Behavioral activation treatments of depression: A meta-analysis

Department of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
Clinical Psychology Review (Impact Factor: 7.18). 05/2007; 27(3):318-26. DOI: 10.1016/j.cpr.2006.11.001
Source: PubMed


Activity scheduling is a behavioral treatment of depression in which patients learn to monitor their mood and daily activities, and how to increase the number of pleasant activities and to increase positive interactions with their environment. We conducted a meta-analysis of randomized effect studies of activity scheduling. Sixteen studies with 780 subjects were included. The pooled effect size indicating the difference between intervention and control conditions at post-test was 0.87 (95% CI: 0.60 - 1.15). This is a large effect. Heterogeneity was low in all analyses. The comparisons with other psychological treatments at post-test resulted in a non-significant pooled effect size of 0.13 in favor of activity scheduling. In ten studies activity scheduling was compared to cognitive therapy, and the pooled effect size indicating the difference between these two types of treatment was 0.02. The changes from post-test to follow-up for activity scheduling were non-significant, indicating that the benefits of the treatments were retained at follow-up. The differences between activity scheduling and cognitive therapy at follow-up were also non-significant. Activity scheduling is an attractive treatment for depression, not only because it is relatively uncomplicated, time-efficient and does not require complex skills from patients or therapist, but also because this meta-analysis found clear indications that it is effective.

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Available from: Pim Cuijpers
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    • "Since a positive significant relationship between positive mood and commitment in activities has been established (Brockmeyer et al., 2015), behavioral treatments of depression aim to decrease patients' avoidance and increase their activation towards pleasurable activities (Dimidjian et al., 2011; Kanter et al., 2010; Lewinsohn and Amenson, 1978). This is specifically the purpose of behavioral activation programs (Lejuez et al., 2011; Martell et al., 2010) which are now wellestablished as efficient treatments of depression (Cuijpers et al., 2007). "
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    ABSTRACT: BACKGROUNG: Depression is a highly prevalent disorder which is usually considered as differentially experienced depending on gender. Behavioral theories of depression pinpoint the importance of the behavioral avoidance in the maintenance of depression. However, little is known about the specific impact of the behavioral avoidance and activation on each depressive symptom as well as on gender differences on the behavioral features of depression. METHODS: This study’s aim was two-fold: (1) to assess the presence of gender differences on the BDI-II; (2) to investigate the respective predictive value of behavioral avoidance and of behavioral activation on each depressive symptom assessed by the BDI-II depending on gender. Community adults and adults attending mental healthcare composed the sample. RESULTS: Results showed differences in symptomatology profiles depending on gender (e.g. higher scores of sadness, self-criticalness in women, higher scores of past failure and loss of pleasure in men). Behavioral avoidance positively predicted almost all depressive symptoms in women and in men while behavioral activation negatively predicted almost all symptoms in both gender. Nevertheless, the strengths of these relationships were different for some symptoms (e.g. pessimism). LIMITATIONS: The use of self-report instruments; the lack of assessment of causal or precipitating factors of the depressive symptomatology; the higher number of women in the sample. CONCLUSIONS: Results are discussed with respect to previous findings and present clinical implications: (1) to underline the relevance of the combination of gender-specific assessment tools; (2) to highlight the need of tailored psychological intervention.
    Full-text · Article · Mar 2016 · Journal of Affective Disorders
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    • "The mechanisms underpinning behavioural approaches are amongst the most broadly applicable and empirically-supported in the whole of applied (and experimental ) psychology. Strong evidence for the effectiveness of behavioural approaches to therapy can be found in a myriad of meta-analyses across a range of presentations and populations, including: depression (e.g., Cuijpers, van Straten, Andersson, & vanOppen, 2008;Cuijpers, Van Straten, & Warmerdam, 2007), anxiety disorders (e.g.,Deacon & Abramowitz, 2004;Feske & Chambless, 1995;Kobak, Greist, Jefferson, Katzelnick, & Henk, 1998), autism (e.g.,Eldevik et al., 2009), attention-deficit hyperactivity disorder (Fabiano et al., 2009), chronic pain (e.g.,Morley, Eccleston, & Williams, 1999), insomnia (Smith et al., 2014) and many others (for an overview, seeKazdin, 2013). Indeed, Pierce and Cheney (2013) state that the principles underpinning behavioural approaches are so broadly applicable " because the world actually operates according to these principles " (p.399) and the effective components of other therapies are often found to be those that rely on behavioural principles (e.g., Weinberger & Rasco, 2007). "
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    ABSTRACT: At its core, Clinical Behaviour Analysis (CBA) is the application of empirically established behavioural learning principles to the clinical domain, providing a framework for the systematic analysis of a person’s historical and current contexts, in terms of the personal learning that has occurred through interaction with those contexts, and using this information to understand the function and maintenance of an individual’s clinically-relevant behaviour. Unlike other established approaches to formulation and therapy, CBA is often misunderstood by individuals who are unfamiliar, or only partially familiar, with the central tenets of the approach. Common charges levied against CBA include: the apparent dismissal of thoughts, feelings and emotions as unobservable and therefore unimportant to the clinician or analyst; the use of aversive techniques and punishment to change behaviour; and the reduction of the complexity of individual experience into simplistic behavioural units. While these criticisms may be valid for some forms of mechanistic behaviourism or misinformed individual therapists, they do not apply to the radical behaviourism of B F Skinner – the behavioural philosophy that underpins our approach. Within this chapter, we formulate the case of ‘Molly’, using the principles of CBA to understand her presentation, current difficulties, and potential areas for intervention.
    Full-text · Chapter · Jan 2016
    • "Psychological interventions have therefore focused on reducing the passiveness that comes along with depression using behavioral activation strategies . Interventions including behavioral activation, such as behavior therapy and cognitive behavior therapy, have indeed been shown effective in reducing depressive symptoms (Cuijpers, van Straten, & Warmerdam, 2007). However, the above-mentioned cross-sectional studies and intervention studies do not make clear whether changing social, physical, and sedentary behaviors in daily life indeed contribute to recovery from depression and to daily mental health. "
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    ABSTRACT: Objective: This study examined associations between daily physical, sedentary, social, and leisure behaviors and depressive symptoms (a) at a macrolevel, over the course of an Experience Sampling (ESM) self-monitoring intervention, and (b) at a microlevel, by examining daily within-person associations. Second, we examined the effects of the ESM self-monitoring intervention on these daily life behaviors. Methods: Individuals with a diagnosis of depression (N = 102) receiving pharmacological treatment were randomized to 1 of 2 six-week ESM intervention conditions or a control condition. Physical, sedentary, social, and leisure behaviors as well as depressive symptoms were assessed prospectively in every-day life at baseline, postintervention, and during the ESM interventions. Results: Change in physical activity and talking from baseline to postintervention was associated with change in depressive symptoms from baseline to postintervention. Within-person daily fluctuations in talking, physical activity, doing nothing/resting, and being alone predicted end-of-day depressive symptoms over and above depressive symptoms at the previous day. The ESM interventions contributed to change in talking, doing nothing/resting, and being alone over time in comparison with the control group. The analyses revealed individual differences in the amount of behavioral change over time and in the within-subject associations between daily behaviors and depressive symptoms. Conclusions: The findings suggest that physical, sedentary, and social behaviors have affective implications for daily mental health of individuals with depression. Self-monitoring using ESM may be a useful add-on tool to achieve behavioral change and to gain personalized insight in behaviors that improve daily depressive symptoms. (PsycINFO Database Record
    No preview · Article · Dec 2015 · Health Psychology
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