Behavioral Activation Treatment for Depression (BATD)

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Behavioral Activation Treatment for Depression (BATD) has been rated by the CEBC in the area of: Depression Treatment (Adult).

Target Population: Depressed adults including those with substance abuse problems

Brief Description

The BATD program’s primary goal is to reduce depressive symptoms. It is aimed at helping clients reconnect with their values across several life areas. It begins with behavioral monitoring of daily activities with an examination of the extent to which the client currently is living according to these values. In moving the client towards this more valued life, BATD uses a structured approach aimed at identifying activities that fit within the client’s values on a daily basis. The program also uses contracts to recruit social support for these efforts. BATD can be conducted individually or in groups. It was designed to be a 10-12 session treatment, but has been shown to be efficacious in shorter durations.

Program Goals:

The overall goals of Behavioral Activation Treatment for Depression (BATD) are:

  • Significant reduction in depressive symptoms
  • Significant reduction in substance use problems
  • Significant improvement in overall functioning and engagement in valued life activities
  • Significant reduction in anxiety and depression associated with a cancer diagnosis
  • Modest reduction in trauma-related symptoms
  • Some initial data supporting its use with adolescents
  • Some initial data supporting its use in a spanish language version

Essential Components

The essential components for Behavioral Activation Treatment for Depression (BATD) include:

  • Can be administered individually or in groups and groups may have as many as 10-20 participants for mildly depressed participants or as few as 3-5 participants if they are more seriously impaired
  • Theoretical Goals including:
    • Have patients reconnect with their values across several life areas with a examination of the extent to which they currently are living according to these values
    • Have patients identify activities that fit within values
    • Help patient utilize structure and planning to help live a valued life on a daily basis
  • Intervention Strategies including:
    • Daily monitoring of activities
    • Identification of behavioral goals in valued life areas
    • Planning of activities and continued monitoring
    • Behavioral contracts to increase social support for healthy behavior

Adult Services

Behavioral Activation Treatment for Depression (BATD) directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:

  • Depression

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Outpatient Clinic
  • School

Homework

Behavioral Activation Treatment for Depression (BATD) includes a homework component:

About 5 minutes per day of monitoring and planning plus a few brief exercises occasionally

Languages

Behavioral Activation Treatment for Depression (BATD) has materials available in a language other than English:

Kurdish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Group or individual therapy room
  • Paper-based patient manuals
  • Group leader (1 or 2 depending on skill level and group size)
  • White board and dry erase markers for session
  • Copier to make copies of homework forms

Minimum Provider Qualifications

Bachelor's degree level therapists and community mental health workers

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

On-site.

Number of days/hours:

6 to 12 hours of training given in 1-2 days total.

Additional Resources:

There currently are additional qualified resources for training:

Implementation Information

Since Behavioral Activation Treatment for Depression (BATD) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

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Pre-Implementation Materials

The program representative did not provide information about pre-implementation materials.

Formal Support for Implementation

The program representative did not provide information about formal support for implementation of Behavioral Activation Treatment for Depression (BATD).

Fidelity Measures

The program representative did not provide information about fidelity measures of Behavioral Activation Treatment for Depression (BATD).

Implementation Guides or Manuals

The program representative did not provide information about implementation guides or manuals for Behavioral Activation Treatment for Depression (BATD).

Research on How to Implement the Program

The program representative did not provide information about research conducted on how to implement Behavioral Activation Treatment for Depression (BATD).

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Jacobson, N., Dobson, K., Truax, P., Addis, M., Koerner, K., Gollan, J., … Prince, S. E. (1996). A component analysis of cognitive-behavioral treatment for depression. Journal of Consulting and Clinical Psychology, 64(2), 295-304.

Type of Study: Randomized controlled trial
Number of Participants: 152

Population:

  • Age — Behavioral Activation (BA) Group: Mean=36.6 years, Automatic Thoughts (AT) Group: Mean=38.3 years, and Cognitive Behavioral Therapy (CT) Group: Mean=39.2 years
  • Race/Ethnicity — BA group: 93% Caucasian, 4% Hispanic, 2% African American, and 2% Native American; AT group: 91% Caucasian, 5% Native American, 2% Hispanic, and 2% Asian; CT group: 76% Caucasian, 6% African American, 6% Native American, and 4% Asian
  • Gender — 72% Female
  • Status — Participants were patients referred by their HMO or recruited through public service announcements.

Location/Institution: Washington State

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants meeting diagnostic criteria for major depression, based on standard clinical interview procedures, were randomly assigned to one of three intervention conditions. The Behavioral Activation (BA) condition focused on helping participants learn to incorporate positive behaviors into their lives, the Automatic Thoughts (AT) condition focused on reducing the occurrence of negative thought patterns and the  Cognitive Behavior Therapy (CT) condition incorporated both approaches into therapy. Outcome measures included the Longitudinal Interval Follow-up Evaluation (LIFE), the Hamilton Rating Scale for Depression (HRSD), and the Beck Depression Inventory (BDI). All treatment conditions showed approximately the same rates of improvement and recovery for participants with about 70% showing improved depression scores and 57% showing recovery. The study was limited by lack of a no-treatment comparison group.

Length of postintervention follow-up: 6 months.

Hopko, D. R., Lejuez, C. W., LePage, J. P., Hopko, S. D., & McNeil, D. W. (2003). A brief behavioral activation treatment for depression: A randomized pilot trial within an inpatient psychiatric hospital. Behavior Modification, 27(4), 458-469.

Type of Study: Randomized controlled trial
Number of Participants: 25

Population:

  • Age — Mean=30.5 years
  • Race/Ethnicity — 96% Caucasian
  • Gender — 64% Male
  • Status — Participants were patients being treated in an acute- to medium-care psychiatric facility.

Location/Institution: West Virginia

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants in this study had received a principal diagnosis of major depression and did not have a current psychotic disorder or a history of psychosis. Participants were randomly assigned to receive either 14 days of Behavioral Activation (BA) treatment or an equivalent period of Supportive Psychotherapy (SP). In the SP condition, a psychotherapist provided a supportive environment for discussion, but did not teach specific skills. Depression was assessed using the Beck Depression Inventory (BDI). Patients in the BA condition showed a decrease in their BDI scores from baseline levels and this decrease was significantly greater than that found in the SP group. Limitations include use of a single assessment and lack of longer-term follow-up.

Length of postintervention follow-up: None.

Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. … Jacobson, N. S. (2006). Randomized trial of Behavioral Activation, Cognitive Therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74(4), 658-670.

Type of Study: Randomized controlled trial
Number of Participants: 241

Population:

  • Age — 18-60 years
  • Race/Ethnicity — 82% White
  • Gender — 66% Female
  • Status — Participants were recruited by referral or through the media.

Location/Institution: Washington State

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants met criteria for major depression on the Beck Depression Inventory (BDI), the Hamilton Rating Scale for Depression (HRSD), and according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). They were randomly assigned to receive Behavioral Activation (BA) treatment, Cognitive Therapy (CT), the antidepressant medication paroxetine (ADM), or a placebo (PLA). Results showed that, among more severely depressed patients, BA treatment performed as well as the ADM treatment. These two treatments also performed significantly better than the CT treatment. The authors note that there was an unusually high rate of drop-outs from the ADM condition in this study, which may have affected results.

Length of postintervention follow-up: None.

Dichter, G. S., Felder, J. N., Petty, C., Bizzell, J., Ernst, M., & Smoski, M. J. (2009). The effects of psychotherapy on neural responses to rewards in major depression. Biological Psychiatry, 66, 886-897.

Type of Study: Non-randomized comparison group
Number of Participants: 30

Population:

  • Age — Depressed: Mean=39.0 years, Non-depressed: Mean=30.8 years
  • Race/Ethnicity — Not Specified
  • Gender — 58% Female
  • Status — Participants were adults with and without unipolar major depressive disorder (MDD).

Location/Institution: North Carolina - Duke Cognitive Behavioral Research and Treatment Program and advertisements at Duke University Medical Center and the University of North Carolina, Chapel Hill

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Depressed and non-depressed individuals participated in a computerized two-choice decision-making task in which they were instructed to try to win as much money as possible. While they participated in the game, participants received a functional magnetic resonance imaging (MRI) scan. Scans were performed at two sessions. In between session the depressed group received an average of 11 sessions of Behavioral Activation Treatment for Depression. Results showed that 75% of the depressed group showed significant reduction in depression scores on the Hamilton Rating Scale for Depression (HRSD). They also showed changes in brain structures that related to responses to rewards. This study is limited by lack of an untreated depressed control group.

Length of postintervention follow-up: None.

Gawrysiak, M., Nicholas, C., & Hopko, D. R. (2009). Behavioral Activation for moderately depressed university students: Randomized controlled trial. Journal of Counseling Psychology, 56(3), 468-475.

Type of Study: Randomized controlled trial
Number of Participants: 30

Population:

  • Age — Mean=18.4 years
  • Race/Ethnicity — 70% Caucasian, 13% African American, 7% Latino, 7% Asian American, and 3% other
  • Gender — 80% Female
  • Status — Participants were students recruited from introductory psychology classes at a Southeastern University.

Location/Institution: Public Southeastern U.S. University

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Recruited students were included if they scored as moderately depressed on the Beck Depression Inventory (BDI), and were not presently undergoing pharmacological treatment or psychotherapy for depression and had not been through psychotherapy in the past two years. They were assessed using the BDI, the Beck Anxiety Inventory (BAI), the Environmental Reward Observation Scale (EROS), and the Multidimensional Scale of Perceived Social Support, which looks at adequacy of support from family and friends. After their initial assessment, participants were randomly assigned to the BATD treatment group or a no-treatment control group. BATD group participants received a 90-minute treatment session and the control group participated in a 90-minute discussion of student research requirements and their participation in the study. The follow-up assessments took place two weeks later. At posttest the BATD group showed significantly greater reductions in depression scores and improvements in scores and social support. Limitations include small sample size and lack of long-term follow-up.

Length of postintervention follow-up: 2 weeks.

MacPherson, L., Tull, M. T., Matusiewicz, A., Rodman, S., Strong, D. R., Kahler, C. W., … Lejuez, C.W. (2010). Randomized controlled trial of behavioral activation smoking cessation treatment for smokers with elevated depressive symptoms. Journal of Consulting and Clinical Psychology, 78, 55–61.

Type of Study: Randomized controlled trial
Number of Participants: 68

Population:

  • Age — Mean=43.8 years
  • Race/Ethnicity — 73.7% African American
  • Gender — 49% Female
  • Status — Participants were recruited through the media for a study on smoking cessation.

Location/Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants were required to be smoking at least 10 cigarettes per day and to score in the moderate range on the Beck Depression Inventory (BDI) at the start of the study. They were randomly assigned to 8 weeks of standard treatment or to the Behavioral Activation Treatment for Depression (BATD) intervention. At the end of the treatment sessions, all participants were also given nicotine patches and dosages were reduced over time on the same schedule for both groups. Participants’ cessation outcomes were measured and were they were also assessed using the BDI and the Environmental Reward Observation Scale (EROS). Participants in the BATD condition were more successful in maintaining smoking cessation and also showed lower levels of depression and higher enjoyment scores.

Length of postintervention follow-up: 22 weeks.

Hopko, D. R., Armento, M. E., Robertson, S., Ryba, M. M., Carvalho, J. P., Colman, L. K., ... & Lejuez, C. W. (2011). Brief Behavioral Activation and Problem-Solving Therapy for depressed breast cancer patients: Randomized trial. Journal of Consulting and Clinical Psychology, 79(6), 834.

Type of Study: Randomized controlled trial
Number of Participants: 80

Population:

  • Age — Mean=55.4 years
  • Race/Ethnicity — 93% Caucasian and 7% African American
  • Gender — 100% Female
  • Status — Participants were women diagnosed with breast cancer and major depression.

Location/Institution: University of Tennessee Medical Center’s Cancer Institute (Knoxville, TN)

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study tested the efficacy of an 8-session version of Behavioral Activation Treatment for Depression (BATD) compared to Problem-Solving Therapy. Women were randomly assigned to one of the two interventions. Outcome measures included the Beck Depression Inventory, Hamilton Rating Scale for Depression, and the Environmental Reward Observation Scale. Analyses showed both treatments had significant pre–post treatment gains across all outcome measures. 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. Limitations include concerns regarding generalizability to other populations, limited assessment of anxiety, and the lack of a no treatment control group.

Length of postintervention follow-up: 12 months.

Hopko, D. R., Funderburk, J. S., Shorey, R. C., McIndoo, C. C., Ryba, M. M., File, A. A., ... & Vitulano, M. (2013). Behavioral Activation and Problem-Solving Therapy for depressed breast cancer patients: Preliminary support for decreased suicidal ideation. Behavior Modification, 37(6), 747-767.

Type of Study: Randomized controlled trial
Number of Participants: 80

Population:

  • Age — Mean age=55.4 years
  • Race/Ethnicity — 93% Caucasian and 7% African American
  • Gender — 100% Female
  • Status — Participants were women diagnosed with breast cancer and major depression.

Location/Institution: University of Tennessee Medical Center’s Cancer Institute (Knoxville, TN)

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study uses data from Hopko et al. (2011) study, to compare the efficacy 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 Major Depressive Disorder (MDD). Subjects were randomly assigned to BATD or PST. Measures utilized include the Hamilton Rating Scale for Depression, the Beck Depression Inventory–II (BDI–II), and Center for Epidemiological Studies of Depression Scale (CES-D). Results indicate that across both treatments analyses revealed decreased depression and suicidal ideation and increased hopefulness at posttreatment. Results also indicate that follow-up patient contact at approximately 2 years posttreatment yielded no indication of completed suicide. Limitations include the largely Caucasian sample, limited measures of suicidal ideation, and lack of no treatment control group.

Length of postintervention follow-up: 3, 6, 9, and 12 months.

Ryba, M. M., Lejuez, C. W., & Hopko, D. R. (2014). Behavioral Activation for depressed breast cancer patients: The impact of therapeutic compliance and quantity of activities completed on symptom reduction. Journal of Consulting and Clinical Psychology, 82(2), 325-335. doi: 10.1037/a0035363

Type of Study: Secondary analyses of one group from randomized controlled trial
Number of Participants: 23

Population:

  • Age — Mean=57 years
  • Race/Ethnicity — 100% Female
  • Gender — 91.3% White and 8.7% African American
  • Status — Participants were women with breast cancer diagnosed with depression.

Location/Institution: University of Tennessee Medical Center’s Cancer Institute

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study uses data from a subsample from the Hopko et al. (2011) study. It examines relationships among the quantity of activities completed, proportion of activities completed (i.e., therapeutic compliance), environmental reward, and depression in breast cancer patients treated with Behavior Activation Treatment for Depression (BATD). Patients assigned to BATD who completed and returned all monitoring logs were examined in this study. Measures utilized include the Anxiety Disorders Interview Schedule-IV (ADIS-IV), the Beck Depression Inventory–II (BDI–II), and the Environmental Reward Observation Scale (the EROS). Results indicate that therapeutic compliance with assigned activities was related to depression reduction, but the specific quantity of completed activities was not systematically related. Analyses indicated that for patients completing all assigned activities, treatment response and remission were achieved for all patients. Neither therapeutic compliance nor the quantity of completed activities was directly associated with self-reported environmental reward during the behavioral activation interval, and environmental reward did not mediate the relation between activation and depression. Limitations include reliance on self-report measures of reinforcement and the small sample size.

Length of postintervention follow-up: None.

Collado, A., Castillo, S. D., Maero, F., Lejuez, C. W., & MacPherson, L. (2014). Pilot of the brief Behavioral Activation Treatment for Depression in Latinos With limited English proficiency: Preliminary evaluation of efficacy and acceptability. Behavior Therapy, 45(1), 102-115.

Type of Study: One group pretest/posttest study
Number of Participants: 10

Population:

  • Age — Mean=41.45 years
  • Race/Ethnicity — 100% Latino
  • Gender — 70% Females
  • Status — Participants were Latinos with limited English proficiency and depressive symptomatology recruited through flyers and referrals provided by two different community centers serving Latinos.

Location/Institution: Maryland

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study evaluated Behavioral Activation Treatment for Depression (BATD) in individuals with limited English proficiency. Measures utilized include the Structured Clinical Interview for DSM-IV (SCID-IV), the Beck Depression Inventory–II (BDI–II), Behavioral Activation for Depression Scale (BADS), Reward Probability Index (RPI), Multidimensional Acculturative Stress Inventory (MASI), The Therapeutic Alliance With Clinician Questionnaire (TAC), and a standard demographics questionnaire. Results indicate that depressive symptomatology decreased, while both activation and environmental reward increased over the course of BATD. Increases in activation corresponded concurrently with decreases in depression, while environmental reward preceded decreases in depressive symptomatology. Limitations include the small sample size, lack of control or comparison group, and generalizability to other ethnic populations.

Length of postintervention follow-up: 1 month.

References

Hopko, D. R., Lejuez, C. W., Ruggiero, K. J., & Eifert, G. H. (2003). Contemporary behavioral activation treatment for depression: Procedures principles, and process. Clinical Psychology Review, 23, 699-717.

Lejuez, C. W., Hopko, D. R., LePage, J. P., Hopko, S. D., & McNeil, D. W. (2001). A brief behavioral activation treatment for depression.Cognitive and Behavioral Practice, 8, 164-175.

Lejuez, C. W., Hopko, D. R., & Daughters, S. B. (2004). A Mental Health Counselor’s Guide to the Brief Behavioral Activation Treatment for Depression (BATD). In New Directions in Mental Health Counseling (pp.81-90). Long Island City, NY: The Hatherleigh Company.

Contact Information

Name: Carl Lejuez, PhD
Agency/Affiliation: University of Maryland-College Park
Website: www.addiction.umd.edu
Email:
Phone: (301) 405-3281
Fax: (301) 405-3223

Date Research Evidence Last Reviewed by CEBC: July 2014

Date Program Content Last Reviewed by Program Staff: March 2010

Date Program Originally Loaded onto CEBC: March 2010