How important is this value to you? (Rate 0-10)
The next step of behavioral activation is to get active. You know by now that it is important to increase your level of activity even if you don’t feel like it to begin with . With behavioral activation for depression we can kick-start your activity by planning it and sticking to the plan. Get a piece of paper and write down a selection of possible activities.
Good places to get some activation targets for your activity plan are:
Do some exercise Meet a friend for coffee Cook a meal for someone Clean the house Take a bath Listen to music you like Do something nice for someone |
Once you have written down a selection of possible activities it is time to create an activity hierarchy. This will help you to choose the best activities to get started with. To create your activity hierarchy write a list of activities and rank them according to how difficult you think they will be to accomplish (0 = not at all difficult, 10 = very difficult).
Go to an exercise class once this week | 7 |
Get out of bed by 8am every day | 6 |
Go for a haircut | 5 |
Repair the kitchen shelf | 4 |
Now it is time to schedule some activities for the next week. Start by choosing some activities with low difficulty ratings. Write down the activities that you will do on an activity monitoring record form. It is important to be specific about:
(Rate mood 0-10) | ||
Go to an exercise class | Tuesday 6pm | Completed (7) |
Get out of bed… | …by 8am every day | 5 out of 7 days |
Go for a haircut | Thursday lunchtime, barber near home | Completed (5) |
Repair the kitchen shelf | Monday morning, at home | Completed (8) |
Once you have planned activities for a week in advance the next step is to put the plan into action. Good luck!
[1] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®) . American Psychiatric Pub.
[2] Elfrey, M. K., & Ziegelstein, R. C. (2009). The “inactivity trap”. General Hospital Psychiatry , 31(4), 303.
[3] Roshanaei-Moghaddam, B., Katon, W. J., & Russo, J. (2009). The longitudinal effects of depression on physical activity. General Hospital Psychiatry , 31(4), 306-315.
[4] Ekers, D., Webster, L., Van Straten, A., Cuijpers, P., Richards, D., & Gilbody, S. (2014). Behavioural activation for depression; an update of meta-analysis of effectiveness and sub group analysis. PloS one , 9(6), e100100.
[5] Kanter, J. W., Manos, R. C., Bowe, W. M., Baruch, D. E., Busch, A. M., & Rusch, L. C. (2010). What is behavioral activation?: A review of the empirical literature. Clinical Psychology Review , 30(6), 608-620.
[6] Dimidjian, S., Barrera Jr, M., Martell, C., Munoz, R. F., & Lewinsohn, P. M. (2011). The origins and current status of behavioral activation treatments for depression. Annual Review of Clinical Psychology , 7, 1-38.
Reviewed by Psychology Today Staff
Behavioral Activation (BA) is a form of short-term outpatient therapy that engages individuals in rewarding activities of their own choosing as a way to counter the negative feelings and withdrawal that are typical of depression . Increasingly, BA is being applied in the treatment of anxiety as well. Behavioral Activation is a basic component of Cognitive Behavioral Therapy, but, applied intensively, it is also used as a treatment in its own right and can be incorporated into many other types of therapy.
BA is a way of changing from the outside in—jump-starting individuals back to the kind of life they once enjoyed. Evidence suggests that even in small doses, engaging in a constructive activity is positively reinforcing, not only rekindling interest in and energy for the activity but providing a sense of achievement—enough to disrupt the negative feelings, avoidant behavior, and disturbed mood that keep people trapped in depression, and the avoidant behavior that is the hallmark of anxiety.
Under the active guidance of a therapist, individuals are assigned to activities they themselves select—whether meeting a friend for coffee, listening to a podcast, or going for a walk in the park—and learn to formulate and accomplish behavioral goals .
The changes in overt behavior are accompanied by changes in thoughts and mood. A number of studies suggest that Behavioral Activation is the component of CBT most responsible for its effectiveness and that it is at least as effective as antidepressant medication , even among the severely depressed.
BA is suitable for people with depression who are not at immediate risk of self-harm . Studies indicate that it may be especially useful for those who are chronically depressed. It is also suitable for those with depression or anxiety who do not want to take medication , or who can’t tolerate medication or its side effects, or for whom medication has failed to relieve symptoms.
Studies show that BA is at least as effective as antidepressant medication, even for people with severe depression. Moreover, because it is action-oriented, it can be used to help people who are reluctant to talk about their feelings or do not have the language to do so
BA usually takes place in weekly sessions for anywhere from eight to 24 weeks, depending on depression severity and response to treatment. One of the essential ingredients of BA is understanding that depression works in vicious cycles. A stressful or negative event—such as ending a relationship or losing a job—triggers negative thoughts and feelings and behavioral shutdown. People withdraw from pleasurable social and other activities; the isolation amplifies negative feelings and provides no relief from them, intensifying depression.
The first step in BA is activity monitoring. Individuals are provided with worksheets on which they note daily activities and rate the moods each is associated with. Next, individuals identify their life values and goals —whether related to work, learning, health and fitness, family, friendship , intimacy , entertainment, or more—as a guide to choosing concrete activities they will focus on adding to their days. They select a mix of those they find meaningful and those that build a sense of mastery, as well as those that bring pleasure.
Then, usually one week at a time, individuals create daily schedules in which they build in both meaningful activities and enjoyable ones. The activities deemed pleasant and those delivering mastery will be different for each person, as will the balance of the two kinds of activities.
In sessions, individuals discuss how to problem-solve, especially how to motivate themselves when they feel stuck. Between sessions, individuals can expect assignments that focus on workarounds for any specific obstacles they encounter in getting things done. And while no one activity will alleviate depression, the effects of building routines of activities and accomplishing goals will build over time.
BA is based on the knowledge that inactivity leads to depression, which leads to more inactivity and deeper depression. BA provides a way of feeling better quickly, directly stimulating improvement in mood through action.
In depression, people generally disengage from their routines and withdraw from their environment; as a result, there is no source of pleasant or rewarding experiences to draw on to motivate continued engagement. With BA, the activity itself generates changes in body physiology and chemistry that are mood-enhancing.
BA works in more sustaining ways as well—participating in valued activities provides a sense of achievement that counters the negative thinking that keeps depressed people stuck. Over time, individuals build a sense of mastery that helps make them emotionally resilient .
Two regimens of BA are in general use—standard BA, presented in 20 to 24 sessions, and a brief form, lasting eight to 12 weeks, called Behavioral Activation Treatment for Depression (BATD). Both focus on activity monitoring and scheduling in accordance with what people value, and both address obstacles to activity and problem-solving.
A BA therapist can be a licensed mental health professional who has additional training and experience in BA or a community health worker who has also undergone training in BA. The training in BA may be stand-alone or embedded in classic training for Cognitive Behavior Therapy , as BA is one of the component skills of CBT. All CBT therapists have had some training in BA.
While BA therapists follow standardized treatment protocols, experience counts. It is advisable to seek a therapist who has not just training but experience using BA to treat people presenting with concerns such as yours.
As with all forms of therapy, it is important to find a BA therapist with whom you feel comfortable. Look for someone with whom you can establish clarity of communication and a sense of good fit.
You might ask a prospective therapist such questions as:
Sticking up for yourself is no easy task. But there are concrete skills you can use to hone your assertiveness and advocate for yourself.
2015 est status : treatment pending re-evaluation very strong: high-quality evidence that treatment improves symptoms and functional outcomes at post-treatment and follow-up; little risk of harm; requires reasonable amount of resources; effective in non-research settings strong: moderate- to high-quality evidence that treatment improves symptoms or functional outcomes; not a high risk of harm; reasonable use of resources weak: low or very low-quality evidence that treatment produces clinically meaningful effects on symptoms or functional outcomes; gains from the treatment may not warrant resources involved insufficient evidence: no meta-analytic study could be identified insufficient evidence: existing meta-analyses are not of sufficient quality treatment pending re-evaluation, 1998 est status : strong research support strong: support from two well-designed studies conducted by independent investigators. modest: support from one well-designed study or several adequately designed studies. controversial: conflicting results, or claims regarding mechanisms are unsupported., strength of research support.
Find a Therapist specializing in Behavioral Activation for Depression List your practice
Editors: Rachel Hershenberg, PhD; Stephanie Goldstein, BS
Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice
Treatment manuals.
Important Note: The apps listed above are based on empirically-supported in-person treatments. They have not all been evaluated empirically either by themselves or in conjunction with in-person treatment. We list them as a resource for clinicians who assign them as an adjunct to conducting in-person treatment.
Videos from the Coalition for the Advancement and Application of Psychological Science featuring Dr. Chris Martell
Brief videos (~15 min) outline components:
Longer videos that show more of the full sessions:
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No man is an island entire of itself; every man is a piece of the continent, a part of the main. - John Donne
Here are a series of forms, questionnaires and handouts that I use regularly in my work. The problem solving diagram is a recurring theme - both at the start of therapy and as a sheet to return to when reviewing and considering additional therapeutic options. Other sheets are classic variants on the tools used by many cognitive behavioural therapists - with occasional alternatives and additions, that I've come up with over the years, thrown in as well.
Problem solving diagrams - here are half a dozen Powerpoint slides providing different options for the Problem solving diagram I use with nearly all clients who come to see me. My typical routine at a first session is to gather information. If the case is relatively straightforward, towards the end of this first session (when I've gathered most of the information I need) I will give them some initial screening and assessment questionnaires to fill in. While they are doing this, I transfer information that I have been jotting down as they told me their story, onto a problem solving diagram. I usually use the diagram making up the fifth of the six slides you can download here, but sometimes (with anxiety problems) I will use the sixth slide diagram. Slides one to four are simpler versions of the same approach. If I'm pushed for time, I may only fill in the top two thirds of the problem solving diagram at this stage - detailing "problems & wellbeing" and their "evolving wishes & worst symptoms". If I get the chance though, I will also brainstorm the best supported therapeutic options that they have. With more complex cases, all this may have to wait until the second session. I then show them the diagram, make changes if they have further comments, and then photocopy it for them to take away and revise/add to if they want before our next session. Typically - although I am simply organizing and feeding back the information they have given me - clients usually seem very grateful for this "making sense of" their symptoms and "giving hope" that there are options that can help them.
Rumination assessment - a simple four question way of assessing initial severity and monitoring progress in reducing rumination.
Rumination, from TRAP to TRAC - classic behavioural activation model of the shift from ruminative Trigger-Response-Avoidance-Pattern TRAP to getting back onto the problem solving Trigger-Response-Alternative-Coping TRAC. This handout also contains plenty of research back-up for the notion that rumination is largely bad news.
Checklist of potential problem areas - this is a list of a dozen potential problem areas that it can be helpful to show clients to jog their memories for any important issues that they have failed to mention in the initial interview.
Hassles scale - this is the classic 117 items hassles assessment scale. More minor hassles of everyday living can be as important as major problems in wearing people down.
Psychological & physical difficulties are so common that they're normal - the facts & figures on this sheet are now somewhat dated. The intention however is clear - to try to reduce a sense of stigma/shame about having difficulties by highlighting how common it is to sometimes struggle with psychological and physical symptoms.
Problem solving therapy - a three page handout I put together describing an approach to effective problem solving.
Initial person-centred outcome measures - assessment measures adapted from the MYMOPS - Measure Yourself Medical Outcome Profile - inititiative.
Follow-up person-centred outcome measures - adapted MYMOPS follow-up assessment measure.
Disability assessment, 3 areas - this is the classic Sheehan three item disability questionnaire using 0 - 10 scales to assess difficulties with work (including housework), family relationships, and recreational & social functioning. This type of simple scale can be very helpful for assessment, clarifying appropriate activity challenges, and monitoring progress.
Disability assessment, 4 areas - this is the Sheehan scale (see above) slightly extended to separate out couple/marriage issues from other family difficulties.
Disability assessment, 5 areas - the NHS Increasing Access to Psychological Therapies (IAPT) initiative has extended this disability measurement still further, using 0 - 8 scales to assess work, home management, social/leisure activities with others, social/leisure activities on one's own, and family & other relationship activities. This "Work & social adjustment scale (W&SAS)" is downloadable as a Word doc and as a PDF file - see too the associated scoring advice .
Disability assessment, 8 areas - and the last of these disability scale options is an eight item questionnaire, where the items are typically more narrowly focused and are chosen by client & therapist to focus on issues that are specifically relevant for the client involved.
Pittsburgh enjoyable activities test (PEAT) - (also available as a PDF file ) this useful 10 item questionnaire looks broadly at both individual and social forms of enjoyable activity. It has been shown to correlate with a whole series of both physical and psychological positive measures. Good both for broadening one's mind about the variety of enjoyable activities to consider and for producing a score showing how the frequency of one's involvement with such activities compares with a general population. Writing more about this questionnaire, I've posted Assessing and encouraging enjoyable activities .
Behavioural activation strategies - a handout detailing the kinds of activation strategies to be used in a Jacobson style approach to depression treatment.
Nourishment, adversity & suffering - a handout giving a simple fairly behavioural view of the development & treatment of depression.
Activity schedule 1 & instructions - slightly adapted classic CBT one page weekly activities record sheet with a second page giving instructions on its use.
Activity schedule 2A and schedule 2B & instructions - here are a couple of slightly more adapted activities record sheets with instructions. These record sheets are designed to take into account more recent research suggesting that increasing pleasant emotional experiences of various kinds and decreasing unpleasant experiences of various kinds may provide additive benefits for depression and other disorders.
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This is a protocol for a Cochrane Review (intervention). The objectives are as follows:
Anxiety disorders are a group of disorders that share features of excessive fear and anxiety and related behavioral disturbances. These disorders include separation anxiety disorder, selective mutism, specific phobia, social anxiety disorder (social phobia), panic disorder, agoraphobia, generalized anxiety disorder, substance/medication‐induced anxiety disorder, and anxiety disorder due to another medical condition as classified by the American Psychiatric Association ( APA 2013 ; Robichaud 2019 ; WHO 2021 ). Anxiety disorders are the most common mental health problem globally and if severe, they can significantly interfere with daily activities ( Baxter 2014 ). In 2019, 300 million individuals suffered from anxiety disorders. In addition, anxiety disorders contributed to 24.6 million years lived with disability (YLD) in 2015 ( GBD 2018 ; Xiong 2022 ).
Despite rising prevalence rates, only one‐third of people with GAD receive treatment ( Waldock 2015 ). To address this treatment gap, the Lancet Commission on global mental health and sustainable development identified scaling‐up of psychotherapeutic interventions as a potential approach, pointing to the use of community‐based support from non‐specialists in mental health as a means of increasing access to care ( Patel 2018 ).
The UK National Institute for Health and Care Excellence (NICE) guidelines for anxiety disorder treatment recommend a stepped‐care approach, first offering low‐intensity psychological interventions, and secondly offering a choice of a high‐intensity psychological intervention or a drug treatment for patients in whom the first intervention fails to achieve the desired response ( Kendall 2011 , NICE 2014 ).
Behavioural activation (BA) is a time‐efficient, evidence‐based psychotherapy for common mental health disorders ( Kanter 2012 ). The primary therapeutic techniques of BA are activity monitoring and scheduling, through which the patient increases active and goal‐oriented behaviours ( Quigley 2017 ). The original model of BA, developed by Jacobson, was defined primarily by the elimination of cognitive intervention elements ( Dimidjian 2011 ; Jacobson 2001 ). On the basis of its original design, components of the BA model commonly include developing a shared treatment rationale; promoting access to meaningful events, activities, and consequences; activity scheduling; developing social skills; and self‐monitoring links between behaviour and mood. In some cases, the use of problem‐solving or functional analysis are added to understand, consider and overcome any potential barriers to the scheduling of activities. In contrast to cognitive behavioural therapy (CBT), no attempt is made to directly change cognitions. However, BA commonly involves an exploration of how cognitive processes, such as rumination, can limit access to behaviours and events which give positive reinforcement; for example, in stopping people with anxiety from meeting up with friends or participating in physical exercise ( Chen 2013 ).
BA can be defined as a brief psychotherapeutic approach that seeks to change the way a person interacts with their environment, aiming to:
Treatments are collaborative between the patient and the therapist and are focused on the present time, rather than the past or future. Many schedule‐planning techniques are incorporated into treatment; however, all use self‐monitoring of a mood‐environment link and scheduling of new or adaptive behaviours to meet targets ( Martell 2011 ). In doing so, BA therapy helps people to make contact with potentially reinforcing experiences ( Jacobson 2001 ). BA interventions have been commonly used in treating depression ( Hopko 2006 ) and have been shown to be effective in improving depression symptoms and recovery ( Cuijpers 2007 ; Quigley 2017 ; Richards 2016 ). There is an overlap between some symptoms of anxiety and depression, and there is evidence that therapies for a given anxiety or depressive disorder may attenuate symptoms associated with not only the target condition, but also improve the 'non‐targeted' disorder ( Schulberg 1996 ; Standley 2003 ). Nevertheless, there are considerable differences in presentation, course and prognosis of these disorders, and therapies may have differential effectiveness in these conditions ( Sheard 1999 ). Evidence for the effectiveness of BA for depression cannot, therefore, be generalised to anxiety disorders.
Using BA to treat anxiety disorder is a relatively new concept ( Boswell 2017 ). Proposed mechanisms for improving anxiety symptoms include reinforcing healthy behaviour and self‐monitoring, which have been shown to enhance the person’s sense of control and predictability over the environment, and decrease self‐focused attention (e.g. ruminative behaviour) ( Hopko 2006 ).
Two studies suggest that BA may be effective in reducing and managing anxiety symptoms ( Hopko 2006 ; Quigley 2017 ). A Cochrane Review found low‐certainty evidence that BA improves anxiety symptoms in people with depression, compared to the outcomes of waiting‐list controls, however found no ( Uphoff 2020 ). Several studies have addressed the feasibility and acceptability of BA for GAD and other anxiety disorders ( Hopko 2016 ; Soleimani 2015 ; Turner 2009 ). However, it is still unclear whether BA is effective as a treatment for anxiety disorders in any setting ( Hopko 2016 ).
There has not yet been a Cochrane Review or other systematic review and meta‐analysis examining the effectiveness of BA for treatment of anxiety disorder. According to NICE clinical guidelines, behavioural therapies are one of the recommended treatment options for anxiety disorders ( Kendall 2011 ). However, the evidence for BA in anxiety disorders is currently less clear than for the other recommended therapies.
Evidence indicates that BA therapy is a skill that can be effectively transferred to primary care providers in five‐day courses ( Moore 2013 ). Combined with its time‐limited nature, this makes BA a potential option to meet the treatment gap for anxiety disorders. To this end, it is important to conduct a synthesis of evidence to know whether BA could be an effective and acceptable treatment to offer to people with anxiety.
BA has increasingly received attention as a potentially cost‐effective intervention for anxiety disorders, which may be delivered and implemented in settings with low resources or where the demand is greater than the availability of mental health practitioners to deliver more complex treatments. Given this resurgence of interest, a comprehensive review of the comparative effectiveness and acceptability of BA interventions for anxiety disorders is timely, to inform and update clinical practice and future clinical guideline development.
Types of studies.
All randomised controlled trials (RCTs), irrespective of their reported outcomes, will be eligible for inclusion in this review. Cross‐over trials (using data from the first active treatment phase), cluster‐RCTs, and quasi‐experimental RCTs will also be eligible for inclusion.
Quasi‐experimental RCTs, in which treatment assignment is decided through methods such as alternating days of the week, will not be eligible for inclusion. We will include trials that replace dropouts without randomisation only when the proportion of replaced participants is less than 20%.
Participants characteristics.
Adults aged 18 years and older and of either sex will be eligible for inclusion. Trials that involve only participants under 18 years of age will be excluded. Trials involving some participants younger and older than 18 years will be eligible for inclusion if the majority of participants are aged 18 or over or if results for those aged 18 and over are reported separately.
Trials conducted in primary, secondary, tertiary, clinic or community settings will be included. Trials that involve inpatients and those which focus on specific populations, e.g. nurses, caregivers, or participants at a specific workplace, will be eligible.Trials conducted in any country will be eligible.
Studies in adults with physical or psychiatric comorbidities will be also be included in the review, as long as the comorbidity was not the focus of the trial. For example, we will exclude trials that focus on anxiety among individuals with Parkinson's disease or acute myocardial infarction, but will accept trials that may have included some participants with Parkinson's disease or with acute myocardial infarction. We made this decision to be consistent with the methods of a similar Cochrane Review that evaluated BA for depression in adults ( Uphoff 2020 ).
Experimental intervention (ba).
We will include trials that use treatment approaches for anxiety that are either explicitly called 'behavioural activation', or are treatments that are described using the main elements of BA. These main elements include pleasant events and activities scheduling, positive reinforcement from the environment, and positive interaction or re‐engagement with the environment. Therapies with only some components of BA, but not its main elements, will not be included.
All comparators will be accepted, as long as they are not a type of BA. Comparators may include the following.
Therapies delivered by therapists of all levels will be eligible for inclusion. These therapists include the following.
We will include computerised and self‐help interventions, if they were facilitated. This means at least some element of interaction with a therapist was required. Psychological therapies conducted on an individual or group basis will be eligible for inclusion.
The number of sessions will not be limited, and we will accept psychological therapies delivered in only one session.
We will not include any behavioural therapies that contain the main elements of BA as comparator.
Social skills training/assertiveness training (SST) subsumes assertion and conversational skills, together with more specialised sub‐skills such as dating and job interview skills. Different social contexts may be targeted; for example, interaction with friends, family members, people at school, or at work, and interventions such as instruction, modelling, rehearsal, feedback and reinforcement are used to enable the development of new responses ( Jackson 1985 ). As assertiveness training represents a key component of SST, we will include it in the SST category.
Relaxation training is a behavioural stress management technique that induces a relaxation response, helping to switch to the rest/digest response and causing levels of stress hormones in the bloodstream to fall. A variety of techniques may be used to induce relaxation, the most common of which is Jacobson's progressive muscle relaxation training ( Bernstein 1973 ).
In CBT, therapists aim to work together with people receiving treatment to understand the link between thoughts, feelings and behaviours, and to identify and modify unhelpful thinking patterns and underlying assumptions about the self, others and the world ( Beck 1979 ). Cognitive change methods for depression are targeted at the automatic thought level in the first instance and include thought catching, reality testing and task assigning, as well as generating alternative strategies ( Williams 1997 ). Behavioural experiments are then used to re‐evaluate underlying beliefs and assumptions .
Third‐wave CBT approaches have been developed more recently and now exist alongside established therapies such as CBT. Rather than focusing on the contents of thoughts, these therapies tend to focus on the process and functions of thoughts and an individual's relationship with thoughts and emotions. This may include suppressing or avoidance of emotions, thoughts, and bodily sensations ( Hofmann 2008 ). Third‐wave approaches use strategies relating to mindfulness, emotions, acceptance, relationships, values, goals, and understanding the thinking process, to bring about changes in thinking ( Hayes 2017 ). Drawing from psychodynamic and humanistic principles, third‐wave CBT approaches place great emphasis on use of the therapeutic relationship. We can categorise these therapies into subcategories: acceptance and commitment therapy, compassionate mind training, functional analytic psychotherapy, metacognitive therapy, mindfulness‐based cognitive therapy, dialectical behaviour therapy and other third‐wave CBTs.
Grounded in psychoanalytic theory ( Freud 1989 ). PDs use the therapeutic relationship to explore and resolve unconscious conflict through transference and interpretation, with development of insight and character change (within certain boundaries) as therapeutic goals, and relief of symptoms as an indirect outcome. Brief therapy models have been devised ( Malan 1963 ; Mann 2009 ; Strupp 1984 ).
Contemporary models of humanistic therapies differ from one another somewhat in clinical approach, but all focus attention on the therapeutic relationship ( Cain 2002 ), within which therapist ‘core conditions’ of empathy, genuineness, and unconditional acceptance and support (positive regard) ( Rogers 1951 ) are regarded as cornerstones for facilitating insight and change.
Integrative therapies are approaches that combine components of different psychological therapy models. Integrative therapy models include interpersonal therapy (IPT) ( Klerman 1987 ), and cognitive analytic therapy (CAT) ( Ryle 1990 ). With its focus on the interpersonal context, IPT was developed to specify what was thought to be a set of helpful procedures commonly used in psychotherapy for depressed outpatients ( Weissman 2008 ), drawing in part from attachment theory ( Albert 1982 ), and cognitive‐behavioural therapy within a set timeframe (time‐limited). CAT, also devised as a time‐limited psychotherapy, integrates components from cognitive and psychodynamic approaches. The conversational model integrates psychodynamic, interpersonal and person‐centred model components.
Counselling interventions traditionally draw from a wide range of psychological therapy models, including person‐centred, psychodynamic and cognitive‐behavioural approaches, applied in combination, according to the theoretical orientation of practitioners. Therefore, we will include trials of counselling with integrative therapies. However, if the counselling intervention consists of a single discrete psychological therapy approach, we will categorise it as such, even if the intervention is referred to as 'counselling'. If the intervention was manualised, this would inform our classification. Motivational interviewing and other forms of integrative therapy approaches are also included in this category.
Participants are randomly assigned to the active intervention group or control group, and they will either receive the intervention first or be assigned to a waiting list until all participants in the intervention group have received the intervention. During the course of the trial, people on the waiting list can receive any appropriate medical care.
We will define this as a control condition that is regarded as inactive by both researchers and participants in a trial.
We define this as a control condition in a trial that is regarded by researchers as inactive but is regarded by participants as active (also called placebo therapy or sham treatment).
All medication prescribed with the goal to treat anxiety, most commonly anti‐anxiety medications; any dose, route of administration, duration and frequency.
Trial participants not receiving any treatment for anxiety during the course of the trial.
Treatment as usual, standard care, or usual care would be any appropriate medical care during the course of the study. This may for example involve monitoring of the person receiving treatment, regular check‐ups, no treatment, or any type of treatment. What constitutes treatment as usual will depend on the setting and healthcare system in which the study was conducted. If a study arm fitted clearly in any of the above categories, for example 'no treatment' or a type of psychological therapy, we will categorise it as such.
We will exclude trials of long‐term, continuation, or maintenance therapy interventions designed to prevent relapse of anxiety, or to treat chronic anxiety disorders. Similarly, we will exclude trials of interventions designed to prevent a future episode of anxiety.
We will exclude psychological therapy models based on social constructionist principles (that focus on the ways in which individuals and groups participate in the construction of their perceived social reality), including couples therapy, family therapy, solution‐focused therapy, narrative therapy, personal construct therapy, neuro‐linguistic programming and brief problem‐solving. These therapies work with patterns and dynamics of relating within and between family, social and cultural systems to create a socially constructed framework of ideas ( O’Connell 2007 ), rather than focusing on an individual's reality.
Primary outcomes.
We will summarise and categorise post‐treatment outcomes and outcomes at each reported follow‐up point as follows: short term (up to six months post‐treatment), medium term (seven to 12 months post‐treatment) and long term (longer than 12 months post‐treatment). If data at multiple time points are available within one of our categories, we will use the latest time point.
Electronic searches.
The Cochrane Common Mental Disorders' Information Specialist will conduct searches on the following bibliographic databases, using relevant subject headings (controlled vocabularies) and search syntax, appropriate to each resource:
There will be no restrictions on date, language or publication status applied to the searches.
We will search for unpublished or ongoing trials via the World Health Organization's International Clinical Trials Registry Platform (ICTRP) (trialsearch.who.int) and the trials registry at the US National Institutes of Health (ClinicalTrials.gov)
We will search for grey literature (primarily for dissertations and theses) via the following sources:
To help identify further published, unpublished or ongoing research we will scan the reference lists of included studies and any relevant systematic reviews.
We may contact original authors to obtain any missing data or information, as required.
Selection of studies.
Two review authors will independently examine each title and abstract obtained through the search strategy for relevance. We will then obtain full texts for all of these articles and two independent review authors will assess the full texts according to the criteria relating to characteristics of the studies, participants, and interventions. Disagreements will be discussed and a decision will be made by a third review author if agreement cannot be reached. We will record reasons for excluding studies at this stage. For all included studies, we will link multiple reports from the same study.
Two review authors will independently extract data from each selected study. The data extracted by the review authors will be compared and any discrepancies will be resolved through consensus. A third review author may be requested as needed to resolve discrepancies.
We will extract and enter information for the following categories into Covidence data extraction forms ( Covidence ): trial design, source of funding, study population, country, interventions and comparators, outcomes, attrition rates, adverse effects, missing data, main findings, missing outcomes (compared with the protocol) and sample size.
We will assess risk of bias for each included trial using Cochrane's 'Risk of bias 2 ' tool (RoB2) ( Cumpston 2019 ), which considers the following domains.
The overall risk of bias will be defined as the worst risk of bias in any of the domains. However, if we judge a study to have some concerns about risk of bias for more than three domains, we will judge it to be at high risk of bias overall ( Sterne 2019 ).
Continuous outcomes.
Where trials have used the same outcome measure for comparison, we will pool data by calculating the mean difference (MD) and 95% confidence intervals (CIs). Where trials have used different measures to assess the same outcome, we will pool data calculating the standardised mean difference (SMD) and 95% CIs.
We will analyse dichotomous outcomes by calculating risk ratios (RRs) and 95% CIs for each comparison in RevMan Web ( RevMan Web 2020 ).
We will identify the number of included RCTs in which the unit of analysis error occurs and conduct reanalysis where possible for these studies. To assess for unit of analysis error, we will look for whether the study population is truly randomly selected, whether the provider effect and patient‐provider interaction effect are accounted for in the analysis, and whether the unit of randomisation and the unit of analysis are the same.
We will include cluster‐randomised trials as long as proper adjustment for the intracluster correlation can be conducted, in accordance with the Cochrane Handbook for Systematic Reviews of Interventions ( Higgins 2021 ).
We will include trials employing a cross‐over design in the review, but we will only use data from the first active treatment phase.
Multiple‐arm trials (those with more than two intervention arms) can pose analytical problems in pairwise meta‐analysis. For trials with more than two eligible arms, we will manage data as follows:
If studies compare multiple eligible experimental interventions with a single control group, we will split the control group to enable pairwise comparisons.
We will contact the authors of the original studies to fill in gaps in our data. We will take a pragmatic approach to contacting authors. We will make contact via email or research sharing platforms only and will make two attempts (one week apart) to contact them. If missing information about study design or methods prevents us from assessing the eligibility of a study, we will include it in the review as a study awaiting assessment. Where missing outcomes data cannot be obtained from authors, we will impute the missing data and use statistical methods to account for the uncertainty in our imputed data. We will conduct a sensitivity analysis to assess the impact of data imputation on our study analysis. We will also address the types of missing data and its implications in our 'Discussion' section.
We will manage missing dichotomous data through intention‐to treat (ITT) analysis, in which we will assume that participants who dropped out after randomisation had a negative outcome. We will also conduct best case/worst case scenarios for the clinical response outcome. In these scenarios, we will assume that dropouts in the active treatment group had positive outcomes and that those in the control group had negative outcomes (best case scenario). We will assume that dropouts in the active treatment group had negative outcomes and that those in the control group had positive outcomes (worst case scenario). These assumptions provide boundaries for the observed treatment effect. Where there is a large amount of missing data, we will give these best case/worst case scenarios greater emphasis in the presentation of results.
We will analyse missing continuous data on an endpoint basis, including only participants with a final assessment; or if trial authors reported these data, by using the last observation carried forward (LOCF) to the final assessment. Where standard deviations (SDs) are missing, we will attempt to obtain these data by contacting trial authors. Where SDs are not available from trial authors, we will calculate them from P values, t values, CIs or standard errors (SEs), if these are reported in the articles ( Deeks 2021 ). If the great majority of SDs are available and only a minority of SDs are unavailable or unobtainable, we will use the method devised by Furukawa and colleagues to impute SDs and calculate percentage responders ( Costa 2012 ; Furukawa 2005 ). We plan to interpret these data with caution and take into account the degree of observed heterogeneity.
We will assess our included studies for clinical, statistical and methodological heterogeneity. We will calculate the I 2 statistic to calculate the percentage of heterogeneity that is not due to chance alone. In our 'Discussion' section, we will address potential causes for heterogeneity in our included studies. Where I 2 values in pooled data suggest substantial or considerable heterogeneity, we will use a random‐effects meta‐analytic model ( Higgins 2021 ).
We will use the heterogeneity thresholds suggested by the Cochrane handbook (Chapter 10) ( Higgins 2021 );
We will minimise the impact of reporting biases as much as possible by undertaking comprehensive searches of multiple sources (including trials registries) to identify unpublished material. We will include reports published in any language. We will also try to identify outcome reporting bias in trials by recording all trial outcomes, planned and reported, and noting where outcomes were missing. If a study protocol is available, we will compare outcomes in the protocol and the published report. If a study protocol is not available, we will compare outcomes listed in the article's 'methods' section with those actually reported in the article's 'results'. If we find evidence of missing outcomes, we will contact trial authors to try to obtain any available data directly, although it is important to note that such information may be unreliable ( Chan 2004 ).
In a narrative synthesis of the results, we will report treatment efficacy (number of participants responding to treatment), treatment acceptability (number of participants who dropped out), improvement in anxiety outcomes as a continuous score, and where available, quality of life. We will present standardized effect size estimates and 95% CIs. We will also present these data in tabular form.
If possible, we will also conduct a meta‐analysis of included trials for each primary and secondary outcome. Given the potential heterogeneity of BA approaches for inclusion, together with the likelihood of differing secondary comorbid mental disorders in the population of interest, we will use a random‐effects model in all analyses.
We will conduct the following subgroup analyses, based on the availability of sufficient data on outcomes and comparators:
We will construct a 'Summary of findings' table to present the findings for the primary and secondary outcomes using GRADE Pro Software ( GRADEpro GDT ), with the GRADE assesment of the quality of the body of evidence as described in the Cochrane Handbook ( Schünemann 2021 ).
For each of our main comparators we will include the following outcomes, measured at six, 12 and up to 24 months.
Cochrane Common Mental Disorders (CCMD) supported the authors in the development of this protocol.
The following people conducted the editorial process for this article:
The authors and the CCMD Editorial Team are grateful to the peer reviewers for their time and comments. They would also like to thank Cochrane Copy Edit Support for the team's help.
Cochrane Group funding acknowledgement: The UK National Institute for Health Research (NIHR) is the largest single funder of the Cochrane Common Mental Disorders Group.
Disclaimer: The views and opinions expressed herein are those of the review authors and do not necessarily reflect those of the NIHR, National Health Service (NHS), or the Department of Health and Social Care.
APA PsycInfo (Ovid) <1806 to October Week 1 2021>
1 behavioral activation system/ 529 2 ((behavio* adj1 activ*) or BATD).ti,ab,id. 7183 3 (behavio* adj3 (reinforce* or re‐inforce*)).ti,ab,id. 5675 4 reinforc*.ti,id. or (((contingent or positive) adj1 reinforc*) or (reinforc* adj3 (environment* or experience*))).ti,ab,id. 30993 5 exp reinforcement/ 53062 6 (reinforce or reinforcer or reinforcement or reinforcements or re‐inforcement or re‐inforcements).ab. /freq=2 16714 7 (behavio* adj2 (contracting or modification or modify*)).ti,ab,id. 8345 8 behavior contracting/ or behavior modification/ 10864 9 ((activit* or event?) adj2 schedul*).ti,ab,id. 882 10 planned behavior/ 2758 11 ((pleas* or enjoyable or rewarding) adj (activit* or event?)).ti,ab,id. 1073 12 (operant conditioning or instrumental learning).ti,ab,id. 4989 13 exp operant conditioning/ 36365 14 (positive interaction* or avoidant coping or environmental contingenc* or contigency management).ti,ab,id. 3177 15 exp contingency management/ 3176 16 ((gain? or reapprais*) adj2 focus*).ti,ab,id. 149 17 functional analysis.ti,ab,id,sh. 4427 18 (behavio* and (self adj (care or efficacy or evaluat* or monitor*))).ti,id,hw. 11068 19 ((psychoeducat* or psycho‐educat*) and (coping behavi* or coping skills or self manag* or (behavi* adj2 chang*))).ti,ab,id,hw. 1050 20 self management/ and behavior change/ 131 21 or/1‐20 140597 22 *behavior therapy/ and anxi*.ti,hw,tm. 1016 23 anxiety/ 67191 24 anxiety disorders/ or generalized anxiety disorder/ or panic attack/ or panic disorder/ or exp phobias/ or separation anxiety disorder/ 39313 25 (anxiety disorder* or agoraphobi* or generalized anxiety or generalised anxiety or GAD or (separation adj2 anxiety) or (social adj2 anxi*) or panic or phobi*).ti,ab,id. 70914 26 anxi*.ti,id. or (worry or worries).ti,ab,id. 111614 27 (mood? or mental health or ((emotion* or psychological) adj (distress or trauma*))).ti,id,hw. 205074 28 or/23‐27 347029 29 (21 and 28) 7119 30 clinical trials.sh. 11982 31 (randomi#ed or randomi#ation or randomi#ing).ti,ab,id. 96092 32 (RCT or at random or (random* adj3 (administ* or allocat* or assign* or class* or control* or crossover or cross‐over or determine* or divide* or division or distribut* or expose* or fashion or number* or place* or recruit* or split or subsitut* or treat*))).ti,ab,id. 112701 33 ((single or double or triple or treble) adj2 (blind* or mask* or dummy)).ti,ab,id. 27591 34 trial.ti. 33752 35 placebo.ti,ab,id,hw. 42017 36 (control* and (trial or study or group?) and (no‐treatment or waitlist* or wait* list* or ((treatment or care) adj2 usual))).ti,ab,id,hw. 14126 37 (((allocat* or assign* or receive*) adj5 ("no‐treatment" or waitlist* or wait* list* or ((treatment or care) adj2 usual))) and (control or group?)).ab. 2712 38 empirical study.md. and (("no‐treatment" or waitlist* or wait* list* or ((treatment or care) adj2 usual)) adj5 (control or group? or compared or comparison)).ab. 10000 39 (treatment adj5 control).ab. 13494 40 treatment outcome.md. 21904 41 treatment effectiveness evaluation.sh. 26099 42 mental health program evaluation.sh. 2216 43 or/30‐42 220940 44 (22 and 43) 297 45 (29 and 43) 829 46 (44 or 45) 1098
Drafting of protocol: GZ, EU, SA, SD, ALB, JVEB, KC, AHE, MI, AJ, KNK, NSM, FNR, SR, RR, TR, NS
Search strategy and search methodology: SD, GZ
Internal sources.
EU time on protocol funded via Cochrane Infrastructure funding to the Common Mental Disorders Cochrane Review Group.
Research funding (NIHR) 17/63/130 (using UK aid from the UK Government to support global health research) supported the training of authors included on this protocol.
SA: no conflicts of interest EU: is a current member of the editorial staff of the Cochrane Common Mental Disorders Review Group. EU was not involved in the editorial process for this protocol. ALB: no conflicts of interest JVEB: no conflicts of interest KC: no conflicts of interest SD: no conflicts of interest AHE: no conflicts of interest MI: no conflicts of interest AJ: no conflicts of interest KNK: no conflicts of interest NSM: no conflicts of interest FNR: no conflicts of interest SR: no conflicts of interest RR: no conflicts of interest TR: no conflicts of interest NS: no conflicts of interest GZ: no conflicts of interest
Albert 1982.
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Depression is common in adults with long-term physical conditions. Long-term physical illnesses, such as cardiovascular disease, diabetes, cancer, or chronic respiratory conditions, can impact on mental health. Mental health problems can also affect how people cope with a physical condition. Behavioural activation is a type of talking therapy used to treat depression in adults and it could be an alternative to other psychological therapies or medication. This review assesses the effects of behavioural activation on depression for people with long-term physical conditions.
We included randomised controlled trials (RCTs) of behavioural activation with adults who were diagnosed with depression and cardiovascular disease, diabetes, cancer, or a chronic respiratory condition. An RCT is a study with a control group, in which participants are allocated to the treatment and control groups at random. We searched a variety of online databases, including regional databases and trial registries. The search, conducted on 4 October 2019, identified 6066 records. After screening records, we included two studies in this review and 181 participants contributed data to the analyses.
Both studies recruited participants from US hospitals. One study included participants recovering from a stroke and the other included women with breast cancer. In both studies, participants received behavioural activation delivered in eight weekly, face-to-face sessions. One study compared behavioural activation with poststroke treatment as usual, while the other compared behavioural activation with problem-solving therapy, a talking therapy.
Low to moderate-certainty evidence suggested that behavioural activation may be more effective in the treatment of depression than included comparators, but these estimates were imprecise and effects were reduced in the longer term. There was no evidence of any differences between groups in the number of people who dropped out of the studies, depression symptoms, quality of life, physical functioning, or anxiety symptoms. The studies did not report on side effects during the study period.
There were several limitations to the included studies. In both studies, participants were aware of the treatment they received. Also, researchers were involved in the design of the intervention in both studies, and may, therefore, have had an interest in a favourable outcome for behavioural activation. In one study, missing data caused by participants dropping out of the study may have influenced results.
We did not find enough evidence in this review to know whether behavioural activation should be used to treat depression in adults with long-term physical conditions.
Evidence from this review was not sufficient to draw conclusions on the efficacy and acceptability of behavioural activation for the treatment of depression in adults with NCDs. A future review may wish to include, or focus on, studies of people with subthreshold depression or depression symptoms without a formal diagnosis, as this may inform whether behavioural activation could be used to treat mild or undiagnosed (or both) depressive symptoms in people with NCDs. Evidence from low-resource settings including low- and middle-income countries, for which behavioural activation may offer a feasible alternative to other treatments for depression, would be of interest.
Depression is common in people with non-communicable diseases (NCDs) such as cardiovascular disease, diabetes, cancer, and chronic respiratory conditions. The co-existence of depression and NCDs may affect health behaviours, compliance with treatment, physiological factors, and quality of life. This in turn is associated with worse outcomes for both conditions. Behavioural activation is not currently indicated for the treatment of depression in this population in the UK, but is increasingly being used to treat depression in adults.
To examine the effects of behavioural activation compared with any control group for the treatment of depression in adults with NCDs.
To examine the effects of behavioural activation compared with each control group separately (no treatment, waiting list, other psychological therapy, pharmacological treatment, or any other type of treatment as usual) for the treatment of depression in adults with NCDs.
We searched CCMD-CTR, CENTRAL, Ovid MEDLINE, Embase, four other databases, and two trial registers on 4 October 2019 to identify randomised controlled trials (RCTs) of behavioural activation for depression in participants with NCDs, together with grey literature and reference checking. We applied no restrictions on date, language, or publication status to the searches.
We included RCTs of behavioural activation for the treatment of depression in adults with one of four NCDs: cardiovascular disease, diabetes, cancer, and chronic respiratory conditions. Only participants with a formal diagnosis of both depression and an NCD were eligible. Studies were included if behavioural activation was the main component of the intervention. We included studies with any comparator that was not behavioural activation, and regardless of reported outcomes.
We used standard methodological procedures expected by Cochrane, including independent screening of titles/abstracts and full-text manuscripts, data extraction, and risk of bias assessments in duplicate. Where necessary, we contacted study authors for more information.
We included two studies, contributing data from 181 participants to the analyses.
Both studies recruited participants from US hospital clinics; one included people who were recovering from a stroke and the other women with breast cancer. For both studies, the intervention consisted of eight weeks of face-to-face behavioural therapy, with one study comparing to poststroke treatment as usual and the other comparing to problem-solving therapy.
Both studies were at risk of performance bias and potential conflict of interest arising from author involvement in the development of the intervention. For one study, risks of selection bias and reporting bias were unclear and the study was judged at high risk of attrition bias.
Treatment efficacy (remission) was greater for behavioural activation than for comparators in the short term (risk ratio (RR) 1.53, 95% confidence interval (CI) 0.98 to 2.38; low-certainty evidence) and medium term (RR 1.76, 95% CI 1.01 to 3.08; moderate-certainty evidence), but these estimates lacked precision and effects were reduced in the long term (RR 1.42, 95% CI 0.91 to 2.23; moderate-certainty evidence). We found no evidence of a difference in treatment acceptability in the short term (RR 1.81, 95% CI 0.68 to 4.82) and medium term (RR 0.88, 95% CI 0.25 to 3.10) (low-certainty evidence).
There was no evidence of a difference in depression symptoms between behavioural activation and comparators (short term: MD –1.15, 95% CI –2.71 to 0.41; low-certainty evidence). One study found no difference for quality of life (short term: MD 0.40, 95% CI –0.16 to 0.96; low-certainty evidence), functioning (short term: MD 2.70, 95% CI –6.99 to 12.39; low-certainty evidence), and anxiety symptoms (short term: MD –1.70, 95% CI –4.50 to 1.10; low-certainty evidence).
Neither study reported data on adverse effects.
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Major depressive disorder (MDD) is the most common psychiatric disorder in breast cancer patients. The prevalence of suicidal ideation in breast cancer patients is considerable, and relative to the general population, the prevalence of completed suicide is elevated, particularly in cancer patients with MDD. A major component of suicide prevention is effective treatment of MDD. Although some research has explored the utility of psychotherapy with breast cancer patients, only three trials have explored the benefits of behavior therapy in patients with well-diagnosed MDD and there has been no systematic investigation of the potential benefits of psychotherapy toward reducing suicidal ideation in breast cancer patients. As a follow-up to a recently completed randomized trial, this study examined the efficacy of 8 weeks of behavioral activation treatment for depression (BATD) and problem-solving therapy (PST) in reducing depression and suicidal ideation, as well as increasing hopefulness in breast cancer patients with MDD (n = 80). Across both treatments, GEE analyses revealed decreased depression and suicidal ideation and increased hopefulness at posttreatment, results that were maintained at 12-month follow-up. Moreover, follow-up patient contact at approximately 2 years posttreatment yielded no indication of completed suicide. Although these data are preliminary, BATD and PST may represent practical approaches to decrease suicidal ideation in depressed breast cancer patients.
Keywords: behavioral activation; breast cancer; depression; problem-solving therapy; suicide.
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IMAGES
COMMENTS
Behavioural experiments are then used to re‐evaluate underlying beliefs and assumptions ( Bennett‐Levy 2004 ). We categorised these therapies into six subcategories: cognitive therapy, rational emotive behaviour therapy, problem‐solving therapy, self‐control therapy, a coping with depression course and other CBTs.
Behavioral Activation (BA) is a specific CBT skill. It can be a treatment all by itself, or can be used alongside other CBT skills such as cognitive restructuring. Behavioral activation helps us understand how behaviors influence emotions, just like cognitive work helps us understand the connection between thoughts and emotions.
Behavioral activation (BA) is "a structured, brief psychotherapeutic approach that aims to (a) increase engagement in adaptive activities (which often are those associated with the experience of pleasure or mastery), (b) decrease engagement in activities that maintain depression or increase risk for depression, and (c) solve problems that ...
Problem-solving skills have been most frequently included along with BA in both standalone and multicomponent interventions to facilitate meeting individualized goals and adopting a positive stance to overcoming barriers [e.g., 33,34,45]. Unlike problem-solving skills, social networks and support have been given limited attention in existing ...
This means that we included behavioural therapies in the treatment group as long as they were described using the main elements of behavioural activation. Experimental interventions that contained some elements of behavioural therapy, such as CBT or problem‐solving therapy, were not eligible for inclusion.
Problem-solving any barriers to activation; This guide will walk you through all of the essential steps to get you started with behavioral activation. Activity monitoring: recording what you do and how you feel. The first step in behavioral activation therapy is to monitor your activity and mood to understand more about how your depression works.
Introduction to Behavioural Activation for Depression. mber 2020Understanding depression 1Missing sources of wellb. ngDepression is often a r. ult of what is missing in our lives. Look at the diagram below. shows some of the things that help give a sense of wellbeing. People usually thri. when their lives contain a range of these sources of ...
Selection criteria: We included randomised controlled trials (RCTs) of behavioural activation for the treatment of depression or symptoms of depression in adults aged 18 or over. We excluded RCTs conducted in inpatient settings and with trial participants selected because of a physical comorbidity. Studies were included regardless of reported ...
Gradually adding enjoyable and meaningful activities into one's day (especially when someone doesn't feel like doing it) will eventually improve mood. 3. Start small with activities or break down problems into smaller chunks, so it's possible to chip away at them. 4.
Behavioral Activation is a basic component of Cognitive Behavioral Therapy, but, applied intensively, it is also used as a treatment in its own right and can be incorporated into many other types ...
Brief behavioral activation and problem-solving therapy for depressed breast cancer patients: Randomized trial (Hopko et al., 2011) Behavioural activation versus mindfulness-based guided self-help treatment administered through a smartphone application: A randomised controlled trial (Ly et al., 2014)
(e.g. rumination) that serve as a form of avoidance. Patients are thus refocused on their goals and valued directions in life. The main advantage of behavioural activation over traditional cognitive-behavioural therapy for depression is that it may be easier to train staff in it and it can be used in both inpatient and outpatient settings.
These include cognitive behavior therapy, interpersonal psychotherapy, non-directive counseling, problem-solving therapy, psychodynamic therapy, and behavioral activation (Cuijpers et al., Citation 2021). Behavioral activation (BA) is one of the best examined methods for treating depression.
One study compared behavioural activation with poststroke treatment as usual, while the other compared behavioural activation with problem‐solving therapy, a talking therapy. Low to moderate‐certainty evidence suggested that behavioural activation may be more effective in the treatment of depression than included comparators, but these ...
What is behavioural activation for depression? Well established (since the 1970s), B.A is an empirically supported, effective, brief, structured standalone treatment for depression with the potential to be helpful in the treatment of other disorders. Not tied to any orientation, although considered important in CBT protocol for depression.
a challenge or opportunity. consistent with your goals and values. something you want (an approach goal, rather than just. something you want to get rid of) it were solvedSometimes it is also helpful to describe how the problem feels - is it a knotty problem, a thorny problem, a tangled problem, a delicate problem, a heavy problem, a.
Abstract. Recent reviews of evidence-based treatment for depression did not identify behavioral activation as an evidence-based practice. Therefore, this article conducted a systematic review of behavioral activation treatment of depression, which identified three meta-analyses, one recent randomized controlled trial and one recent follow-up of ...
The problem solving diagram is a recurring theme - both at the start of therapy and as a sheet to return to when reviewing and considering additional therapeutic options. Other sheets are classic variants on the tools used by many cognitive behavioural therapists - with occasional alternatives and additions, that I've come up with over the ...
Keywords: behavioral activation, problem-solving therapy, depression, cancer, randomized trial Among cancer patients, major depression is the most common psychiatric disorder, with prevalence rates ranging from 10% to 50% (Croyle & Rowland, 2003; Fann et al., 2008; Massie, 2004).
Behavioural activation (BA) is a time‐efficient, evidence‐based psychotherapy for common mental health disorders ( Kanter 2012 ). The primary therapeutic techniques of BA are activity monitoring and scheduling, through which the patient increases active and goal‐oriented behaviours ( Quigley 2017 ).
One study compared behavioural activation with poststroke treatment as usual, while the other compared behavioural activation with problem-solving therapy, a talking therapy. Low to moderate-certainty evidence suggested that behavioural activation may be more effective in the treatment of depression than included comparators, but these ...
As a follow-up to a recently completed randomized trial, this study examined the efficacy of 8 weeks of behavioral activation treatment for depression (BATD) and problem-solving therapy (PST) in reducing depression and suicidal ideation, as well as increasing hopefulness in breast cancer patients with MDD (n = 80). Across both treatments, GEE ...
Using behavioral activation in a nursing home setting makes a lot of sense. It is shown to be effective in several dozens of trials with comparable effects to other therapies and for example antidepressants, it can be applied by the nursing staff of nursing homes when they are trained, and it should be possible to build it structurally into the system of a nursing home.