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 range — Behavioral Activation (BA) Group: 36.6 year on average; Automatic Thoughts (AT) Group: 38.3 years on average; Cognitive Behavioral Therapy (CT) Group: 39.2 years on average.
• Race/Ethnicity — Over 90% of the participants in the BA and AT groups were Caucasian. In the CT group, 76% were Caucasian, 6% African American, 6% Native American, and 4% Asian.
• Gender — Not Specified
• Status — 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 post-intervention 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 range — 30.5 years on average
• Race/Ethnicity — 96% Caucasian
• Gender — Not Specified
• Status — 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 post-intervention 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 range — 18 to 60 years
• Race/Ethnicity — Not Specified
• Gender — Not Specified
• Status — 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 post-intervention follow-up: None.

Daughters, S. B., Braun, A. R., Sargeant, M. N., Reynolds, E. K., Hopko, D. R., Blanco, C. … Lejuez, C. W. (2008). Effectiveness of a brief behavioral treatment for inner-city illicit drug users with elevated depressive symptoms: The Life Enhancement Treatment for Substance Use (LETS Act!). Journal of Clinical Psychiatry, 69(1), 122-129.

Type of Study: Randomized controlled trial
Number of Participants: 44

Population:

• Age range — 42.1 years on average
• Race/Ethnicity — 86% Black
• Gender — Not Specified
• Status — Inpatients at a Salvation Army substance abuse treatment center.

Location / Institution: Washington, D.C.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants were patients at least 18 years of age who met Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for substance dependence, had completed at least two weeks at the inpatient treatment center and scored at least in the moderate range for depression on the Beck Depression Inventory (BDI). Participants were randomly assigned to receive the LETS Act! Treatment or to a Treatment as Usual (TAU) condition. They were evaluated at baseline using the Mini-International Neuropsychiatric Interview (M.I.N.I), the Hamilton Rating Scale for Depression (HAM-D), the BDI and the Beck Anxiety Inventory (BAI). Patients also completed the Environmental Reward Observation Scale (EROS) , which measures the association between behaviors and rewarding environmental experiences. Measures were collected at baseline and at the conclusion of treatment sessions. An additional BDI score was collected following the second of two weekly maintenance sessions which took place after treatment. Patients in the TAU condition showed no significant changes in depression, anxiety, or EROS scores at the conclusion of the study. In contrast, the LETS Act! group showed improvements in BDI, HAMD, BAI, and EROS scores at posttest and in depression symptoms at the two-week follow-up. The authors suggest that further testing should include a more diverse sample and longer-term follow-up.

Length of post-intervention follow-up: Two weeks.

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 range — Depressed: 39.0 years on average; Non-depressed: 30.8 years on average
• Race/Ethnicity — Not Specified
• Gender — Not Specified
• Status — Not Specified

Location / Institution: Not Specified

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 post-intervention 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 range — 18.4 years on average
• Race/Ethnicity — 70% Caucasian, 13% African American, 7% Latino, 7% Asian American, 3% Other
• Gender — Not Specified
• Status — Student 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 post-test 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 post-intervention follow-up: 2 weeks.

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

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

Population:

• Age range — 43.8 years on average
• Race/Ethnicity — 73.7% African American
• Gender — Not Specified
• 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 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 post-intervention follow-up: 22 weeks post-treatment.