Improving behavioral activation for depression

Major depressive disorder is the most prevalent mental health disorder and a leading cause of disability worldwide. Behavioral Activation (BA) is a parsimonious, cost-effective, and easily disseminated psychotherapy. Although efficacious, BA leaves many patients symptomatic, suggesting there is room for improvement. This dissertation aimed to contribute to the growing literature developing augmentation strategies for BA. Toward this end, I conducted (1) a meta-analysis of the efficacy of BA and (2) an experiment that aimed to test the efficacy of an in-session strategy to enhance BA outcomes. The primary aim of the meta-analysis was to examine the efficacy of BA beyond depression symptom reduction. I computed effect sizes for BA relative to control conditions for both anxiety symptoms and activation, the putative target of the intervention. Findings supported the use of BA as an intervention for patients with depression and co-occurring anxiety and as a strategy to increase activation. It is important to note, however, that study quality varied and was low on average. There was also evidence of publication bias present. Hence, there is a need for high quality efficacy studies of BA. In addition, effect sizes were modest for all three outcomes, which underscores the need for continued treatment development research. One avenue for improving activation may be through increasing homework compliance with activity scheduling. The primary aim of this experiment was to test whether briefly practicing a target activity (guided practice) during BA would result in higher homework completion compared to activity planning alone (control). Participants (N=100) were college students with depressive symptoms. All participants selected an activity to monitor for 7 days with a goal of completing the activity 5 times. Self-report questionnaires were completed at baseline and 7 days later. Consistent with hypothesis, participants assigned to the guided practice condition evidenced a higher rate of activity completion relative to those assigned to the control condition. Results provide initial support for the utility of guided practice as a strategy for improving homework compliance in BA. Together, this research documents overall efficacy of BA, and highlights specific areas for improvement.Psycholog