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Derek R Hopko,
Maria E A Armento, Sarah M C Robertson,
Marlena M Ryba,
John P Carvalho,
Lindsey K Colman,
Christen Mullane,
Michael Gawrysiak,
John L Bell,
James K McNulty,
Carl W Lejuez
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ABSTRACT: Major depression is the most common psychiatric disorder among breast cancer patients and is associated with substantial impairment. Although some research has explored the utility of psychotherapy with breast cancer patients, only 2 small trials have investigated the potential benefits of behavior therapy among patients with well-diagnosed depression.
In a primarily Caucasian, well-educated sample of women (age = 55.4 years, SD = 11.9) diagnosed with breast cancer and major depression (n = 80), this study was a randomized clinical trial testing the efficacy of 8 sessions of behavioral activation treatment for depression (BATD) compared to problem-solving therapy. Primary outcome measures assessed depression, environmental reward, anxiety, quality of life, social support, and medical outcomes.
Across both treatments, results revealed strong treatment integrity, excellent patient satisfaction with treatment protocols, and low patient attrition (19%). Intent-to-treat analyses suggested both treatments were efficacious, with both evidencing significant pre-post treatment gains across all outcome measures. Across both treatments, gains were associated with strong effect sizes, and based on response and remission criteria, a reliable change index, and numbers-needed-to-treat analyses, approximately ¾ of patients exhibited clinically significant improvement. No significant group differences were found at posttreatment. Treatment gains were maintained at 12-month follow-up, with some support for stronger maintenance of gains in the BATD group.
BATD and problem-solving interventions represent practical interventions that may improve psychological outcomes and quality of life among depressed breast cancer patients. Study limitations and future research directions are discussed.
Journal of Consulting and Clinical Psychology 12/2011; 79(6):834-49. · 4.85 Impact Factor
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ABSTRACT: Many patients who receive cognitive-behavioral therapy experience sudden gains that are associated with improved treatment response and decreased risk of relapse. Extending prior research, this study examined sudden gains among depressed cancer patients receiving brief (9-session) behavioral activation therapy. Fifty percent of patients experienced sudden gains of large magnitude (M=11.8 BDI-II points), with sudden gains associated with improved treatment response and maintenance of gains at 3-month follow-up. Relative to those without sudden gains, at pretreatment assessment, cancer patients with sudden gains were more likely to present with less severe depression, less somatic anxiety, fewer coexistent anxiety disorders, as well as less bodily pain, better overall physical functioning, and fewer problems with daily activities as a result of emotional problems. These findings provide increasing support for behavioral activation with a difficult-to-treat population but raise important questions regarding mechanism of change. Clinical implications for treating depressed cancer patients are discussed.
Behavior therapy 12/2009; 40(4):346-56. · 2.85 Impact Factor
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ABSTRACT: Experiential avoidance (EA) is the unwillingness to remain in contact with particular private experiences, and higher levels of EA are associated with increased psychopathology. This study explored relationships between EA, age, and the use of emotion words in positive and negative autobiographical narratives.
Participants included younger (n = 60) and older adults (n = 60) who completed a measure of EA and described a positive and negative autobiographical narrative.
In the positive autobiographical narrative, there was a significant interaction between age and EA whereby among low EA participants, younger adults used more emotion words than older adults. In the negative autobiographical narrative, there was a main effect of age in which older adults utilized fewer emotional words and a significant interaction whereby among high EA participants, younger adults used more emotion words than older adults.
Results are explained in the developmental context of Socioemotional Selectivity Theory (Carstensen, 1991), which posits that older adults may be more likely to verbally communicate in a style characterized by emotion regulation. Research and clinical implications are discussed.
Aging and Mental Health 08/2009; 13(4):611-8. · 1.37 Impact Factor
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ABSTRACT: Clinical depression is the most common psychiatric disorder among cancer patients and is associated with significant functional impairment. Unfortunately, depression in cancer patients is often under- diagnosed and untreated, and studies examining the predictive utility of assessment instruments in detecting clinically depressed cancer patients are sparse. Using a structured interview, thirty-three patients with various cancer types were diagnosed as having major depression (n = 24) or no psychiatric diagnosis (n = 9). All patients were administered the Beck Depression Inventory-II (BDI-II), the Center for Epidemiological Studies in Depression Scale (CES-D), Hamilton Rating Scale for Depression (HRSD), Quality of Life Inventory (QOLI), a medical and psychosocial functioning questionnaire (SF-36), and given co-morbidity of depression with anxiety disorders, the Beck Anxiety Inventory (BAI). Depressed and non-depressed cancer patients were compared and contrasted across all assessment measures and accuracy of instruments was based on evaluating their sensitivity, specificity, and positive predictive values. Depressed cancer patients exhibited more severe depressive symptoms and poorer quality of life, increased anxiety and bodily pain, and decreased vitality and social functioning. All instruments exhibited strong predictive properties, with the CES-D and BDI-II considered most feasible given their time efficiency, administrative simplicity, and strong psychometric properties.
Journal of Psychosocial Oncology 02/2008; 26(1):31-51. · 0.98 Impact Factor
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ABSTRACT: Accumulating data suggest that behavioral activation interventions may be an effective approach to treating clinical depression. Given the high comorbidity and construct overlap between anxiety and mood disorders, a conceptually and methodologically integrated intervention that addresses symptoms of both conditions is indicated.As a means to this end, two questions are addressed. First, is the construct overlap and functional similarities of anxiety and mood disorders substantial enough to warrant an integrated intervention? Second, are behavioral activation treatments conceptually compatible with traditional behavioral interventions for anxiety disorders? Toaddress these questions, behavioral activation interventions and their underlying principles briefly are described,followed by a functional analytic framework in which depressive and anxiety based symptom patterns are viewed as conceptually parallel in the context of a general negative affective syndrome. Finally, practical applications of behavioral activation for anxiety are discussed, and a case illustration is presented to highlight how behavioralactivation may be used to treat a patient with coexistent anxiety and depressive pathology.
The Behavior Analyst Today. 01/2006;
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ABSTRACT: Many patients who receive cognitive-behavioral therapy experience sudden gains that are associated with improved treatment response and decreased risk of relapse. Extending prior research, this study examined sudden gains among depressed cancer patients receiving brief (9-session) behavioral activation therapy. Fifty percent of patients experienced sudden gains of large magnitude (M = 11.8 BDI-II points), with sudden gains associated with improved treatment response and maintenance of gains at 3-month follow-up. Relative to those without sudden gains, at pretreatment assessment, cancer patients with sudden gains were more likely to present with less severe depression, less somatic anxiety, fewer coexistent anxiety disorders, as well as less bodily pain, better overall physical functioning, and fewer problems with daily activities as a result of emotional problems. These findings provide increasing support for behavioral activation with a difficult-to-treat population but raise important questions regarding mechanism of change. Clinical implications for treating depressed cancer patients are discussed.
Behavior Therapy.
