From: Effects of behavioural activation on substance use and depression: a systematic review
Author (year) | BA intervention description | Control condition description | Therapist Session number (duration) | Depression outcomes | Substance use outcomes | Conclusion |
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Daughters et al. (2018) [49] | LET’S ACT: (1) to generate, schedule, engage in and record value-driven substance-free behaviours that serve to increase daily positive reinforcement; (2) to identify important life areas, values and activities that aid in the movement from a maladaptive response to negative mood to an increase behaviours that facilitate positive reinforcement. | Supportive counselling: therapist provided unconditional support, utilized reflective listening techniques and managed group dynamics by encouraging equal participation among patients. Participants established a list of continually evolving discussion topics. | Clinical psychology doctoral students and post-doctoral fellows trained in both conditions. Session length: five or eight sessions (60 min each session), balanced across conditions. | No significant changes in depressive symptoms by condition, time or their interaction. Significant time x abstinence interaction. Participants who were abstinent from pre-treatment to 12-month follow-up reported significantly fewer depressive symptoms at 12-months compared to substance users. | Abstinence rates were significantly higher for LETS ACT compared to the control condition at 3, 6 and 12 months follow-up. | LET’S ACT is an effective intervention to reduce the incidence of post-treatment substance use and substance use-related adverse consequences. |
Gonzalez-Roz et al. (2018) [50] | CBT + BA: (1) BA treatment rationale; (2) psycho-education about the association between smoking and depression; (3) identification of life areas for generating meaningful, reinforcing and positive activities; and (4) encouraging to engage in and monitor each planned in-session activity. | CBT-BA + CM: Included components of CBT + BA and also reinforcing abstinence through earn points exchangeable for rewards on a schedule of escalating magnitude of reinforcement. | Master- and doctoral-level psychologists with experience in smoking cessation treatments, and trained in the specific treatments used in the study. Session length: eight weekly sessions (90 min each session). | There was a significant reduction in depressive symptoms from pre- to post-treatment. No significant differences between conditions were found in depression symptoms. | No significant differences were found between conditions in abstinence rates. | Adding a CM protocol to CBT-BA resulted in better treatment retention although it did not improve abstinence rates. |
Busch et al. (2017) [43] | BAT-CS: (1) increasing pleasant and/or meaningful activities; (2) increasing activities for a non-smoking lifestyle; and (3) developing specific steps for a quit attempt. | SC: five mailings of 10 smoking cessation educational brochures. | Licensed clinical psychologist and clinical psychology post-doctoral fellow Session length: All participants: one smoking cessation session at the hospital (50 min). BAT-CS: a minimum of five post-discharge contacts at 1, 3, 6, 9, and 12 weeks (duration not specified). | No significant differences were found in depression from baseline to end-of-treatment, or at 24-week follow-up. | AOR favoured BAT-CS at the end-of-treatment and at 24-week follow-up. Mean number of days to first lapse and to first relapse after discharge was significantly greater for BAT-CS. | Preliminary evidence favouring BA and standard smoking cessation counselling combination for depressed mood and smoking cessation in patients following ACS. |
Delgadillo et al. (2015) [46] | BA: (1) self-monitoring of depressive and maladaptive behaviours; (2) activity scheduling to increase and reinforce adaptive behaviour patterns; (3) reducing avoidant behaviours, rumination and maladaptive coping strategies. | GSH: to describe and encourage participants to apply a self-help booklet for depression based on CBT principles. | Qualified psychological well-being practitioners trained in BA (postgraduate level in structured guided self-help interventions, 1 year supervised clinical training course) and CDAT workers who delivered GSH (trained by a counseling psychologist). Session length: BA: 12 sessions (duration not specified). GSH: one session (60 min). | Moderate and comparable improvements in depressive symptoms over time were found for participants in both treatment groups. | There was a reduction in substance use in the BA group, but the difference was not statistically significant. | Psychological interventions integrated within CADT are needed to improve patients’ mental health. |
Mimiaga et al. (2012) [48] | BA-RR: (1) building rapport, treatment rationale, and gathering information about participant’s patterns of substance use, mental health history, and substance use treatment history; (2) information and motivation to sexual risk reduction; (3) BA integrated with risk-reduction counselling; (4) review and relapse prevention planning. | No comparison group. | Therapist level not reported. Session length: 10 sessions (50 min each session). | Significant reductions in depression scores from baseline to acute post-intervention and to 3-month follow-up. | Significant reductions in crystal methamphetamine use and polysubstance use. | An integrated behavioural program may impact sexual risk, substance use, and depression outcomes. |
MacPherson et al. (2010) [47] | BATS: (1) structuring reinforcing activities; (2) activity monitoring; (3) identification of values and life goals; (4) planning activities; (5) recording the engagement in planned activities; (6) activities related with smoking cessation process and to stay abstinent, addressing lapses, and coping with triggers; (7) incorporating non-smoking lifestyle activities. | ST: self-monitoring, identifying cessation strategies from prior quit attempts, relaxation, coping with triggers, identifying social support for cessation, making lifestyle changes, and homework. | Clinical psychologist (doctoral degrees and clinical psychology doctoral students), trained for both conditions. Session length: 8 sessions (30 min of BA and 30 min of core ST components each session). | A reduction in depressive symptoms from baseline to 26-week post assigned quit date was observed. The reduction in depressive symptoms over time was greater for BATS than for ST participants. | BATS showed greater odds of smoking abstinence during the follow-up period compared to ST. | BATS is a promising intervention for smoking cessation and reduction of depression among smokers with depressive symptoms. |
Carpenter et al. (2008) [45] | BTDD: (1) increasing the frequency and/or breadth of pleasant activities; (2) assessment of the relation between mood and pleasant activities; (3) rating frequency and pleasure of activities, and satisfaction in 9 life areas; (4) weekly definition of out-of-session activities to increase the amount of pleasant activities. | REL: (1) progressive muscle relaxation, (2) autogenic relaxation exercises and, (3) visual imagery. | Trained therapist. Session length: 24 weekly sessions (duration not specified) for both conditions. | Depression decreased during treatment. The average depression ratings at end of treatment were equivalent across treatments. | In both treatment conditions there was a significant increase in the odds of benzodiazepine use, and a significant decrease in the odds of opiate use. | REL and BTDD targeting depressive and substance use disorders facilitate clinical improvement. |
Carpenter et al. (2006) [44] | BTDD: (1) education about the relation between mood and activity level; (2) increasing activities in relevant life areas; (3) developing skills to increase activities; and (4) CM for therapy adherence and completion of therapeutic activities. | No comparison group. | Trained therapist. Session length: 16 individual sessions (duration not specified) over 24-weeks. | Significant decrease in self-rated and clinician-rated depression at weeks 12 and 24. During treatment 48.30% of patients demonstrated ≥50% reduction in HAMD. | There were no significant changes in opiate and cocaine use. Treatment responders reported a significant reduction on BZ use. | A behaviourally based treatment for depression seeking to increase rewarding activities in targeted life areas is associated with a significant reduction in depression severity. |