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Behavioral activation for depression delivered by drug and alcohol treatment workers: A pilot randomized controlled trial
Abstract
Background
One in two patients seeking help for substance use disorders (SUDs) has clinically significant depression symptoms. This co-occurrence impairs treatment outcomes, but limited evaluation of the implementation of evidence-based interventions has taken place.
Methods
This pilot randomized controlled trial (RCT) assessed the feasibility and potential efficacy of a brief, protocol-driven behavioral activation (BA) intervention delivered by drug and alcohol workers in a community drug and alcohol treatment (CDAT) service. Eligible participants (n = 34) were randomly allocated to either BA (n = 17) or treatment as usual (n = 17) and assessed at baseline and 6-, 12-, and 24-week follow-up. Feasibility outcomes were participant engagement and worker protocol adherence. The primary pilot outcome was severity of depression symptoms (PHQ-9) at 12-week follow-up. Secondary outcomes included percent days abstinent (PDA) in the past month, severity of dependence (SDS), anxiety symptoms (GAD-7), and valued living (VQ) at all follow-up points.
Results
Fifty-nine percent of BA participants attended at least one session and there was 95% adherence to the treatment protocol. BA was associated with significantly reduced depression at 12-week follow-up (PHQ-9 mean difference − 5.69, 95% CI –10.07 to −1.31). BA participants had significantly greater improvements in PDA (mean difference 17.9, 95% CI 0.99 to 34.82) and VQ-Progress (mean difference 5.34, 95% CI 1.47 to 9.22) at 6-week follow-up and PDA (mean difference 27.69, 95% CI 4.44 o 50.95) at 12-week follow-up. The study found no significant between-group differences at 24-week follow-up.
Conclusion
BA implemented by drug and alcohol treatment workers in CDAT appears feasible and may add clinical benefit to usual care for SUD patients with elevated depressive symptoms accessing CDAT. Fully powered RCTs are warranted to better investigate the replicability of these preliminary findings. Methodological limitations are discussed and suggestions for future research are provided.
Introduction:
Reward deficits negatively impact recovery from substance use disorder (SUD). LETS ACT, a behavioral activation treatment targeting substance-free reward, has demonstrated effectiveness in reducing post treatment substance use. There remains room for modifications to extend recovery gains, and LETS ACT remains largely untested in outpatient treatment. We tested the effect of LETS ACT when delivered alongside intensive outpatient SUD treatment, with and without a smartphone app designed to extend access to treatment content outside of clinician-administered sessions.
Methods:
In this three-arm randomized controlled trial (N = 206; 54 % White, 67 % male), all participants received intensive outpatient SUD treatment as usual (TAU) and either LETS ACT (n = 56), smartphone-enhanced LETS ACT (n = 65), or assessments only (n = 61). Substance use days and substance related problems were assessed through 12 months posttreatment.
Results:
Generalized estimating equations indicated a significant condition*time interaction for substance use days; Days of substance use significantly declined from pretreatment until 1-month for TAU, 3-months for LETS ACT-SE, and 6-months for LETS ACT. Decreases in substance-related problems were maintained across all conditions through 12 months.
Conclusions:
Adding LETS ACT to intensive outpatient treatment resulted in significant decreases in substance use through 6 months posttreatment, yet these gains were not sustained through 12 months posttreatment. A smartphone app did not facilitate superior treatment outcomes. Future studies should consider factors impacting treatment efficacy in outpatient settings and the utility of providing more than six sessions of behavioral activation.
Behavioral theories of choice are applied to an analysis of the conditions under which alcohol consumption emerges as a highly preferred activity from among a set of available activities. This approach highlights two classes of variables as important determinants of alcohol preference: (a) direct constraints on access to alcohol and (b) availability of other reinforcers and constraints on access to them. A selective review of studies of human and animal alcohol and drug self-administration indicates that preference for alcohol and drug consumption (a) varies inversely with direct constraints on consumption and (b) varies inversely with the availability of alternative reinforcers and directly with constraints on access to them. Environmental conditions under which alcohol consumption emerges as a highly preferred activity may thus involve minimal constraints on access to alcohol and sparse alternative reinforcers and/or heightened constraints on access to them. The latter variables may be more important in determining alcohol consumption in natural environments. A research application to alcoholic relapse is described, and general implications for clinical research in natural environments are explored. Limitations of the approach and its complementary relation to other approaches to studying alcohol abuse are discussed.
An integrative model of change was applied to the study of 872 Ss (mean age 40 yrs) who were changing their smoking habits on their own. Ss represented the following 5 stages of change: precontemplation, contemplation, action, maintenance, and relapse. 10 processes of change were expected to receive differential emphases during particular stages of change. Results indicate that Ss (a) used the fewest processes of change during precontemplation; (b) emphasized consciousness raising during the contemplation stage; (c) emphasized self-reevaluation in both contemplation and action stages; (d) emphasized self-liberation, a helping relationship, and reinforcement management during the action stage; and (e) used counterconditioning and stimulus control the most in both action and maintenance stages. Relapsers responded as a combination of contemplaters and people in action would. Results are discussed in terms of developing a model of self-change of smoking and enhancing a more integrative general model of change. (14 ref)
Introduction:
Behavioural activation is an effective treatment for depression, but little is known about its working mechanisms. Theoretically, its effect is thought to rely on an interplay between activation and environmental reward.
Objective:
The present systematic review examines the mediators of behavioural activation for depression.
Methods:
A systematic literature search without time restrictions in Medline, EMBASE, PsycINFO, The Cochrane Library, and CINAHL resulted in 14 relevant controlled and uncontrolled prospective treatment studies that also performed formal mediation analyses to investigate their working mechanisms. After categorising the mediators investigated, we systematically compared the studies' methodological quality and performed a narrative synthesis of the findings.
Results:
Most studies focused on activation or environmental reward, with 21 different mediators being investigated using questionnaires that focused on psychological processes or beliefs. The evidence for both activation and environmental reward as mediators was weak.
Conclusions:
Non-significant results, poor methodological quality of some of the studies, and differences in questionnaires employed precluded any firm conclusions as to the significance of any of the mediators. Future research should exploit knowledge from fundamental research, such as reward motivation from neurobiology. Furthermore, the use of experience sampling methods and idiographic analyses in bigger samples is recommended to investigate potential causal pathways in individual patients.
Introduction:
The adoption of adult roles that provide meaning in life is associated with reduced harmful drinking. The current study examined whether this relationship is mediated by increased self-control and reduced value of alcohol.
Methods:
Cross-sectional design. 1043 adults (786 females) ≥18 years old completed an online survey. The outcome variable was scores on the Alcohol Use Disorders Identification Test (AUDIT), predictor variables were presence of and search for meaning in life (Meaning in Life Questionnaire), and mediating variables were trait self-control (Brief Self-Control Scale) and the value of alcohol (Brief Assessment of Alcohol Demand).
Results:
Presence of meaning in life had a significant negative association (B = -0.01, SE = 0.00, 95% CI -0.02 to -0.00, p = .015), whilst search for meaning in life had a significant positive association (B = 0.01, SE = 0.00, 95% CI 0.01 to 0.02, p = .001) with AUDIT scores. The negative association was mediated by increased self-control (B = -0.09, SE = 0.01, 95% CI -0.12 to -0.06) and decreased value of alcohol (B = -0.02, SE = 0.01, 95% CI -0.04 to 0.00), whilst the positive association was mediated by decreased self-control (B = 0.05, SE = 0.01, 95% CI 0.03 to 0.07) and increased value of alcohol (B = 0.02, SE = 0.01, 95% CI 0.00 to 0.04), thereby supporting our hypotheses.
Conclusions:
The relationships between presence and search for meaning in life and harmful drinking are mediated by individual differences in both trait self-control and the value of alcohol.
Objective:
This meta-analysis examined 30 randomized controlled trials (32 study sites; 35 study arms) that tested the efficacy of cognitive-behavioral therapy (CBT) for alcohol or other drug use disorders. The study aim was to provide estimates of efficacy against three levels of experimental contrast (i.e., minimal [k = 5]; nonspecific therapy [k = 11]; specific therapy [k = 19]) for consumption frequency and quantity outcomes at early (1 to 6 months [kes = 41]) and late (8+ months [kes = 26]) follow-up time points. When pooled effect sizes were statistically heterogeneous, study-level moderators were examined.
Method:
The inverse-variance weighted effect size was calculated for each study and pooled under random effects assumptions. Sensitivity analyses included tests of heterogeneity, study influence, and publication bias.
Results:
CBT in contrast to minimal treatment showed a moderate and significant effect size that was consistent across outcome type and follow-up. When CBT was contrasted with a nonspecific therapy or treatment as usual, treatment effect was statistically significant for consumption frequency and quantity at early, but not late, follow-up. CBT effects in contrast to a specific therapy were consistently nonsignificant across outcomes and follow-up time points. Of 10 pooled effect sizes examined, two showed moderate heterogeneity, but multivariate analyses revealed few systematic predictors of between-study variance.
Conclusions:
The current meta-analysis shows that CBT is more effective than a no treatment, minimal treatment, or nonspecific control. Consistent with findings on other evidence-based therapies, CBT did not show superior efficacy in contrast to another specific modality. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Introduction and Aims
Cognitive impairments in substance use disorder predict treatment outcome and are assumed to differ between substances. They often go undetected, thus the current study focuses on the prevalence of and differences in cognitive functioning across substances by means of a cognitive screen at the early stage of addiction treatment.
Design and Methods
The Montreal Cognitive Assessment was administered to outpatients seeking treatment for substance use disorder. Patient characteristics (age, years of regular use, polysubstance use, severity of dependence/abuse, depression, anxiety and stress) were also taken into account.
Results
A total of 656 patients were included (n = 391 used alcohol, n = 123 used cannabis, n = 100 used stimulants and n = 26 used opioids). The prevalence of cognitive impairments was 31%. Patients using alcohol had a lower total‐ and memory domain score than those using cannabis. Patients using opioids scored lower on visuospatial abilities than those using cannabis or stimulants. Younger patients scored higher than older patients. No effect was found for the other investigated characteristics.
Discussion and Conclusions
Given the high prevalence of cognitive impairments, standard screening at an early stage of treatment is important to determine the course of treatment and maximise treatment outcome. Caution is needed in interpreting results about opioids due to an underrepresentation of this patient group, and more research is needed on the effect of age on Montreal Cognitive Assessment performance.
Objective:
This study aimed to investigate the relationship between therapist competence in case conceptualization and outcome in psychotherapy.
Method:
Twenty-eight adults received Cognitive Behavioral Therapy (CBT) for depression. The Conceptualization Rating Scale (CRS) was used to systematically evaluate therapist competence in case conceptualization using ratings from 225 DVD recordings of live therapy in real time across the first ten sessions of treatment.
Results:
Multilevel modelling (MLM) analysis revealed that after controlling for time and other pertinent therapy influencing variables, therapist competence in case conceptualization explained 40% of within patient variance and 19% of between patient variance associated with significant and positive change on the BDI-II.
Conclusions:
This study provided evidence that increased therapist competence in using case conceptualization in CBT is associated with greater reductions in depressive symptomology. The implications for supervision, training, and practice are discussed.
Introduction:
Substance use and depression co-occurrence is a frequent phenomenon and an important public health concern. Given the clinical implications and the high prevalence of both disorders, effective interventions are needed.
Methods:
The aim of this study is to review Behavioural Activation (BA) intervention effects to improve substance use behaviour and depression. A systematic review was conducted using MEDLINE, EMBASE, and PsycINFO. The Effective Public Health Practice Project Quality Assessment Tool (EPHPP) was used to assess the methodological quality of included studies. Two authors independently screened titles and abstracts, reviewed selected studies, and extracted data.
Results:
Of the 7286 studies identified, eight met inclusion criteria. Designs of the studies included six randomized controlled trials (RCTs), and two pre-post design studies. One trial received weak methodological quality, six moderate, and one strong. Three studies addressed smoking behaviour; two targeted opiate dependence; two focused on alcohol/drug dependence; and, one on crystal methamphetamine abuse. Results showed that BA had a positive effect on substance use outcomes in seven of the eight reviewed studies, and improved depression over time in six studies.
Conclusions:
Although studies conducted so far are limited by their heterogeneity and sample sizes, results are promising. There is a need of well controlled and powered studies to establish and to confirm the effectiveness of BA for the treatment of substance use and depression. Future studies should include stronger methodological designs, larger sample sizes, and long-term follow-ups.
Trial registration:
PROSPERO registration number: CRD42016039412 .
Background:
The CONSORT (Consolidated Standards of Reporting Trials) Statement was developed to help biomedical researchers report randomised controlled trials (RCTs) transparently. We have developed an extension to the CONSORT 2010 Statement for social and psychological interventions (CONSORT-SPI 2018) to help behavioural and social scientists report these studies transparently.
Methods:
Following a systematic review of existing reporting guidelines, we conducted an online Delphi process to prioritise the list of potential items for the CONSORT-SPI 2018 checklist identified from the systematic review. Of 384 international participants, 321 (84%) participated in both rating rounds. We then held a consensus meeting of 31 scientists, journal editors, and research funders (March 2014) to finalise the content of the CONSORT-SPI 2018 checklist and flow diagram.
Results:
CONSORT-SPI 2018 extends 9 items (14 including sub-items) from the CONSORT 2010 checklist, adds a new item (with 3 sub-items) related to stakeholder involvement in trials, and modifies the CONSORT 2010 flow diagram. This Explanation and Elaboration (E&E) document is a user manual to enhance understanding of CONSORT-SPI 2018. It discusses the meaning and rationale for each checklist item and provides examples of complete and transparent reporting.
Conclusions:
The CONSORT-SPI 2018 Extension, this E&E document, and the CONSORT website ( www.consort-statement.org ) are helpful resources for improving the reporting of social and psychological intervention RCTs.
In this paper, we argue that CBT is the gold-standard psychological treatment—as the best standard we have in the field currently available—for the following reasons: (1) CBT is the most researched form of psychotherapy. (2) No other form of psychotherapy has been shown to be systematically superior to CBT; if there are systematic differences between psychotherapies, they typically favor CBT. (3) Moreover, the CBT theoretical models/mechanisms of change have been the most researched and are in line with the current mainstream paradigms of
human mind and behavior (e.g., information processing). At the same time, there is clearly room for further improvement, both in terms of CBT’s efficacy/effectiveness and its underlying theories/mechanisms of change. We further argue for an integrated scientific psychotherapy, with CBT serving as the foundational platform for integration.
Acceptance and commitment therapy (ACT) has been found to be effective for various mental health disorders but the processes through which it affects change remain unclear. Much process research in the area is on physical rather than mental health, and focuses on the broad concept of psychological flexibility with little research on specific mechanisms identified in theory such as fusion and values. This study explored whether there was a relationship between two of the main ACT processes (cognitive defusion and values) and levels of depression and distress. Thirty-three participants completed questionnaires at the start and end of their treatment measuring general mental health and distress, depression, levels of cognitive fusion and how much they were living in line with their values and how important their values were to them. Results showed reductions in levels of fusion and increases in values-based action were significantly related to reductions in distress and depression. There was no correlation between changes in values importance and changes in distress or depression. This study therefore suggests decreased defusion and increased values-based action is an important mechanism in the efficacy of ACT in those with depression and mental health problems. The study is however limited by a small sample size and future research with a sample large enough for mediation analysis would be beneficial.
Cognitive-behavioral therapy (CBT) approaches have among the highest level of empirical support for the treatment of drug and alcohol use disorders. As Psychology of Addictive Behaviors marks its 30th anniversary, we review the evolution of CBT for the addictions through the lens of the Stage Model of Behavioral Therapies Development. The large evidence base from Stage II randomized clinical trials indicates a modest effect size with evidence of relatively durable effects, but limited diffusion in clinical practice, as is the case for most empirically validated approaches for mental health and addictive disorders. Technology may provide a means for CBT interventions to circumvent the "implementation cliff" in Stages III-V by offering a flexible, low-cost, standardized means of disseminating CBT in a range of novel settings and populations. Moreover, returning to Stage I to reconnect clinical applications of CBT to recent developments in cognitive science and neuroscience holds great promise for accelerating understanding of mechanisms of action. It is critical that CBT not be considered as a static intervention, but rather 1 that constantly evolves and is refined through the stage model until the field achieves a maximally powerful intervention that addresses core features of the addictions. (PsycINFO Database Record
We report the current best estimate of the effects of cognitive behavior therapy (CBT) in the treatment of major depression (MDD), generalized anxiety disorder (GAD), panic disorder (PAD) and social anxiety disorder (SAD), taking into account publication bias, the quality of trials, and the influence of waiting list control groups on the outcomes. In our meta-analyses, we included randomized trials comparing CBT with a control condition (waiting list, care-as-usual or pill placebo) in the acute treatment of MDD, GAD, PAD or SAD, diagnosed on the basis of a structured interview. We found that the overall effects in the 144 included trials (184 comparisons) for all four disorders were large, ranging from g=0.75 for MDD to g=0.80 for GAD, g=0.81 for PAD, and g=0.88 for SAD. Publication bias mostly affected the outcomes of CBT in GAD (adjusted g=0.59) and MDD (adjusted g=0.65), but not those in PAD and SAD. Only 17.4% of the included trials were considered to be high-quality, and this mostly affected the outcomes for PAD (g=0.61) and SAD (g=0.76). More than 80% of trials in anxiety disorders used waiting list control groups, and the few studies using other control groups pointed at much smaller effect sizes for CBT. We conclude that CBT is probably effective in the treatment of MDD, GAD, PAD and SAD; that the effects are large when the control condition is waiting list, but small to moderate when it is care-as-usual or pill placebo; and that, because of the small number of high-quality trials, these effects are still uncertain and should be considered with caution.
This report describes a systematic literature review of voucher and related monetary-based contingency management (CM) interventions for substance use disorders (SUDs) over 5.2 years (November 2009 through December 2014). Reports were identified using the search engine PubMed, expert consultations, and published bibliographies. For inclusion, reports had to (a) involve monetary-based CM; (b) appear in a peer-reviewed journal; (c) include an experimental comparison condition; (d) describe an original study; (e) assess efficacy using inferential statistics; (f) use a research design allowing treatment effects to be attributed to CM. Sixty-nine reports met inclusion criteria and were categorized into 7 research trends: (1) extending CM to special populations, (2) parametric studies, (3) extending CM to community clinics, (4) combining CM with pharmacotherapies, (5) incorporating technology into CM, (6) investigating longer-term outcomes, (7) using CM as a research tool. The vast majority (59/69, 86%) of studies reported significant (p < 0.05) during-treatment effects. Twenty-eight (28/59, 47%) of those studies included at least one follow-up visit after CM was discontinued, with eight (8/28, 29%) reporting significant (p < 0.05) effects. Average effect size (Cohen's d) during treatment was 0.62 (95% CI: 0.54, 0.70) and post-treatment it was 0.26 (95% CI: 0.11, 0.41). Overall, the literature on voucher-based CM over the past 5 years documents sustained growth, high treatment efficacy, moderate to large effect sizes during treatment that weaken but remain evident following treatment termination, and breadth across a diverse set of SUDs, populations, and settings consistent with and extending results from prior reviews.
Background:
The co-occurrence of depression and substance use disorders (SUD) is highly prevalent and associated with poor treatment outcomes for both disorders. As compared to individuals suffering from either disorder alone, individuals with both conditions are likely to endure a more severe and chronic clinical course with worse treatment outcomes. Thus, current practice guidelines recommend treating these co-occurring disorders simultaneously.
Objectives:
The overarching aims of this narrative are two-fold: (1) to provide an updated review of the current empirical status of integrated psychotherapy approaches for SUD and depression comorbidity, based on models of traditional cognitive-behavioral therapy (CBT) and newer third-wave CBT approaches, including acceptance- and mindfulness-based interventions and behavioral activation (BA); and (2) to propose a novel theoretical framework for transdiagnostic CBT for SUD-depression, based upon empirically grounded psychological mechanisms underlying this highly prevalent comorbidity.
Results:
Traditional CBT approaches for the treatment of SUD-depression are well-studied. Despite advances in the development and evaluation of various third-wave psychotherapies, more work needs to be done to evaluate the efficacy of such approaches for SUD-depression.
Conclusion:
Informed by this summary of the evidence, we propose a transdiagnostic therapy approach that aims to integrate treatment elements found in empirically supported CBT-based interventions for SUD and depression. By targeting shared cognitive-affective processes underlying SUD-depression, transdiagnostic treatment models have the potential to offer a novel clinical approach to treating this difficult-to-treat comorbidity and relevant, co-occurring psychiatric disturbances, such as posttraumatic stress.
Background
The notion that substance use can induce symptoms of depression and anxiety is influential in clinical practice, however questions remain about the empirical support for this hypothesis.
Methods
We analysed mental health and substance dependence screening records for 280 outpatients in addictions treatment. Item-level data for depression (PHQ-9), anxiety (GAD-7), severity of dependence (SDS) and self-reported weekly substance use were studied using factor analysis and correlations. Symptom-level associations between substance use and psychological distress symptoms were examined after controlling for underlying levels of psychopathology.
Results
We obtained a two-factor solution accounting for approximately 48 % of total variance. Depression and anxiety symptoms loaded onto a single psychopathology factor. Severity of dependence (SDS) and substance use measures loaded onto a distinct but correlated factor. After controlling for latent levels of psychopathology, the only remaining symptom-level associations were impaired concentration linked to cannabis use and irritability linked to alcohol use. Dependence (SDS) was prominently associated with depressive rumination, and negatively correlated with residual anxiety symptoms related to substance use (e.g., craving).
Conclusions
Overall, this analysis supports a psychological understanding of comorbidity; with dependence, craving, negative reinforcement and rumination as key variables.
Background:
Depression is a common, debilitating, and costly disorder. Many patients request psychological therapy, but the best-evidenced therapy-cognitive behavioural therapy (CBT)-is complex and costly. A simpler therapy-behavioural activation (BA)-might be as effective and cheaper than is CBT. We aimed to establish the clinical efficacy and cost-effectiveness of BA compared with CBT for adults with depression.
Methods:
In this randomised, controlled, non-inferiority trial, we recruited adults aged 18 years or older meeting Diagnostic and Statistical Manual of Mental Disorders IV criteria for major depressive disorder from primary care and psychological therapy services in Devon, Durham, and Leeds (UK). We excluded people who were receiving psychological therapy, were alcohol or drug dependent, were acutely suicidal or had attempted suicide in the previous 2 months, or were cognitively impaired, or who had bipolar disorder or psychosis or psychotic symptoms. We randomly assigned participants (1:1) remotely using computer-generated allocation (minimisation used; stratified by depression severity [Patient Health Questionnaire 9 (PHQ-9) score of <19 vs ≥19], antidepressant use, and recruitment site) to BA from junior mental health workers or CBT from psychological therapists. Randomisation done at the Peninsula Clinical Trials Unit was concealed from investigators. Treatment was given open label, but outcome assessors were masked. The primary outcome was depression symptoms according to the PHQ-9 at 12 months. We analysed all those who were randomly allocated and had complete data (modified intention to treat [mITT]) and also all those who were randomly allocated, had complete data, and received at least eight treatment sessions (per protocol [PP]). We analysed safety in the mITT population. The non-inferiority margin was 1·9 PHQ-9 points. This trial is registered with the ISCRTN registry, number ISRCTN27473954.
Findings:
Between Sept 26, 2012, and April 3, 2014, we randomly allocated 221 (50%) participants to BA and 219 (50%) to CBT. 175 (79%) participants were assessable for the primary outcome in the mITT population in the BA group compared with 189 (86%) in the CBT group, whereas 135 (61%) were assessable in the PP population in the BA group compared with 151 (69%) in the CBT group. BA was non-inferior to CBT (mITT: CBT 8·4 PHQ-9 points [SD 7·5], BA 8·4 PHQ-9 points [7·0], mean difference 0·1 PHQ-9 points [95% CI -1·3 to 1·5], p=0·89; PP: CBT 7·9 PHQ-9 points [7·3]; BA 7·8 [6·5], mean difference 0·0 PHQ-9 points [-1·5 to 1·6], p=0·99). Two (1%) non-trial-related deaths (one [1%] multidrug toxicity in the BA group and one [1%] cancer in the CBT group) and 15 depression-related, but not treatment-related, serious adverse events (three in the BA group and 12 in the CBT group) occurred in three [2%] participants in the BA group (two [1%] patients who overdosed and one [1%] who self-harmed) and eight (4%) participants in the CBT group (seven [4%] who overdosed and one [1%] who self-harmed).
Interpretation:
We found that BA, a simpler psychological treatment than CBT, can be delivered by junior mental health workers with less intensive and costly training, with no lesser effect than CBT. Effective psychological therapy for depression can be delivered without the need for costly and highly trained professionals.
Funding:
National Institute for Health Research.
Background
Depression is a common, disabling condition for which psychological treatments are recommended. Behavioural activation has attracted increased interest in recent years. It has been over 5 years since our meta-analyses summarised the evidence supporting and this systematic review updates those findings and examines moderators of treatment effect.
Method
Randomised trials of behavioural activation for depression versus controls or anti-depressant medication were identified using electronic database searches, previous reviews and reference lists. Data on symptom level and study level moderators were extracted and analysed using meta-analysis, sub-group analysis and meta-regression respectively.
Results
Twenty six randomised controlled trials including 1524 subjects were included in this meta-analysis. A random effects meta-analysis of symptom level post treatment showed behavioural activation to be superior to controls (SMD −0.74 CI −0.91 to −0.56, k = 25, N = 1088) and medication (SMD −0.42 CI −0.83 to-0.00, k = 4, N = 283). Study quality was low in the majority of studies and follow- up time periods short. There was no indication of publication bias and subgroup analysis showed limited association between moderators and effect size.
Conclusions
The results in this meta-analysis support and strengthen the evidence base indicating Behavioural Activation is an effective treatment for depression. Further high quality research with longer term follow-up is needed to strengthen the evidence base.
To review published studies on the effectiveness of combining cognitive-behavioural therapy (CBT) and motivational interviewing (MI) to treat comorbid clinical and subclinical alcohol use disorder (AUD) and major depression (MDD) and estimate the effect of this compared with usual care.
We conducted systematic literature searches in PubMed, PsycINFO and Embase up to June 2013 and identified additional studies through cross-references in included studies and systematic reviews. Twelve studies comprising 1721 patients met our inclusion criteria. The studies had sufficient statistical power to detect small effect sizes.
CBT/MI proved effective for treating subclinical and clinical AUD and MDD as compared with controls, with small overall effect sizes at post-treatment (g = 0.17, CI: 0.07-0.28, p <.001 for decrease of alcohol consumption and g = 0.27, CI: 0.13-0.41, p <.001 for decrease of symptoms of depression respectively). Subgroup analyses revealed no significant differences for both AUD and MDD. However, digital interventions showed a higher effect size for depression than face to face interventions (g = 0.73 and g= 0.23 respectively p = .030).
Combined cognitive-behavioural therapy and motivational interviewing for clinical or subclinical depressive and alcohol use disorders has a small but clinically significant effect in improving outcomes compared with treatment as usual.
In recent years, behavioral activation approaches have been used to treat individuals with clinical depression. Extension of these strategies toward individuals presenting with coexistent depressive and anxiety symptoms may represent a parsimonious, practical, and time-and cost-effective treatment method. The present study outlines a case in which coexistent anxiety and depressive symptoms predominate, a clinical presentation made somewhat more complex given an Axis III diagnosis of colitis. A brief behavioral activation treatment for depression (BATD) is used to simultaneously incorporate activation and exposure strategies to ameliorate affective symptoms. Following a 10-session treatment protocol, the patient demonstrated notable decreases in self-reported anxiety and depressive symptoms and increased quality of life. Although these data are preliminary, they suggest some efficacy for BATD as a viable treatment alternative for individuals with a mixed anxiety-depressive disorder presentation.
Major depression is a common psychiatric disorder among cancer patients and is associated with psychosocial impairment and decreased quality of life. Although some research has explored psychological interventions with cancer patients, outcome studies investigating the benefits of behavior therapy among cancer patients with well diagnosed depression are nonexistent. The present study was a preliminary clinical trial (n = 6) used to assess the effectiveness of a Brief Behavioral Activation Treatment for Depression (BATD) among depressed cancer patients in primary care. Results revealed strong treatment integrity, good patient compliance, excellent patient satisfaction with the BATD protocol, and significant pre–post treatment gains across measures assessing depression, quality of life, and medical outcomes. These gains were associated with strong effect sizes and were maintained at 3-month follow up. BATD may represent a practical primary care treatment that may remedy problems associated with traditional psychosocial interventions. Study limitations and future research directions are discussed.
Presents a behavioral analysis of depression which includes a discussion of avoidance, escape, and reinforcement parameters. The decreased frequency of many kinds of positively reinforced activity is seen as the common denominator among depressed persons. Basic behavioral processes which contribute to or reduce the frequency of a person's conduct are discussed, including changes in the environment, schedules of reinforcement, and suppressed anger. Implications of a behavioral analysis for research and verbal interaction with the therapist are discussed. It is concluded that behavioral and clinical concepts can be combined as a method of uncovering the actual events of psychopathology and therapy. (16 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Background
Depression often co-occurs with substance use problems and is associated with poor treatment outcomes. While the efficacy of behavioral activation (BA) has been tested in clinical trials with substance users, outcomes have not yet been quantitatively synthesized.
Methods
The study team performed a random effects meta-analysis of the randomized clinical trial evidence base. We compared outcomes for individual or group BA against passive or active controls. We also compared attendance and dropout rates. The meta-analysis used a grading of recommendations assessment, development, and evaluation (GRADE) approach to assess the quality of each meta-analytic comparison.
Results
We included five trials in the meta-analysis (N = 195). The analysis found no significant differences between BA and controls with regard to depression (Post-treatment: k = 5; N = 195; SMD: 0.19, CI –0.10 to 0.49; p = 0.20; GRADE = Low; Follow-up: k = 5; N = 195; SMD: –0.10, CI –0.51 to −0.30; p = 0.62; GRADE = Low) or substance use (post-treatment: k = 4; N = 151; SMD: 0.14, CI –0.33 to −0.6; p = 0.57, GRADE = Low; Follow-up: k = 4; N = 151; SMD: 0.17, CI –0.34 to 0.69; p = 0.51, GRADE = Low) and there was little evidence of publication bias. The average session attendance rate for BA was 72%. An average dropout rate of 35% was reported for both BA and comparator conditions.
Conclusion
BA does not emerge as a differentially efficacious treatment for comorbid depression and substance use disorders, although it does appear to be an acceptable treatment option. Our confidence in the results are limited by the number and quality of the original studies and the possibility of the effect of small study bias. We make suggestions for improving the methodological quality and direction of future BA trials.
Background:
Mental health conditions are leading causes of disability worldwide. Psychosocial interventions for these conditions might have a key role in their treatment, although applicability of findings to poor-resource settings might be a challenge. We aimed to evaluate the strength and credibility of evidence generated in low-income and middle-income countries (LMICs) on the efficacy of psychosocial interventions for various mental health outcomes.
Methods:
We did an umbrella review of meta-analyses of randomised studies done in LMICs. Literature searches were done in Medline, Embase, PsychINFO, CINAHL, Cochrane Library, and Epistemonikos from Jan 1, 2010, until May 31, 2019. Systematic reviews of randomised studies investigating the efficacy of psychosocial interventions for mental health conditions in LMICs were included. Systematic reviews of promotion, prevention, and protection interventions were excluded, because the focus was on treatment interventions only. Information on first author, year of publication, outcomes, number of included studies, and reported summary meta-analytic estimates was extracted from included meta-analyses. Summary effects were recalculated using a common metric and random-effects models. We assessed between-study heterogeneity, predictive intervals, publication bias, small-study effects, and whether the results of the observed positive studies were more than expected by chance. On the basis of these calculations, strength of associations was assessed using quantitative umbrella review criteria, and credibility of evidence using the GRADE approach. This study is registered with PROSPERO, number CRD42019135711.
Findings:
123 primary studies from ten systematic reviews were included. The evidence on the efficacy of psychosocial interventions in adults with depression in humanitarian settings (standardised mean difference 0·87, 95% CI 0·67-1·07; highly suggestive association, GRADE: moderate) and in adults with common mental disorders (0·49, 0·36-0·62; highly suggestive association, GRADE: moderate) was supported by the most robust evidence. Highly suggestive strength of association was found for psychosocial interventions in adults with schizophrenia for functional outcomes, in adults with depression, and in adults with post-traumatic stress disorder in humanitarian settings. In children in humanitarian settings, and in children with disruptive behaviour, psychosocial interventions were supported by suggestive evidence of efficacy.
Interpretation:
A relatively large amount of evidence suggests the benefit of psychosocial interventions on various mental health outcomes in LMICs. However, strength of associations and credibility of evidence were quite variable, depending on the target mental health condition, type of population and setting, and outcome of interest. This varied evidence should be considered in the development of clinical, policy, and implementation programmes in LMICs and should prompt further studies to improve the strength and credibility of the evidence base.
Funding:
University of Verona.
The evidence base for behavioral activation (BA) as a frontline treatment for depression is grounded in individual delivery. No valid previous meta-analytic reviews of BA delivered in groups have been conducted. This study therefore examined the efficacy and acceptability of group BA drawn from clinical trial evidence. Randomized controlled trials of group BA were identified using a comprehensive literature search. Depression outcomes at post-treatment/follow-up, recovery and drop-out rates were extracted and analyzed using a random-effects meta-analysis. Treatment moderators were analyzed using meta-regression and subgroup analyses. Nineteen trials were quantitatively synthesized. Depression outcomes post-group BA treatment were superior to controls (SMD 0.72, CI 0.34 to 1.10, k = 13, N = 461) and were equivalent to other active therapies (SMD 0.14, CI -0.18 to 0.46, k = 15, N = 526). Outcomes were maintained at follow-up for group BA and moderators of treatment outcome were limited. The drop-out rate for group BA (14%) was no different to other active treatments for depression (17%). Further research is required to refine the conditions for optimum delivery of group BA and define robust moderators and mediators of outcome. However, BA delivered in groups produces a moderate to large effect on depressive symptoms and should be considered an appropriate front-line treatment option.
Introduction and aims:
Health literacy refers to the degree to which people can access and understand health information, as well as communicate their health needs to service providers. Whilst health literacy is increasingly being examined within general community samples, there is limited research focused on substance use disorders where the need for health literacy is likely to be high. The aim of this study was to examine the health literacy profiles of people attending substance use disorder treatment and to examine how these profiles were related to measures of quality of life, mental health, and physical health.
Design and methods:
Participants were attending specialist non-government substance use disorder treatment across New South Wales, Queensland, and the Australia Capital Territory, Australia (N = 298). Participants completed the Health Literacy Questionnaire, a multi-dimensional measure of health literacy. Latent profile analysis was conducted to identify profiles of health literacy within the sample.
Results:
Three distinct health literacy profiles were identified, and termed low (24.2%), moderate (62.8%) and high health literacy (13.1%). Participants with lower levels of health literacy had lower levels of social support in their home environment outside of treatment, as well as lower levels of quality of life, higher levels of psychological distress, and poorer mental health. There was no difference between the three profiles on measures of physical health.
Discussion and conclusion:
The current study found that low to moderate health literacy levels were common for those attending residential substance abuse treatment. Participants with lower health literacy tended to have poorer quality of life and mental health. Future research should examine strategies to improve health literacy amongst people attending alcohol and other drug treatment. It may also be useful for service providers to consider ways to minimise the impact of low health literacy on the health needs and outcomes of this vulnerable population.
Existing measures of valued living present several limitations: 1) focus on values in life domains, 2) potentially overlap with satisfaction with life, or 3) do not measure obstacles to valued living. The Valuing Questionnaire (VQ) is a 10-item tool of valued living, able to measure Progress in and Obstructions to valued living. This study tests VQ´s measurement invariance in a sample of women with Chronic Pain (CP) (N = 231) and from the general population (N = 268), its temporal stability in CP (6-months) (N = 117) and its incremental validity in a sample of men and women from the general population (N = 169). Results confirmed the VQ´s two-factor structure, as well as its measurement invariance. Also, the VQ was temporally stable (6-months) in CP. Both factors (Progress and Obstruction) were significantly correlated in the expected directions with cognitive fusion, mindful awareness, self-compassion, depressive, anxiety and stress symptoms, and quality of life. VQ Obstruction showed incremental validity, as it significantly predicted depression, anxiety and stress symptoms above and beyond psychological inflexibility and other measures of valued living. The current study shows the VQ's applicability to CP, and provides additional empirical support for its convergent, concurrent, and incremental validity, as well as its temporal stability.
Aims:
to compare outcomes for a behavioral activation group treatment for substance use (LETS ACT), versus a time and group size matched control condition delivered in a residential treatment setting.
Design:
single-site two-arm parallel-group randomized clinical trial with follow-up assessment at 3, 6 and 12 months post-treatment.
Setting:
residential substance use treatment facility in the USA.
Participants:
participants were 263 adults [mean age 42.7 [11.8]; 29.3% female; 94.7% African American; 72.6% court mandated] whose insurance dictated 30-day (65.4%) or 90-day (34.6%) treatment duration.
Intervention and comparator:
LETS ACT (n=142) is a treatment originally developed for depression and modified for substance use. It teaches participants to increase positively reinforcing value-driven activities in order to counter depression and relapse. The control group (SC; n=121) received time and group-size matched supportive counseling. Treatment was delivered in five or eight one-hour sessions depending on patient length of stay.
Measurements:
percent abstinent at follow-up, percent of substance use days among those reporting use, depressive symptoms (BDI), and adverse consequences of drug use (SIP-AD).
Findings:
LETS ACT had significantly higher abstinence rates at 3 months (odds ratio=2.2, 95% confidence interval=1.3-3.7), 6 months (odds ratio=2.6, 95% confidence interval=1.3-5.0), and 12 months (odds ratio=2.9, 95% confidence interval=1.3-6.1) post-treatment compared with SC. LETS ACT participants reported significantly fewer adverse consequences from substance use at 12 months post-treatment (B=4.50, SE=2.17, 95% confidence interval=0.22-8.78). Treatment condition had no effect on percent substance use days among those who resumed use or on change in depressive symptoms; the latter decreased over time only in those who remained abstinent after residential treatment irrespective of condition (B=0.43, SE=0.11, 95% confidence interval=0.22-0.65).
Conclusions:
a behavioral activation group treatment for substance use (LETS ACT) appears to increase the likelihood of abstinence and reduce adverse consequences from substance use up to 12 months post-treatment.
Viktor Frankl theorized that an absence of meaning in one’s life can result in boredom and apathy—the “existential vacuum”—and attempts to avoid or “escape” the vacuum can include short-acting distracting behaviors. This study investigated whether the presence of meaning (PM) or the search for meaning are associated with alcohol, drug, and cigarette use by young adults, and whether boredom mediates those relationships. Hundred and seventy-six young adults completed the Meaning in Life Questionnaire, the Alcohol Use Disorders Identification Test, and provided information about cigarette and illicit drug use over the preceding year. The results partly support Frankl’s model: higher PM was associated with lower alcohol/other drug use and boredom mediated those relationships, but PM was not related to cigarette smoking. Contrary to Frankl’s model, no relationship was found between search for meaning and alcohol, drug, or cigarette use. This suggests that psychological interventions that assist individuals who use drugs or alcohol to identify meaning or purpose in their lives might reduce levels of drug and alcohol use. The process of searching for meaning may not have substantial direct impact on levels of substance use, but once some meaning was established there may be decreased impetus to continue using drugs and alcohol.
People with severe and enduring mental health difficulties attending groups on 10 inpatient wards were asked to identify the ‘Most Important Event’ (MIE) in each group session they attended, as part of a routine service evaluation. Using the methods of thematic analysis, five main themes were identified from the 192 Most Important Events recorded over the course of one year: Being part of a group, Communication, Help and support, Hope for the future, and Relationships. The main themes and subthemes were largely compatible with Yalom’s therapeutic factors, but also suggested that more fundamental levels of therapeutic factors may be present in groups with people with severe and enduring mental health difficulties. These factors include feeling connected, communication, and a sense of belonging. This evaluation of Most Important Events in inpatient groups adds to the evidence base in the field of group analysis and group psychotherapy.
Purpose
– Substance use disorders (SUDs) often co-occur with major depressive disorder (MDD), yet treatments targeting this comorbidity are limited, especially in resource-limited settings where individuals with SUDs often receive treatment. The paper aims to discuss this issue.
Design/methodology/approach
– Based upon principles of reinforcement and behavioral economic models of substance use, as well as the Brief Behavioral Activation Treatment for Depression (Lejuez et al., 2011), the Life Enhancement Treatment for Substance Use (LETS ACT) (Daughters et al., 2008) was developed to meet the unique needs of patients with MDD-SUD comorbidity.
Findings
– This paper presents a summary of the theoretical foundations and key components of LETS ACT.
Originality/value
– A specific focus on increasing dissemination via the flexible delivery dependent on patient and treatment setting characteristics is provided throughout.
I argue that denial plays a central but insufficiently recognized role in addiction. The puzzle inherent in addiction is why drug use persists despite negative consequences. The orthodox conception of addiction resolves this puzzle by appeal to compulsion; but there is increasing evidence that addicts are not compelled to use but retain choice and control over their consumption in many circumstances. Denial offers an alternative explanation: there is no puzzle as to why drug use persists despite negative consequences if these consequences are not straightforwardly known. I describe the nature of the causal knowledge that one's drug use is causing negative consequences; map the conceptual landscape of denial and explain how it can block such knowledge; and explore some of the processes and mechanisms that have been studied by philosophy and the cognitive sciences and which may underpin denial in addiction, including well-established information-processing biases, motivational influences on belief formation and self-deception, and cognitive deficits with respect to insight and self-awareness. I conclude by suggesting that addiction is as much a disorder of cognition as a disorder of conation.
Objective Anxiety disorders are commonly experienced by breast cancer patients and are associated with decreased quality of life, significant deterioration in recreational and physical activities, sleep problems, and increased pain and fatigue. Behavioural activation (BA) is an empirically validated treatment for depression but is much less often studied in the treatment of anxiety symptomology. Considering that depression and anxiety disorders frequently coexist in breast cancer patients and given highly overlapping symptom patterns, it is reasonable to postulate that BA might help attenuate anxiety symptoms. Method Addressing this issue as a follow-up to three recently completed clinical trials, the efficacy of BA for treating anxiety in breast cancer patients was examined (n = 71). Results Based on a reliable change index, 41% of patients experienced clinically significant anxiety reductions, with these breast cancer patients more likely to have severe anxiety and depression at pre-treatment. Item analyses indicated that BA is generally effective in reducing most symptoms of anxiety, including somatic and cognitive manifestations. Conclusions BA may represent a parsimonious and practical treatment that may reduce anxiety symptoms in breast cancer patients. Study limitations and future research directions are discussed.
Depressed mood often co-exists with frequent drug and alcohol use. This trial examined the feasibility of screening, recruitment, randomization and engagement of drug and alcohol users in psychological interventions for depression symptoms. A total of 50 patients involved in community drugs and alcohol treatment (CDAT) were randomly allocated to behavioral activation delivered by psychological therapists (n=23) or to cognitive behavioral therapy based self-help introduced by CDAT workers (n=27). We examined recruitment and engagement rates, as well as changes in depression (PHQ-9) symptoms and changes in percent days abstinent (PDA within last month) at 24weeks follow-up. The ratio of screened to recruited participants was 4 to 1, and the randomization schedule successfully generated 2 groups with comparable characteristics. Follow-up was possible with 78% of participants post-treatment. Overall engagement in psychological interventions was low; only 42% of randomized participants attended at least 1 therapy session. Patients offered therapy appointments co-located in CDAT clinics were more likely to engage with treatment (odds ratio=7.14, p=.04) compared to those offered appointments in community psychological care clinics. Intention-to-treat analyses indicated no significant between-group differences at follow-up in mean PHQ-9 change scores (p=.59) or in PDA (p=.08). Overall, it was feasible to conduct a pragmatic trial within busy CDAT services, maximizing external validity of study results. Moderate and comparable improvements in depression symptoms over time were observed for participants in both treatment groups.
Copyright © 2015. Published by Elsevier Inc.
Important work has been carried out adapting cognitive behavioural therapy for people with intellectual disabilities. However, there is a lack of alternative psychological therapies available for people with intellectual disabilities and emotional difficulties. Behavioural activation for depression is less reliant on verbal communication and focuses on increasing purposeful activity and reducing avoidance.
This feasibility study involved the development and piloting of an adapted manual of behavioural activation for people with intellectual disabilities. The intervention consisted of 10-12 sessions and a key adaptation was that the therapist worked with the clients alongside a significant other in their life, either a paid carer or family member. Baseline, post-intervention (3 months after entering the study) and 6-month quantitative follow-up data were obtained. Primary outcome data were gathered, concerning depressive symptoms, participants' levels of activity and general well-being.
Twenty-three adults with intellectual disabilities with symptoms of depression were recruited from specialist health services. In terms of acceptability, the behavioural activation intervention was well received and only two individuals dropped out, with a further two lost to follow-up. The main measures of depression appeared to be sensitive to change. Pre- to post-intervention data showed a significant reduction in self-report of depressive symptoms with a strong effect size (r = 0.78), that was maintained at follow-up (r = 0.86). Positive change was also obtained for informant reports of depressive symptoms from pre- to post-intervention, with a strong effect size (r = 0.7). Once again, this positive change was maintained at follow-up (r = 0.72).
The study suggested that behavioural activation may be a feasible and worthwhile approach to tackling depression in people with intellectual disabilities. However, a randomised controlled trial would be required to establish its effectiveness, with more sensitive measurement of change in activity.
© 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.
Acceptance and Commitment Therapy (ACT) aims to facilitate valued living; however, there are few well-validated questionnaires to assess this. Valuing Questionnaire (VQ) items were generated from ACT texts and rated as representative and face-valid by ACT authors. Exploratory and confirmatory factor analyses supported a 2-factor solution (Factor 1=Progress (in valued living); Factor 2=Obstruction (to valued living)) in undergraduate university (N=630) and clinical adult (N=285) samples. Concurrent validity was measured with the Satisfaction With Life Scale (SWLS), Ryff's Psychological Scales of Wellbeing (PSWB), the Valued Living Questionnaire (VLQ), the Acceptance and Action Questionnaire (AAQ-II), the Mindfulness Attention Awareness Scale (MAAS), the Positive and Negative Affect Scales (PANAS) and the Depression Anxiety Stress Scales (DASS). The pattern of relationships with validation measures was predominantly as expected. The VQ should provide ACT researchers and clinicians a convenient, reliable, and valid alternative to symptom measures consistent with ACT theory and useful for evaluating ACT interventions.
The effect of group therapy on substance-dependent patients has been demonstrated in several studies emphasizing the cost-effectiveness of this intervention. However, little research was conducted on how group therapy can help these patients. The objective of this article is to study the therapeutic factors of group therapy among a group of substance-dependent patients and to study the relation between the therapeutic factors of group therapy with these patients and clinical outcome of relapse or continuing abstinence. The study includes 80 patients divided into two groups. Group I includes 40 substance-dependent patients attending group therapy sessions. Group II is a comparison group of 40 substance-dependent patients who did not attend group therapy. Both groups received the same treatment except for group therapy. All subjects were diagnosed according to a structured interview applying the International Classification of Diseases-10th Revision. Fifteen-session group therapy was conducted for Group I, and subjects were subjected to the Yalom test for assessing group therapeutic factors. The relapse/sobriety outcome was assessed and compared between the two groups 1 year after the intervention. All subjects have been subjected to drug screening before and after 1 year follow-up. The relation between choice of the therapeutic factor and outcome was studied. Group I patients cited the most helpful therapeutic factor in group therapy as catharsis, followed by group cohesiveness and interpersonal learning (output). Identification is perceived as the least helpful factor in group therapy. One year into the study, 52.5 % of Group I remained sober in comparison to 22.5 % of Group II. No significant statistical relation was found between the choice of therapeutic factor and the outcome in Group I subjects. The most helpful factor perceived by addicts in group therapy is catharsis, followed by group cohesiveness and interpersonal learning (output). Patients who received group therapy had a significantly more favorable outcome rate than those who received other modes of treatment.
A common concern when faced with multivariate data with missing values is whether the missing data are missing completely at random (MCAR); that is, whether missingness depends on the variables in the data set. One way of assessing this is to compare the means of recorded values of each variable between groups defined by whether other variables in the data set are missing or not. Although informative, this procedure yields potentially many correlated statistics for testing MCAR, resulting in multiple-comparison problems. This article proposes a single global test statistic for MCAR that uses all of the available data. The asymptotic null distribution is given, and the small-sample null distribution is derived for multivariate normal data with a monotone pattern of missing data. The test reduces to a standard t test when the data are bivariate with missing data confined to a single variable. A limited simulation study of empirical sizes for the test applied to normal and nonnormal data suggests that the test is conservative for small samples.
Behavioral activation is a positive approach to treating depression. Working within this framework the therapist helps clients to see depression not as something inside of them but as a natural consequence of the way they cope with the shifting contexts of daily life. There is no search for mental illness, skill deficits, or distortions in thinking. Rather, the therapist coaches the client to engage in activities that will lead to a more rewarding life. This book is arranged in 3 parts. Part I reviews theories of depression and various treatments for depression, particularly pharmacological treatments, cognitive therapy, and behavioral therapy. Part II describes the behavioral activation treatment approach and provides ample case transcript material. Part III looks at problems that can arise in therapy and at future opportunities for the use of behavioral activation. Combining practical, theoretical, and empirical discussions, this book will be of value to a wide range of clinicians, students, and anyone interested in the treatment of depression. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
more than two decades ago, the timeline was developed as a procedure to aid recall of past drinking / that method, first referred to as the gathering of daily drinking disposition data and later labeled as the timeline follow-back (TLFB) method, is the focus of this chapter / TLFB appears to provide a relatively accurate portrayal of drinking and has both clinical and research utility
administration of the TLFB technique / psychometric properties / test–retest reliability / subject-collateral comparisons / concurrent validity (PsycINFO Database Record (c) 2012 APA, all rights reserved)
focuses on the importance of alternative nondrug reinforcers in analyzing problems of drug dependence / identify optimal economic conditions for preventing or reducing drug abuse / focus . . . on the phase of the addiction process, such as acquisition, maintenance, withdrawal, and relapse / examine the drug–nondrug interactions that are unique to each phase, and, where it is possible to describe those interactions, a behavioral economic analysis will be applied
human studies / animal studies / maintenance of drug-reinforced behavior (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Presents a review of the literature on patterns of intelligence, rigidity and age, tolerance of ambiguity, creativity, extremity ratings, and inductive vs deductive reasoning in obsessional neurosis or obsessional personality. A theory of obsessional thinking based on G. H. Kelly's theory of personality constructs is presented, and suggestions for therapy are noted. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Describes a new program that evaluates the effects of marital therapy on the marital problems associated with depression, as well as on the depressive symptoms themselves. It is hoped that marital therapy will facilitate both recovery from depression and the long-term maintenance of the positive changes, especially when it is conducted concurrently with cognitive behavior therapy (CBT) for the depressed spouse alone. The treatment model used for working with couples is a social learning or behavior marital therapy model with recent modifications designed to deal more effectively with cognitive and affective components of relationships. CBT includes many techniques for modifying dysfunctional cognitions, including behavioral experiments that are designed to test specific beliefs held by the depressed client. The use of CBT as a vehicle for overcoming excessive dependency and powerlessness and for enhancing social support is discussed. It is concluded that the treatment of depression is moving in an interpersonal direction because depression seems to keep recurring, and impairments in intimate relationships seem to be one of the main factors associated with recurrence. (45 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
There is evidence that treatment for opiate addiction is effective in reducing drug use and offending (Prendergast et al. 2002; Gossop et al. 2003), based on effective combinations of substitution prescribing and evidenced psychosocial treatments (McLellan et al. 1993), yet concerns that few structured interventions are delivered in ‘real life’ settings. The current study assessed what keyworkers perceive as going on in drug working sessions in the criminal justice system. To assess what is actually delivered, cross-sectional case reviews were undertaken of 344 files of drug-using offenders in treatment, and interviews with the 35 keyworkers delivering case management and psychosocial interventions to the clients in these cases. This constituted all the active cases in the Drug Intervention Programme (DIP) in Birmingham, UK. Clients were typically seen for a mean of 44.3 min per session, in which time a range of tasks were undertaken, and workers estimating that evidenced interventions accounted for an average of 10 minutes per session. There was marked variability in session length and content, with some of this variability predicted by client characteristics, and by worker and team factors. The study provides little support for the delivery of evidence-based psychosocial interventions in mandated drug treatment services.