced stress (Vira+Coaching: Cohen d=-1.05, 95% CI -1.57 to --0.50; Vira Self-Care: Cohen d=-0.78, 95% CI -1.33 to -0.23) and were perceived as useful and easy to use. Coached users also reported reductions in sleep-related impairment (Cohen d=-0.51, 95% CI -1.00 to -0.01). Moreover, participants increased their motivation for and confidence in making behavioral changes, with greater improvements in confidence among coached users. An app-based intervention using passive mobile sensing to track behavior and deliver personalized insights into behavior-mood associations demonstrated feasibility, acceptability, and preliminary effectiveness for reducing depressive symptoms and other mental health problems in young adults. Future directions include (1) optimizing the interventions, (2) conducting a fully powered trial that includes an active control condition, and (3) testing mediators and moderators of outcome effects. ClinicalTrials.gov NCT05638516; https://clinicaltrials.gov/study/NCT05638516.

A Randomized Controlled Trial of a Behavioral Activation Intervention to Increase Engagement with Life and Well-Being in Older Adults

Introduction: Engagement with life is central to aging well. There is currently a lack of flexible programs for promoting engagement that tailor to the unique interests, capacities, and life circumstances of individuals. We designed and evaluated a new program for promoting engagement with later life based on principles of behavioral activation. Methods: A total of 135 adults aged 65 years and older who scored at or below the median on the Life Engagement Test were randomly assigned to either a 6-week behavioral activation program (n = 69) or a 6-week well-being program based on brief positive psychology interventions (the active control; n = 66). Participants completed assessments at baseline, 1-week follow-up, and 3-month follow-up. The primary outcome was engagement with life, and secondary outcome measures included social network characteristics, measures of mental health, well-being, and psychological and self-regulatory resources. Results: Participants in both conditions showed improvements in engagement with life post-intervention that were sustained at 3 months. Post-intervention improvements in both conditions were observed across most secondary outcomes; however, for several outcomes, participants with more limited functional and cognitive resources benefitted from participation in the positive psychology (active control) condition, but not the treatment condition. Conclusion: Similar levels of improvement in engagement with life and well-being were evident for participants who completed a behavioral activation-focused intervention, compared with participants who completed a positive psychology-focused intervention. The positive psychology approach may confer greater benefits for emotional well-being among those with poorer functional and cognitive abilities.

A parallel-arm, randomized trial of Behavioral Activation Therapy for anhedonia versus mindfulness-based cognitive therapy for adults with anhedonia

BackgroundAnhedonia, deficits in motivation and pleasure, is a transdiagnostic symptom of psychopathology and negative prognostic marker. MethodsIn this randomized, parallel-arm clinical trial, a novel intervention, Behavioral Activation Treatment for Anhedonia (BATA), was compared to an individually administered Mindfulness-Based Cognitive Therapy (MBCT) in a transdiagnostic cohort of adults with clinically significant anhedonia (ClinicalTrials.gov Identifiers NCT02874534 and NCT04036136). Participants received 8–15 individual psychotherapy sessions, once weekly, with either BATA (n = 61) or MBCT (n = 55) and completed repeated self-report assessment of anhedonia and other internalizing symptoms. ResultsIndicators of treatment feasibility were similar across conditions, though MBCT showed a trend towards greater attrition rates than BATA, with an adjusted odd's ratio of 2.04 [0.88, 4.73]. Treatment effects on the primary clinical endpoint of anhedonia symptoms did not significantly differ, with a 14-week estimated difference on the Snaith Hamilton Pleasure Scale (SHAPS) of −0.20 [-2.25, 1.84] points in BATA compared to MBCT (z = 0.19, p = 0.845, d = 0.05). The expected 14-week change in SHAPS scores across conditions was −7.18 [-8.22, −6.15] points (z = 13.6, p < 0.001, d = 1.69). There were no significant differences in the proportion of participants demonstrating reliable and clinically significant improvements in SHAPS scores, or in the magnitude of internalizing symptom reductions. LimitationsLimitations included a modest sample size, lack of longer-term follow up data, and non-preregistered analytic plan. DiscussionThere was no evidence to support superior clinical efficacy of BATA over MBCT in a transdiagnostic cohort of adults with elevated anhedonia. Both interventions reduced anhedonia symptoms to a comparable magnitude of other existing treatments.

Harm reduction-focused behavioral activation for people who inject drugs: Mixed methods outcomes from a pilot open trial

IntroductionPeople who inject drugs (PWID) experience high rates of mental health problems and drug-related harms. Harm reduction-focused interventions aim to reduce harms associated with drug use and are an important approach for engaging people who are not seeking traditional abstinence-focused treatment. Yet, few studies to date have examined the effectiveness of harm reduction psychosocial treatment for drug use. We evaluated the outcomes of a harm reduction-focused behavioral activation (BA) intervention from pretreatment to a 1-month follow-up. MethodsA total of N = 23 PWID (65.2 % White; 52.2 % women; mean age 35.4 ± 7.8 years) were recruited from syringe services programs and n = 19 received the intervention via teletherapy. Assessment of study outcome measures occurred at pre- and posttreatment and a one-month follow-up. ResultsResults reflected post-intervention increases in behavioral activation and readiness to change drug use, as well as decreases in substance use, depression, and HIV risk behaviors. There were mixed outcomes on substance-related problems with increases at follow-up, possibly reflecting increased problem recognition. ConclusionsThese results suggest initial promise for the harm reduction-focused treatment. Additional research with randomized designs and larger sample sizes is needed, and more intensive treatment may be required to support sustained treatment gains in this population.

Effects of a 6-month physical activity behavioral intervention in patients following metabolic bariatric surgery: a randomized controlled trial

BackgroundPromoting habitual physical activity (PA) among bariatric patients is crucial for long-term surgery success, yet it poses a significant challenge for healthcare practitioners. ObjectivesThis randomized controlled trial (RCT) aimed to examine the effectiveness of a theory-based behavioral intervention on PA level in post-metabolic bariatric surgery (MBS) patients. SettingUniversity Hospital, Israel MethodsForty-four patients undergoing MBS were randomized to the intervention (n = 22) or control group (n = 22). The intervention group received a 6-month PA counseling program based on self-determination theory (SDT) and the 5 A’s framework, while the control group received usual care. PA level and self-efficacy for exercise (SEE) were assessed pre- (baseline, preintervention) and postoperatively (14 and 28 weeks follow-ups). Anthropometrics, physical function, cardiovascular, and biochemical outcomes were measured at all time points. ResultsThe intervention group showed greater increases in PA levels across time compared to the control group. A significant increase in step counts from baseline to 14 weeks was observed (P = .003). Significant differences favoring the intervention group were observed in self-reported PA changes from baseline to 14- and 28-week follow-ups (P = .020 and P = .024, respectively). Additionally, Physical function, as assessed by the 6-minute walk test (6MWT) and the 5 sit-to-stand (5STS) test, significantly improved in the intervention group throughout the follow-up period (P < .05 for all), However, no between-group differences were observed in SEE, anthropometrics, cardiovascular, or biochemical parameters. ConclusionsA 6-month behavioral intervention post-MBS significantly enhanced patients' PA levels and physical function. Given its theory-based approach and structured protocol, this intervention could be disseminated to support MBS clinicians and centers. Further research with longer follow-up period is warranted to confirm these findings and assess the long-term effects.

The effects of a telenursing scheduled intervention of brief behavioral activation therapy on depression and anxiety symptoms of patients with mixed depression and anxiety disorder: A randomized controlled trial

BackgroundAlthough many studies have been conducted on the efficacy of behavioral activation in depression, few studies have evaluated the efficacy of this treatment in patients with mixed depression and anxiety through telecare. AimTo determine the effects of a telenursing scheduled intervention of brief behavioral activation therapy on depression and anxiety symptoms of patients with mixed anxiety and depression disorder (MADD). DesignA randomized controlled trial. MethodsThirty subjects with MADD were randomly assigned to an intervention group and a control group. The eight-session person-centered behavioral activation intervention was delivered twice weekly via tele-nursing. Depression and anxiety symptom severity were assessed using the Hamilton Anxiety Rating Scale and the Hamilton Depression Rating Scale at baseline, at the end, and one month after the intervention. Data were analyzed by independent t-tests, chi-square tests, and repeated-measures tests using SPSS version 24. ResultsThe results showed that after the implementation of the intervention, the depression score in the intervention group decreased from 19.86 (±8.56) to 17.21 (±6.71). In contrast, depression scores increased from 18.67 (±9.72) to 19.47 (±7.33) in the control group. For anxiety symptoms, there was a clinically significant decrease after the intervention only in the intervention group. ConclusionThe results showed the effects of brief behavioral activation tele-nursing on a non-significant reduction in depression symptoms and a significant clinical reduction in anxiety symptoms after the intervention in MADD.

Behavioral Activation and Brain Network Changes in Depression.

Behavioral activation (BA) is a well-established method of evidence-based treatment for depression. There are clear links between the neural mechanisms underlying reward processing and BA treatment for depressive symptoms, including anhedonia; however, integrated interpretations of these two domains are lacking. Here we examine brain imaging studies involving BA treatments to investigate how changes in brain networks, including the reward networks, mediate the therapeutic effects of BA, and whether brain circuits are predictors of BA treatment responses. Increased activation of the prefrontal and subcortical regions associated with reward processing has been reported after BA treatment. Activation of these regions improves anhedonia. Conversely, some studies have found decreased activation of prefrontal regions after BA treatment in response to cognitive control stimuli in sad contexts, which indicates that the therapeutic mechanism of BA may involve disengagement from negative or sad contexts. Furthermore, the decrease in resting-state functional connectivity of the default-mode network after BA treatment appears to facilitate the ability to counteract depressive rumination, thereby promoting enjoyable and valuable activities. Conflicting results suggest that an intact neural response to rewards or defective reward functioning is predictive of the efficacy of BA treatments. Increasing the benefits of BA treatments requires identification of the unique individual characteristics determining which of these conflicting findings are relevant for the personalized treatment of each individual with depression.

Multifaceted, Brief Intensive Home-Based Exposure Treatment in Patients with Obsessive-Compulsive Disorder Who are Nonresponsive to Regular Cognitive Behavior Therapy: An Uncontrolled Pilot Study.

To test a multifaceted treatment program for patients with obsessive-compulsive disorder (OCD) who did not respond to regular cognitive behavior therapy (CBT). The treatment addresses several factors that may play a role in maintaining OCD. We designed a treatment consisting of a 6-day intensive, individual exposure in vivo with response prevention (ERP) format, with 24 therapist-assisted treatment hours at the patient's home and 12 self-controlled ERP hours, including behavioral activation and family interventions. Next, we investigated the effect (obsessive-compulsive symptoms, comorbidity, functioning, quality of life, OCD-related interaction patterns) and feasibility (dropout, treatment satisfaction, and organization) of this program using pre-post-tests, pre-follow-up tests, and qualitative data from patients, family members, and therapists. In a sample of 22 participants, obsessive-compulsive symptoms (Y-BOCS pre: 28.7, post: 15.9; Wilcoxon S-R tests P<0.01) improved significantly, as did most other effect measures. Results were largely, but not completely, preserved at 3-month follow-up. There was only 1 dropout. Patients, family members, and therapists were satisfied with the treatment. Implementation of the treatment did not pose difficulties. In nonresponders with OCD, a multifaceted, brief, intensive home-based ERP program targeting factors maintaining OCD is promising and feasible. Extra care is needed to maintain improvement.

Layperson-Delivered Telephone-Based Behavioral Activation Among Low-Income Older Adults During the COVID-19 Pandemic

Older adults are particularly vulnerable to loneliness and its physical and psychosocial sequelae, but scalable interventions are lacking, especially during disasters such as pandemics. To compare the effects of layperson-delivered, telephone-based behavioral activation and mindfulness interventions vs telephone-based befriending on loneliness among at-risk older adults. This assessor-blinded, 3-arm randomized clinical trial screened Chinese older adults through household visits and community referrals from April 1, 2021, to April 30, 2023, in Hong Kong. Eligible participants (≥65 years of age) who were lonely, digitally excluded, living alone, and living below the poverty line and provided consent to participate were randomized into behavioral activation, mindfulness, and befriending groups. Assessments were conducted at baseline, 1 month, and 3 months. As part of the Helping Alleviate Loneliness in Hong Kong Older Adults (HEAL-HOA) dual randomized clinical trial, 148 older laypersons were trained to deliver a twice-weekly 30-minute intervention via telephone for 4 weeks. The primary outcome was loneliness measured by the UCLA Loneliness Scale (range, 20-80) and the De Jong Gierveld Loneliness Scale (range, 0-6), with higher scores on both scales indicating greater loneliness. Secondary outcomes were depression, perceived stress, life satisfaction, psychological well-being, sleep quality, perceived social support, and social network. A total of 1151 participants (mean [SD] age, 76.6 [7.8] years; 843 [73.2%] female) were randomized to the behavioral activation (n = 335), mindfulness (n = 460) or befriending (n = 356) group. Most were widowed or divorced (932 [81.0%]), had primary education or below (782 [67.9%]), and had 3 or more chronic diseases (505 [43.9%]). Following intention-to-treat principles, linear mixed-effects regression model analyses showed that loneliness measured by the UCLA Loneliness Scale was significantly reduced in the behavioral activation group (mean difference [MD], -1.96 [95% CI, -3.16 to -0.77] points; P < .001]) and in the mindfulness group (MD, -1.49 [95% CI, -2.60 to -0.37] points; P = .004) at 3 months compared with befriending. Loneliness measured by the De Jong Gierveld Loneliness Scale was not significantly reduced at 3 months in the behavioral activation group (MD, -0.06 [95% CI, -0.26 to 0.13] points; P > .99]) but was in the mindfulness group (MD, 0.22 [95% CI, 0.03 to 0.40] points; P = .01) at 3 months compared with befriending. In the behavioral activation and mindfulness groups, sleep quality improved compared with befriending, but perceived stress increased. Psychological well-being and perceived social support improved in the behavioral activation group. No statistically significant between-group differences were observed in depression, life satisfaction, or social network. In this randomized clinical trial, scalable psychosocial interventions delivered remotely by older laypersons appeared promising in reducing later life loneliness and addressing the pressing mental health challenges faced by aging populations and professional geriatric mental health workforce shortages. Further research should explore ways to maximize the clinical relevance and cost-effectiveness of these interventions. Chinese Clinical Trial Registry Identifier: ChiCTR2300072909.

Study protocol for the Treating Opioid Patients' Pain and Sadness (TOPPS) study — A randomized control trial to lower depression and chronic pain interference, and increase care retention among persons receiving buprenorphine

BackgroundPersons receiving prescription buprenorphine for opioid use disorder experience high rates of comorbid conditions such as chronic pain and depression, which present barriers to buprenorphine care retention. This paper describes the protocol of the TOPPS (Treating Opioid Patients' Pain and Sadness) study, which compares a values-based, behavioral activation intervention with a health education contact-control condition, with the aim of decreasing chronic pain and depression, and increasing buprenorphine care retention for persons with opioid use disorder. MethodsThis randomized controlled trial (RCT) enrolls and randomizes up to 250 participants currently being treated with buprenorphine to receive three months of either TOPPS, a six-session phone-based behavioral intervention, or a health education (HE) control condition. We compare the TOPPS intervention to HE on the following outcomes: 1) pain interference and pain severity over the 3-month treatment phrase; 2) depressive symptoms over the 3-month treatment phase; and 3) sustained improvements in pain interference, depressive symptoms, and buprenorphine treatment retention over the 12-month study period. We also examine mechanisms by which the intervention may reduce pain interference. DiscussionThis RCT explores a novel intervention to address chronic pain and depression for individuals receiving buprenorphine in office-based settings. TOPPS may lead to improved pain, depression, and substance use outcomes, and can utilize providers available within buprenorphine programs, broadening the disseminability of this intervention and heightening its public health impact. Clinical Trial#NCT03698669

Effectiveness of a modified behavioural activation treatment training program for primary medical staff to manage depressive symptoms among rural elderly in Hunan Province, China: study protocol for a cluster randomised controlled trial

IntroductionDepression is a major global health problem, with high prevalence rates of depressive symptoms observed among the elderly population in China, particularly exacerbating in rural areas. Due to a lack...

Counteract Anhedonia! Introducing an Online-Training to Enhance Reward Experiencing - A Pilot Study.

Anhedonia is a risk factor for a severe course of depression but is often not adequately addressed in psychotherapy. This study presents the Training to Enhance Reward Experience (T-REx), a novel self-help approach that uses savoring and mental imagery to target impairments in reward experience associated with anhedonia. We aimed to examine feasibility and acceptability of T-REx and exploratively investigated its effects on anhedonia and other clinical variables. In an online, randomized controlled trial, 79 subjects participated for five days in T-REx or the active control condition Gratitude Writing (GW). We assessed changes in anhedonia, depression, and active behavior at inclusion, after the waiting period, post-intervention and at follow-up. The intervention effects were examined for the full sample and an anhedonic sub-sample. T-REx and GW were equally feasible and clearly accepted by the sample. Both interventions significantly reduced depressive symptoms and increased behavioral activation. Although there was no significant main effect of the interventions, between-group differences were observed for depressive symptoms and active behavior at post-intervention and follow-up, favoring T-REx. Further, within-group changes for T-REx were larger than for GW. The observed effects had a greater magnitude in the anhedonic sub-sample, suggesting that individuals with more pronounced anhedonic symptoms derived greater benefit from the interventions. This first study of T-REx provides promising results that should prompt further investigations of T-REx in clinical samples. The results suggest that T-REx has a positive effect on depression symptoms and active behavior. Further, its potential as a valuable adjunct to behavioral activation interventions is discussed.

The effects of psychotherapy for anhedonia on subcortical brain volumes measured with ultra-high field MRI

BackgroundAnhedonia is a transdiagnostic symptom often resistant to treatment. The identification of biomarkers sensitive to anhedonia treatment will aid in the evaluation of novel anhedonia interventions. MethodsThis is an exploratory analysis of changes in subcortical brain volumes accompanying psychotherapy in a transdiagnostic anhedonic sample using ultra-high field (7-Tesla) MRI. Outpatients with clinically impairing anhedonia (n = 116) received Behavioral Activation Treatment for Anhedonia, a novel psychotherapy, or Mindfulness-Based Cognitive Therapy (ClinicalTrials.gov Identifiers NCT02874534 and NCT04036136). Subcortical brain volumes were estimated via the MultisegPipeline, and regions of interest were the amygdala, caudate nucleus, hippocampus, pallidum, putamen, and thalamus. Bivariate mixed effects models estimated pre-treatment relations between anhedonia severity and subcortical brain volumes, change over time in subcortical brain volumes, and associations between changes in subcortical brain volumes and changes in anhedonia symptoms. ResultsAs reported previously (Cernasov et al., 2023), both forms of psychotherapy resulted in equivalent and significant reductions in anhedonia symptoms. Pre-treatment anhedonia severity and subcortical brain volumes were not related. No changes in subcortical brain volumes were observed over the course of treatment. Additionally, no relations were observed between changes in subcortical brain volumes and changes in anhedonia severity over the course of treatment. LimitationsThis trial included a modest sample size and did not have a waitlist-control condition or a non-anhedonic comparison group. ConclusionsIn this exploratory analysis, psychotherapy for anhedonia was not accompanied by changes in subcortical brain volumes, suggesting that subcortical brain volumes may not be a candidate biomarker sensitive to response to psychotherapy.

Effectiveness of a Behavioral Activation Intervention for Peripartum Women with Opioid Use Disorder.

Pregnant women with opioid use disorder show elevated rates of comorbid mental health problems, both of which are associated with negative health outcomes for mothers and children. There is substantial evidence supporting the benefits of treatment of perinatal opioid use disorder, as well as perinatal depression and anxiety, but there are gaps in knowledge about the effectiveness of perinatal behavioral health interventions in the context of co-occurring substance use disorder. The current study seeks to address this gap by examining outcomes of a behavioral activation treatment in a group of peripartum women with opioid use disorder (N = 68). Behavioral activation has shown promise in treating co-occurring depression and substance use problems. The intervention was delivered as part of an integrated care treatment model, in which patients received co-located obstetric, substance use, and mental health care in a hospital-based clinic. Hierarchical linear modeling was used to assess change in symptoms over time. Results suggest that the group behavioral activation intervention was associated with reduced depression and anxiety symptoms, demonstrated by significant reductions in PHQ-9 and GAD-7 scores over the course of treatment. Moreover, there were indications that increased attendance was associated with further reductions in depressive symptoms. Results contribute to understanding the effectiveness of behavioral activation in the context of peripartum opioid use disorder. Findings also add to the evidence supporting integrated care models and offer a potential blueprint for improving outcomes and reducing barriers to care in this population.

A Digital Behavioral Activation Intervention (JuNEX) for Pregnant Women With Subclinical Depression Symptoms: Explorative Co-Design Study.

Digital interventions are gaining increasing interest due to their structured nature, ready availability, and self-administered capabilities. Perinatal women have expressed a desire for such interventions. In this regard, behavioral activation interventions may be particularly suitable for digital administration. This study aims to exploratorily investigate and compare the feasibility of the internet-based self-help guided versus unguided version of the Brief Behavioral Activation Treatment for Depression-Revised, an empirically supported in-person behavioral activation protocol, targeting pregnant women with subclinical depression symptoms. A user-centered design is used, whereby data are collected with the intent of evaluating how to adjust the intervention in line with pregnant women's needs. Usability and user engagement were evaluated. A total of 11 Italian pregnant women with subclinical depressive symptoms based on the Patient Health Questionnaire-9 (scoring<15) participated in this study; of them, 6 (55%) women were randomly assigned to the guided group (age: mean 32.17, SD 4.36 years) and 5 (45%) to the unguided group (age: mean 31, SD 4.95 years). The Moodle platform was used to deliver the interventions in an e-learning format. It consisted of 6 core modules and 3 optional modules; the latter aimed at revising the content of the former. In the guided group, each woman had weekly chats with their assigned human guide to support them in the homework revisions. The intervention content included text, pictures, and videos. Semistructured interviews were conducted, and descriptive statistics were analyzed. Collectively, the data suggest that the guided intervention was better accepted than the unguided one. However, the high rates of dropout (at T6: guided group: 3/6, 50%; unguided: 4/5, 80%) suggest that a digital replica of Behavioral Activation Treatment for Depression-Revised may not be feasible in an e-learning format. The reduced usability of the platform used was reported, and homework was perceived as too time-consuming and effort-intensive. Moreover, the 6 core modules were deemed sufficient for the intervention's goals, suggesting that the 3 optional modules could be eliminated. Nevertheless, participants from both groups expressed satisfaction with the content and found it relevant to their pregnancy experiences. Overall, the findings have emphasized both the intervention's merits and shortcomings. Results highlight the unsuitability of replicating an in-person protocol digitally as well as of the use of nonprofessional tools for the implementation of self-help interventions, ultimately making the intervention not feasible. Pregnant women have nonetheless expressed a desire to receive psychological support and commented on the possibilities of digital psychosocial supports, particularly those that are app-based. The information collected and the issues identified here are important to guide the development and co-design of a more refined platform for the intervention deployment and to tailor the intervention's content to pregnant women's needs.

Harm Reduction Behavioral Activation Teletherapy for People Who Inject Drugs: Development, Feasibility, and Acceptability

People who inject drugs (PWID) experience severe substance-related harms and yet have low rates of engagement in substance use disorder treatment. Low-barrier and telepsychology interventions represent promising strategies for engaging PWID in treatment, but few studies have tested the feasibility of these approaches among non-treatment-seeking PWID. A behavioral activation (BA) treatment for substance use was adapted through a harm reduction lens to assist PWID in working toward healthy, meaningful lives and achieving their goals. This study aims to: (a) describe the development and harm reduction–focused adaptation of the BA intervention, and (b) examine the feasibility and acceptability of administering a telepsychology BA treatment for substance use among non-treatment-seeking PWID. We recruited N = 23 PWID (65.2% White; 52.2% women; mean age 35.4 ± 7.8 years) from syringe services programs into an open trial and n = 19 received up to eight sessions of BA over 4 weeks. Qualitative treatment feedback interviews occurred at posttreatment. Among those who attended ≥1 session of treatment, 84% attended a second assessment, and 58% attended ≥7 intervention sessions. Feasibility challenges were primarily related to participant vulnerabilities (e.g., hospitalization, incarceration, loss of access to technology). Participants indicated high acceptance of the intervention and its telepsychology format. In conclusion, while PWID face significant barriers to engaging in treatment, some also demonstrate a desire, willingness, and capacity for psychological intervention. Remote interventions may help increase feasibility of treatment participation. Future studies should examine longer harm reduction-focused treatments for PWID that balance barriers to initial engagement with the need to reinforce treatment gains and improve long-term outcomes.