The behavioral activation for depression scale-short form: development and validation.

Following a landmark component analysis of cognitive therapy by Jacobson and colleagues (1996), there has been renewed interest in behavioral activation (BA) treatments for depression. The Behavioral Activation for Depression Scale (BADS) was developed to measure when and how clients become activated over the course of BA treatment. Multiple studies have provided initial support for the BADS but have also identified several potential problems. Four studies were conducted in order to develop and provide initial evaluation of a short form of the BADS that addresses these concerns. In Study 1, an exploratory factor analysis was conducted on existing data using the original BADS in order to identify items to retain for the short form. In Study 2, these items were administered to a new sample of college students with elevated depressive symptoms and were analyzed with exploratory and confirmatory factor analyses. Study 3 examined the predictive validity of the BADS-SF by examining the BADS-SF and depression scores in relation to activity tracking and reward-value ratings over the course of 1 week. Study 4 examined BADS-SF data over the course of BA treatment for two clients using cross-lagged panel correlations. With one client, changes in BADS-SF scores led changes in depression scores by 1 week, whereas with the other client changes in BADS-SF and depression scores occurred concurrently. These studies resulted in a nine-item scale that demonstrated good item characteristics as well as acceptable internal consistency reliability, construct validity, and predictive validity.

What is behavioral activation? A review of the empirical literature.

Behavioral Activation (BA) for depression is an empirically supported psychotherapy with a long history dating back to the 1970s. To date there have been no systematic reviews of how BA treatment packages and their accompanying components have evolved over the years. This review sought to identify and describe the specific treatment components of BA based on the descriptions of techniques provided in empirical articles on BA and referenced treatment manuals when available. The following component techniques were identified: activity monitoring, assessment of life goals and values, activity scheduling, skills training, relaxation training, contingency management, procedures targeting verbal behavior, and procedures targeting avoidance. The implementation of these techniques is reviewed, along with their empirical support both as stand-alone components and as components of larger treatment packages. Whereas activity scheduling, relaxation, and skills training interventions have received empirical support on their own, other procedures have shown effectiveness as parts of larger treatment packages. Although BA interventions differed in tools used, activity monitoring and scheduling were shown to be constant components across interventions. Possible directions for the future evolution of BA are discussed.

The impact of experiential avoidance and obsessive beliefs on obsessive-compulsive symptoms in a severe clinical sample.

The present study sought to replicate and extend a study by Abramowitz et al. (2009), who examined how well experiential avoidance (EA) and obsessive beliefs predicted obsessive-compulsive (OC) symptoms in a non-clinical sample. The current study utilized a severe, clinical, treatment-seeking sample (N=108), and examined how well EA and obsessive beliefs predicted changes in OC symptoms from pre- to post-treatment. Findings were generally consistent with Abramowitz et al. EA was generally not related to OC severity and did not add significantly to the prediction of OC symptom domains above and beyond depression or general anxiety, whereas obsessive beliefs did. Pre- to post-treatment change in one type of obsessive belief (perfectionism/certainty), but not change in EA, predicted global change in OC severity. Results suggest that EA as it is measured currently may not play a significant role in OC severity or changes in OC severity across treatment.

A critical review of assessment strategies to measure the behavioral activation model of depression.

Behavioral activation (BA) treatments for depression are based on a model of psychopathology indicating that losses of, reductions in, or chronically low levels of positive reinforcement produce behavioral and emotional changes in depression. The corresponding mechanism theory is that using BA techniques to increase activation will lead to a subsequent increase in positive reinforcement, which will decrease depressive symptoms. We attempt to review BA literature relevant to its psychopathology and mechanism models, paying particular attention to attempts to measure activation as conceptualized within BA treatments and attempts to measure reinforcement. Suggestions on ways in which to improve these measurements in order to better evaluate the psychopathology and mechanism models are provided.

Depression stigma in a predominantly low income African American sample with elevated depressive symptoms.

It is widely recognized that stigmatization of depression leads individuals with depression to avoid treatment and discontinue treatment prematurely. However, this research has been conducted with predominantly White samples and there is limited research on stigma of depression and how it relates to previous treatment seeking among African Americans. The current study examined stigma of depression and related constructs in a predominantly low income African American sample with elevated depressive symptoms. Specifically, general self-stigma, secrecy, public stigma, treatment stigma, and stigmatizing experiences, as well as depression severity, and whether these factors predicted previous treatment seeking for depression were explored. Previous treatment seeking significantly predicted decreased public stigma and increased self-stigma. Implications and future directions are discussed.

Making behavioral activation more behavioral.

Behavioral Activation, an efficacious treatment for depression, presents a behavioral theory of depression--emphasizing the need for clients to contact positive reinforcement--and a set of therapeutic techniques--emphasizing provision of instructions rather than therapeutic provision of reinforcement. An integration of Behavioral Activation with another behavioral treatment, Functional Analytic Psychotherapy, addresses this mismatch. Functional Analytic Psychotherapy provides a process for the therapeutic provision of immediate and natural reinforcement. This article presents this integration and offers theoretical and practical therapist guidelines on its application. Although the integration is largely theoretical, empirical data are presented in its support when available. The article ends with a discussion of future research directions.