Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-26T05:08:55.929Z Has data issue: false hasContentIssue false

Effects of Brief Behavioural Activation on Approach and Avoidance Tendencies in Acute Depression: Preliminary Findings

Published online by Cambridge University Press:  03 October 2016

Farjana Nasrin
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
Katharine Rimes
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
Andrea Reinecke
Affiliation:
University of Oxford, UK
Mike Rinck
Affiliation:
Radboud University Nijmegen, The Netherlands
Thorsten Barnhofer*
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
*
Correspondence to Thorsten Barnhofer, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Perry Road, Exeter EX4 4QG, UK. E-mail: t.barnhofer@exeter.ac.uk

Abstract

Background: It has been suggested that the behavioural activation (BA) treatments for depression unfold their effects, at least partly, through changes in approach and avoidance tendencies. However, as yet, little research has examined the cognitive effects of these interventions. Aims: This study investigated the impact of a single session of BA on depressive symptomatology, self-reported avoidance, and behavioural approach and avoidance tendencies. Method: Forty-six patients with a diagnosis of Major Depression were recruited from primary care psychological therapies services and block randomized to either a single session of behavioural activation (n = 22) or waiting list control (n = 24) delivered by an unblinded therapist. Self-reports of symptoms and cognitive factors were assessed before and after the one-week intervention phase. Approach and avoidance behavioural tendencies were assessed using the Approach-Avoidance Task (AAT). Results: Data from 40 participants (n = 20 in each group) was available for analyses. Depressive symptoms significantly decreased, and activation significantly increased from before to after treatment in the treatment group, but not in the control group. Performance on the AAT showed a trend indicating increased approach to positive valence stimuli in the treatment group, but not in the control group. Mediational analyses indicated small indirect effects of self-reported change in activation as mediators of the effect of condition on symptoms. Conclusions: The findings suggest that a single session of BA can have significant effects on symptoms in clinically depressed patients. Results hint at the possibility that increased behavioural approach might mediate the effect of BA.

Type
Research Article
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Daughters, S. B., Braun, A. R., Sargeant, M. N., Reynolds, E. K., Hopko, D. R., Blanco, C., et al. (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, 122129.CrossRefGoogle ScholarPubMed
Dichter, G. S., Felder, J. N., Petty, C., Bizzell, J., Ernst, M. and Smoski, M. J. (2009). The effects of psychotherapy on neural responses to rewards in major depression. Biological Psychiatry, 66, 886897.Google Scholar
Dickson, J. M. and MacLeod, A. K. (2004a). Anxiety, depression and approach and avoidance goals. Cognition and Emotion, 18, 423430.CrossRefGoogle Scholar
Dickson, J. M. and MacLeod, A. K. (2004b). Approach and avoidance goals and plans: their relationship to anxiety and depression. Cognitive Therapy and Research, 28, 415432.CrossRefGoogle Scholar
Ekers, D., Webster, L., Van Straten, A., Cuijpers, P., Richards, D. and Gilbody, S. (2014). Behavioural activation for depression: an update of meta-analysis of effectiveness and sub group analysis. PloS One, 9, e100100.CrossRefGoogle ScholarPubMed
Ferster, C. B. (1973). A functional analysis of depression. American Psychologist, 28, 857.Google Scholar
First, M. D., Spitzer, R. L., Gibbon, M. and Williams, J. B. W. (2002). Structured Clinical Interview for DSM-IV TR Axis I Disorders, Research Version. New York: Biometrics Research, New York State Biometric Institute.Google Scholar
Gawrysiak, M., Nicholas, C. and Hopko, D. R. (2009). Behavioral activation for moderately depressed university students: randomized controlled trial. Journal of Counseling Psychology, 56, 468.Google Scholar
Hayes, S. C., Strosahl, K. D., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., et al. (2004). Measuring experiential avoidance: a preliminary test of a working model. The Psychological Record, 54, 553578.Google Scholar
Heuer, K., Rinck, M. and Becker, E. S. (2007). Avoidance of emotional facial expressions in social anxiety: the Approach-Avoidance Task. Behaviour Research and Therapy, 45, 29903001.CrossRefGoogle ScholarPubMed
Hopko, D. R., Bell, J. L., Armento, M. E. A., Hunt, M. K. and Lejuez, C. W. (2005). Behavior therapy for depressed cancer patients in primary care. Psychotherapy: Theory, Research, Practice, Training, 42, 236243.Google Scholar
Hopko, D. R. and Lejuez, C. W. (2007). A Cancer Patient's Guide to Overcoming Depression and Anxiety: getting through treatment and getting back to your life. Oakland, CA: New Harbinger.Google Scholar
Hopko, D. R., Lejuez, C. W., Ruggiero, K. J. and Eifert, G. H. (2003). Contemporary behavioral activation treatments for depression: procedures, principles, and progress. Clinical Psychology Review, 23, 699717.CrossRefGoogle ScholarPubMed
Jacobson, N. S., Martell, C. R. and Dimidjian, S. (2001). Behavioral activation treatment for depression: returning to contextual roots. Clinical Psychology: Science and Practice, 8, 255270.Google Scholar
Kanter, J. W., Mulick, P. S., Busch, A. M., Berlin, K. S. and Martell, C. R. (2007). The behavioral activation for depression scale (BADS): psychometric properties and factor structure. Journal of Psychopathology and Behavioral Assessment, 29, 191202.CrossRefGoogle Scholar
Kroenke, K., Spitzer, R. L. and Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606613.Google Scholar
Lejuez, C. W., Hopko, D. R. and Hopko, S. D. (2001). A brief behavioral activation treatment for depression: treatment manual. Behavior Modification, 25, 255286.Google Scholar
Lejuez, C. W., Hopko, D. R., LePage, J. P., Hopko, S. D. and McNeil, D. W. (2001). A brief behavioral activation treatment for depression. Cognitive and Behavioral Practice, 8, 164175.Google Scholar
Martell, C. R., Addis, M.E. and Dimidjian, S. (2004). Finding the action in behavioral activation: the search for empirically-supported interventions and mechanisms of change. In Hayes, S.C., Linehan, M. M. and Follette, V.M. (Eds.), Mindfulness and Acceptance: expanding the cognitive-behavioral tradition (pp. 152167). New York: Guilford Press.Google Scholar
Martell, C. R., Addis, M. E. and Jacobson, N. S. (2001). Depression in Context: strategies for guided action. New York: Norton.Google Scholar
McCauley, E., Schloredt, K., Gudmundsen, G., Martell, C. and Dimidjian, S. (2011). Expanding behavioral activation to depressed adolescents: lessons learned in treatment development. Cognitive and Behavioral Practice, 18, 371383.CrossRefGoogle Scholar
Meeks, S., Teri, L., Van Haitsma, K. and Looney, S. (2006). Increasing pleasant events in the Nursing Home: collaborative behavioral treatment for depression. Clinical Case Studies, 5, 287304.CrossRefGoogle Scholar
Moulds, M. L., Kandris, E., Starr, S. and Wong, A. (2007). The relationship between rumination, avoidance and depression in a non-clinical sample. Behaviour Research and Therapy, 45, 251261.CrossRefGoogle Scholar
Ottenbreit, N. D. and Dobson, K. S. (2004). Avoidance and depression: the construction of the Cognitive-Behavioral Avoidance Scale. Behaviour Research and Therapy, 42, 293313.Google Scholar
Preacher, K. J. and Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879891.Google Scholar
Reinecke, A., Waldenmaier, L., Cooper, M. J. and Harmer, C. J. (2013). Changes in automatic threat processing precede and predict clinical changes with exposure-based cognitive-behavior therapy for panic disorder. Biological Psychiatry, 73, 10641070.CrossRefGoogle ScholarPubMed
Rinck, M. and Becker, E. S. (2007). Approach and avoidance in fear of spiders. Journal of Behavior Therapy and Experimental Psychiatry, 38, 105120.Google Scholar
Trew, J. L. (2011). Exploring the roles of approach and avoidance in depression: an integrative model. Clinical Psychology Review, 31, 11561168.Google Scholar
Treynor, W., Gonzalez, R. and Nolen-Hoeksema, S. (2003). Rumination reconsidered: a psychometric analysis. Cognitive Therapy and Research, 27, 247259.Google Scholar
Vrijsen, J. N., Van Oostrom, I., Speckens, A., Becker, E. S. and Rinck, M. (2013). Approach and avoidance of emotional faces in happy and sad mood. Cognitive Therapy and Research, 37, 16.Google Scholar
Webb, C. A., Dillon, D. G., Pechtel, P., Goer, F. K., Murray, L., Huys, Q. J. M., et al. (2016). Neural correlates of three promising endophenotypes of depression: evidence from the EMBARC study. Neuropsychopharmacology, 41, 454463.Google Scholar
Submit a response

Comments

No Comments have been published for this article.