Behavioral Activation Therapy Research Articles

Development and efficacy of Non-Face-to-Face Behavioral Activation Therapy for Young Adult Reclusive Loners

Development and efficacy of Non-Face-to-Face Behavioral Activation Therapy for Young Adult Reclusive Loners

Childhood maltreatment as predictor and moderator for treatment outcome in patients with major depressive disorders treated with metacognitive therapy or behavioral activation

BackgroundChildhood maltreatment (CM) is a risk factor for developing and maintaining depression. It is unclear whether CM influences the effect of treatments for depression. This study examined CM's predictor and moderator effect in Behavioral Activation (BA) and Metacognitive Therapy (MCT). MethodCM was analyzed in a trial comparing a six months treatment program of either BA or MCT for 122 outpatients with major depressive disorder (MDD). Depression was assessed by the Hamilton Rating Scale for Depression (HRSD-24). CM was assessed using the Childhood Trauma Questionnaire (CTQ). ResultsLinear mixed models showed no predictor or moderator effects for the CTQ total score (all p > .58) but revealed a moderator effect for ‘sexual abuse’ on the reduction of depressive symptoms (β = 10.98, SE = 4.48, p = .015) indicating that patients with experiences of childhood sexual abuse benefited more from BA. There also was a predictor effect for ‘physical neglect’ (β = −3.35, SE = 1.70, p = .049): patients without the experience of physical neglect benefited more from treatment regardless of condition. Exploratory analyses indicated no predictor or moderator effects for the onset or persistence of depression, comorbid anxiety disorders or Cluster-C PDs (all p > .28). LimitationsLimitations include small sample sizes for some of the subsamples. ConclusionChildhood sexual abuse seems to moderate treatment effectiveness in a sample of severely affected outpatients with MDD treated with MCT or BA. If confirmed in further trials, a history of sexual abuse might guide the choice between MCT and BA. Trial registrationGerman Clinical Trials Register DRKS-ID: DRKS00011536 (retrospectively registered on February 13, 2017, without changes to the study protocol).

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.

The utility of behavioral activation therapy in addressing emotional problems of two depressed students with borderline intellectual disability: A case study.

Intellectual disability is one of the neurodevelopmental disorders. Studies indicated that depression and anxiety are the most prevalent emotional problems among the people with intellectual disability. The aim of this study was to investigate the utility of behavioral activation therapy in addressing emotional problems of two depressed students with borderline intellectual disability. This study is a single-subject design with multiple baseline and one month follow-up. Two students with borderline intelligence underwent behavioral activation therapy for 12 sessions. Beck Depression Inventory-Second Edition, Beck Anxiety Inventory, Oxford Happiness Inventory and Rosenberg Self-Esteem Scale were used. Data were analyzed using visual inspection of graphed data, changes in trends, improvement percentage and effect size. The findings of this study support the utility of behavioral activation therapy in addressing the emotional problems of two depressed students with borderline intellectual disability. Behavioral activation therapy has had favorable outcomes in reducing depression and anxiety in depressed students with borderline intellectual disabilities.

Dynamic processes in behavioral activation therapy for anhedonic adolescents: Modeling common and patient-specific relations.

Behavioral activation (BA) is a brief intervention for depression encouraging gradual and systematic re-engagement with rewarding activities and behaviors. Given this treatment focus, BA may be particularly beneficial for adolescents with prominent anhedonia, a predictor of poor treatment response and common residual symptom. We applied group iterative multiple model estimation (GIMME) to ecological momentary assessment (EMA) treatment data to investigate common and person-specific processes during BA for anhedonic adolescents. Thirty-nine adolescents (Mage = 15.7 years old, 67% female, 81% White) with elevated anhedonia (Snaith-Hamilton Pleasure Scale) were enrolled in a 12-week BA trial, with weekly anhedonia assessments. EMA surveys were triggered every other week (2-3 surveys per day) throughout treatment assessing current positive affect (PA) and negative affect (NA), engagement in pleasurable activities and social interactions, anticipatory pleasure, rumination, and recent pleasurable and stressful experiences. A multilevel model revealed significant decreases in anhedonia, t(25.5) = -4.76, p < .001, over the 12-week trial. GIMME results indicated substantial heterogeneity in variable networks across patients. PA was the variable with the greatest number (22% of all paths vs. 11% for NA) of predictive paths to other symptoms (i.e., highest out-degree). Higher PA (but not NA) out-degree was associated with greater anhedonia improvement, t(25.8) = -2.22, p = .035. Results revealed substantial heterogeneity in variable relations across patients, which may obscure the search for common processes of change in BA. PA may be a particularly important treatment target for anhedonic adolescents in BA. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Relationship between outcomes and processes in patients with chronic low back pain plus depressive symptoms: idiographic analyses within a randomized controlled trial

Objective This study explored the extent to which within-patient changes in processes targeted in Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD) are associated with changes within-patient in pain intensity and depressed mood and evaluated the extent that process-outcome relationships differed between patients. Methods An idiographic analysis embedded within a randomized controlled trial comparing ACT, BATD, and treatment-as-usual (TAU) was conducted to examine the strength of the relationship between outcomes and process variables in patients with chronic low back pain (CLBP) plus depressive symptoms. Based on data from ecological momentary assessment in patients (n = 82), the level of heterogeneity and the pooled effects of these relationships during the intervention period (70 days) were explored. Results Overall, a high level of heterogeneity was identified in the relationship between pain intensity or depressed mood and psychological inflexibility or behavioral activation. Individual differences in the relationships between outcomes and process variables were identified in individual people during the intervention period. These individual differences appear independent of the group (ACT, BATD, and TAU) and other definable differences (responders/non-responders, completers/non-completers, and clinical depression/non-clinical depression). Conclusions These findings suggest the potential utility of personalizing psychological interventions according to the therapeutic needs of these patients.

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.

Internet-based self-administered intervention to reduce anxiety and depression symptomatology and improve well-being in 7 countries: protocol of a randomized control trial.

Online psychological interventions have emerged as a treatment alternative because they are accessible, flexible, personalized, and available to large populations. The number of Internet interventions in Latin America is limited, as are Randomized Controlled Trials (RCTs) of their effectiveness and a few studies comparing their effectiveness in multiple countries at the same time. We have developed an online intervention, Well-being Online, which will be available to the public free of charge in 7 countries: Mexico, Ecuador, Peru, Chile, Brazil, Spain, and the Netherlands. We expect a reduction in depression and anxiety symptoms and an increase in well-being of the participants. A multi-country, randomized controlled trial will be conducted. The intervention is multicomponent (Cognitive Behavioral Therapy, Behavioral Activation Therapy, Mindfulness, Acceptance and Commitment Therapy, and Positive Psychology), with 10 sessions. In each country, eligible participants will be randomized to one of three groups: Enriched Intervention (interactive web design with videos, infographics, text, audio, and forum), Text Intervention (text on the website), and Wait List (control group). Repeated measures will be obtained at 5-time points. Our primary outcomes will be anxiety symptomatology, depressive symptomatology, and mental well-being. MANOVA analysis will be used for our main analysis. This protocol describes the design of a randomized trial to evaluate the efficacy of a web-based intervention to reduce anxiety and depression symptomatology and increase subjective well-being. The intervention will be made available in four languages (Spanish, Portuguese, Dutch, and English). Its results will contribute to the evidence of effectiveness in terms of randomized trials and Internet interventions, mainly in Latin America and Europe.

Protocol for a randomised controlled trial of ketamine versus ketamine and behavioural activation therapy for adults with treatment-resistant depression in the community

IntroductionAlthough short-term benefits follow parenteral ketamine for treatment-resistant major depressive disorder (TR-MDD), there are challenges that prevent routine use of ketamine by clinicians. These include acute dissociative effects of parenteral...

Behavioral activation for depression in groups embedded in psychosomatic rehabilitation inpatient treatment: a quasi-randomized controlled study.

Behavioral activation (BA) and cognitive-behavioral therapy (CBT) have shown to be efficacious treatment methods for depression. Previous studies focused mostly on the outpatient treatment either in group or individual setting. The present study aimed at comparing the efficacy of group treatment BA vs. CBT, when embedded in inpatient psychosomatic rehabilitation treatment. 375 inpatients were randomly assigned to either BA (N = 174) or CBT (N = 201). We used established scales for depression such as the Beck Depression Inventory II (BDI-II, self-rating), the Quick Inventory of Depressive Symptomatology (QIDS; expert rating) and the Behavioral Activation for Depression Scale (BADS) to assess changes over the course of the treatment and at follow-up (4 to 6 months). In addition, we measured disability-related functioning with the Mini-ICF-APP, a rating scale built in reference to the International Classification of Functioning, Disability and Health (ICF). Multilevel models with repeated measures were conducted to examine the differences between groups in relation to change over time with patients' random effects. Both group formats showed substantial reduction in depressive symptoms at the end of treatment (d= 0.83 BA vs. d= 1.08 CBT; BDI-II) and at follow-up after 4 to 6 months (d = 0.97 BA vs. d = 1.33 CBT, BDI-II; and d = 1.17 BA vs. d = 1.09 CBT, QIDS). There were no significant differences between treatment approaches. At least 50% symptom reduction was achieved by 53.7% and 54.2% in BA vs. CBT respectively. Reported activation levels increased from pre- to posttreatment (d = 0.76 BA vs. d = 0.70CBT), while showing loss of increment between the end of the treatment until follow up in both formats (d = 0.28 BA vs. d = 0.29 CBT). Both modalities led to significant improvement of symptomatology and functioning at the end of the treatment and at follow-up, thus for the first time demonstrating the practicability of BA in rehabilitation clinics. Considering its lower requirements regarding cognitive abilities and its easier implementation, BA proved to be a good alternative to other psychotherapeutic treatments.

Psychotherapy, antidepressants show comparable results in patients with heart failure

A randomized trial involving patients with heart failure and depression has found that behavioral activation therapy and antidepressant treatment had comparable efficacy in reducing depressive symptoms. Behavioral activation therapy was more effective than medication on some secondary outcome measures.

Different components of cognitive-behavioral therapy affect specific cognitive mechanisms.

Psychological therapies are among the most effective treatments for common mental health problems-however, we still know relatively little about how exactly they improve symptoms. Here, we demonstrate the power of combining theory with computational methods to parse effects of different components of cognitive-behavioral therapies onto underlying mechanisms. Specifically, we present data from a series of randomized-controlled experiments testing the effects of brief components of behavioral and cognitive therapies on different cognitive processes, using well-validated behavioral measures and associated computational models. A goal setting intervention, based on behavioral activation therapy activities, reliably and selectively reduced sensitivity to effort when deciding how to act to gain reward. By contrast, a cognitive restructuring intervention, based on cognitive therapy materials, reliably and selectively reduced the tendency to attribute negative everyday events to self-related causes. The effects of each intervention were specific to these respective measures. Our approach provides a basis for beginning to understand how different elements of common psychotherapy programs may work.

The effectiveness of behavioral activation therapy on the symptoms of depression, rumination, and social-occupational functioning impairment among women with postpartum depression.

Postpartum depression is caused by a wide range of factors, and women in their postpartum period are highly vulnerable, either physically or emotionally. The present study aimed to investigate the effects of behavioral activation therapy on the symptoms of depression, rumination, and social-occupational functioning impairment among women with postpartum depression (PPD). This quasi-experimental research included a pre-test, a post-test, and a one-month follow-up, as well as experimental and control groups. The participants were screened using Edinburgh Postnatal Depression Scale (EDPS) in 2019. The research included 32 women who had visited Isfahan Healthcare Centers. They were selected using convenience sampling and then randomly divided into experimental (16 individuals) and control groups (16 individuals). Both groups answered the following questionnaires before, immediately after, and one month after the intervention: Beck Depression Inventory (BDI), Nelon, et al. Ruminative Response Scale, and Mundt et al. Work and Social Adjustment Scale (WSAS). The experimental group received behavioral activation therapy for nine 90-minute sessions once a week. The data were analyzed using the statistical method of multivariance analysis of covariance (MANCOVA). The results showed that behavioral activation therapy had a significant effect on the symptoms of depression (P = 0.001, F = 79.65), postpartum depression (P = 0.001, F = 220.359), rumination (P = 0.001, F = 121.765), and social-occupational functioning impairment (P = 0.001, F = 368.512) among women with postpartum depression. The effects of behavioral activation therapy also lasted in the follow-up stage of the study. According to the present research, behavioral activation therapy is an effective method that decreases the symptoms of depression, rumination, and occupational-social functioning impairment among women with postpartum depression. Therefore, behavioral activation therapy could be beneficial to intervention designs and treatment of postpartum depression.

Comparison of the Effectiveness of Mindfulness-Based Cognitive Therapy and Behavioral Activation on Irrational Thoughts and Depression in Generalized Anxiety Disorder

Objective: The aim of the present study was to compare the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) and Behavioral Activation (BA) therapy on irrational thoughts and depression in individuals with Generalized Anxiety Disorder (GAD). Methods and Materials: This applied research utilized a quasi-experimental method with a pre-test and post-test design. The statistical population included all individuals diagnosed with GAD who visited psychotherapy clinics in Mashhad in 2020. From this population, 45 participants were purposefully selected from the Nabz-e Zindagi Counseling Center in Mashhad and randomly assigned to three groups of 15 (two experimental groups and one control group). The subjects responded to the Irrational Beliefs Test (IBT) by Ahwaz and Mo'tamedi (2005) and the Beck Depression Inventory (BDI) (1961) at three stages: pre-test, post-test, and follow-up. The MBCT and BA therapies were administered to the experimental groups, while the control group did not receive any treatment. Data were analyzed using SPSS software. Findings: The results indicated that the main effect of the group on irrational thoughts and depression was significant in both experimental groups (p &lt; .05). However, there was no significant difference in the impact of the two methods on irrational thoughts (p = .144) and depression (p = .950). Conclusion: Both treatments were equally effective in individuals with GAD. Therefore, both treatments can be utilized to reduce psychological problems in individuals with GAD.

Internet-based behavioural activation therapy versus online psychoeducation for self-reported suicidal ideation in individuals with depression in Indonesia: a secondary analysis of an RCT

BackgroundSoutheast Asia has the highest suicide mortality worldwide. To improve our knowledge on the effectiveness of interventions for suicidal ideation (SI) in individuals with depression in Indonesia, we conducted a...

Assessing the Impact of Behavioral Activation Therapy on Physiological and Chemical Markers of Depression in Adolescents: A Study in Puducherry Schools

Background: According to WHO, Sep 2020 reported globally, depression is the leading cause of illness and disability among adolescents aged 15-19 years. Adolescence is a period in which an individual undergoes physical, psychological and cognitive changes. Additionally, the adolescent experiences changes in social expectations and perceptions. This affects how the adolescents feel, think, make decisions, and interact with the world around them. The main aim of the study is to assess the effectiveness of Behavioral Activation Therapy on Bio-physiological and Biochemical measures on Depression among Adolescents. Methods: True experimental research design (Pretest and posttest design) was obtained for this study to check the feasibility of the effectiveness of Behavioral Activation Therapy among adolescents with Mild and Moderate Depression. Demographic variables and a standardized tool Beck Depression Inventory-II (BDI-II) was given to the study participants. The total sample size was 150 adolescents with Mild and Moderate Depression. True experimental research design was used between two group pretest and posttest design). BMI and Salivary Cortisol was calculated prior to the interventions and after the interventions in experimental group and control group. Experimental group received Behavioral Activation Therapy and routine care for control group. Behavioral Activation Therapy involves 10 weeks sessions Situation-mood-activity cycle, solving intruistic issues, social skills training, shaping healthy behaviors, rewards and follow up behavior contract. Theduration of intervention was three months. After three months of duration Post test was conducted in both experimental and control group. The data were analyzed by using descriptive and inferential statistics. Data were tabulated by Sigma plot software.

Psychological interventions for the prevention of depression relapse: systematic review and network meta-analysis

Depression is highly prevalent and easily relapses. Psychological interventions are effective for the prevention of depression relapse. This systematic review and network meta-analysis aimed to compare the efficacy at the same follow-up time points of psychological interventions in depression. We searched PubMed, Embase, and PsycINFO via OVID, and the Cochrane Library published up to December 12, 2021, and PubMed up to July 1, 2022. The primary outcome was depression relapse, considering the same time points that were extracted on survival curves or relapse curves. The study protocol was registered with PROSPERO, CRD42022343327. A total of 2,871 patients were included from 25 RCTs. Mindfulness-based cognitive therapy (MBCT) was significantly better than placebo at the 3 months, the 6 months, and the 9 months at follow-up. Cognitive behavioral therapy (CBT) was significantly better than treatment as usual at the 3 months, the 9 months, the 12 months, and the 15 months at follow-up. CBT was significantly better than placebo at the 21 months and the 24 months at follow-up. Behavioral activation therapy was significantly better than placebo at the 21 months and the 24 months at follow-up. Interpersonal psychotherapy was significantly better than placebo at the 24-month follow-up. All psychological interventions included in the study were significantly better than supportive counseling most of the time. The results were robust in various sensitivity and subgroup analyses. In conclusion, MBCT had a continuous effect in preventing relapse of depression. CBT had the longest but not continuous effect in preventing relapse of depression. The effects of behavioral activation therapy and interpersonal therapy for the prevention of depression appeared late. All psychological interventions included in the study were more effective than supportive counseling. More evidence is needed from large comparative trials that provide long-term follow-up data.

Systematic review on the efficacy of behavioral activation therapy in the management of adult patients with depression

Introduction: This work aimed to assess the approach of behavioral activation for the treatment of adult patients diagnosed with depressive disorder; the importance of this study in the clinical setting is significant since it allowed us to know the viability and acceptability of the treatment. Behavioral activation is the basis of this study. Materials and method: Systematic review, under the PRISMA methodology, the PICO tool was implemented to formulate the research question. Results: 42 articles were located, of which, upon complete reading, 23 met the inclusion criteria established for the review.

Stressful life events and passive behavioral patterns in women with major depressive disorder: a mixed method analysis nested in a clinical trial

BackgroundWomen are more vulnerable to presenting with major depressive disorder (MDD) as they seem more sensitive to stressful life events (SLE). Few studies describe the effect of SLE on the development of avoidant/passive behavioral patterns (PBP) of MDD. Understanding the relationship between SLE and PBP is essential for the clinical management of MDD. Here, we aim (1) to describe and categorize the perceptions about SLE, emotional experience, and PBP in women with MDD and (2) to discuss the PBP according to evolutionary and behavioral processes. This mixed-method study, including qualitative and quantitative analyses, was nested in a clinical trial with 76 patients. We selected a sample of 18 female patients, randomized to behavioral activation therapy (BAT). In the first sessions, we interviewed the patients about SLE, emotional experience, and PBP perceived during their current depressive episode. The reports were submitted to content analysis and categorized under similar themes. We performed bivariate Spearman correlations to test the strenghts of associations between depressive symptoms (HAM-D), anxiety symptoms (BAI), disability (SDS), and cognitive distortions (CD-Quest).ResultsIn our sample, the most frequent SLE were romantic relationship problems and family problems. The patients most reported emotional experiences were sadness, discouragement, and anxiety. The most common PBP categories were getting isolated, stopping doing activities, and ruminating.ConclusionsWomen frequently perceive interpersonal, family, and affective problems as triggers of depressive episodes. The most common passive patterns include isolation, stopping doing activities, and ruminations. The evolutionary functions of PBP are to keep the organism passive, avoiding energy expenditure, and risk exposure in the face of a chronically stressful environment with few opportunities for reward.

Sustaining the benefits of intravenous ketamine with behavioural activation therapy for depression: A case series

BackgroundDespite advances in treatments for depression, approximately one third of patients do not benefit from available therapies. Intravenous ketamine is a novel intervention that can yield rapid yet transient antidepressant effects. Behavioural activation (BA) therapy for depression has been shown to be effective in preventing relapse of major depressive episodes. In this pilot study, we examined whether antidepressant response achieved through repeated ketamine infusions could be maintained with BA. MethodsIn this case series, patients with treatment-resistant depression who met antidepressant response criteria in a clinical trial of repeated ketamine infusions subsequently completed 12–17 sessions of BA. Depressive symptoms were measured at each session with the Beck Depression Inventory-II (BDI-II). Secondary outcomes included changes in work and social adjustment, suicidal ideation, and anxiety. ResultsTen of the 13 participants who initiated BA completed the full course of psychotherapy. These participants showed significant improvement in self-reported depressive symptoms (p = 0.007) and work and social adjustment scores (p<0.001) with BA. The 6 participants who started BA therapy prior to relapse of depressive symptoms following cessation of ketamine sustained the clinical gains achieved with ketamine. LimitationsThe small sample size and lack of control group limit the conclusions. ConclusionsThe transient period of increased mood after repeated ketamine treatment offers a window of opportunity to intervene with psychotherapy such as BA. A better understanding of how to best integrate psychological treatments with pharmacological treatment, particularly the novel use of rapid-acting medications such as ketamine is an unmet clinical need and promising research area.