Behavioral activation therapy for depression and anxiety in cancer patients: a case series study

Efficacy of behavioral activation in reducing fear of cancer recurrence in non-small cell lung cancer patients: a randomized controlled trial

Fear of cancer recurrence (FCR) is a significant risk factor affecting treatment outcomes and prognosis in non-small cell lung cancer (NSCLC) survivors. Behavioral activation (BA), a structured therapeutic approach based on cognitive-behavioral therapy (CBT) principles, has demonstrated efficacy in alleviating psychological distress among cancer patients. This study aims to investigate the effect of BA on FCR in patients with NSCLC and explore the underlying mechanisms. A total of 82 eligible patients were randomly assigned to either the intervention group (BA) (n = 41) or the usual care group (CAU) (n = 41). Assessments were conducted at baseline (T0), week 4 (T1), and week 8 (T2) using the Cancer Recurrence Fear Scale-Brief Form (FCRI-SF), the Hospital Anxiety and Depression Scale (HADS), the Brief Resilient Coping Scale (BRCS), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) version 3.0. Negative emotions (depression and anxiety), as well as resilient coping, were identified as potential mediators. The intervention effect and its potential mediating effects were analyzed using generalized estimating equations (GEE). GEE analysis revealed significantly lower FCR scores in the BA group at weeks 4 and 8 (Group*T1: Wald X2 = 25.79, P < 0.001; Group*T2: Wald X2 = 59.59, P < 0.001). Depression and anxiety scores decreased over time in the BA group and remained consistently lower than those in the usual care group (depression: Group*T1 Wald X2 = 34.67, P < 0.001; Group*T2 Wald X2 = 56.05, P < 0.001; anxiety: Group*T1 Wald X2 = 36.22, P < 0.001; Group*T2 Wald X2 = 64.85, P < 0.001). Scores for resilient coping and quality of life increased over time in the BA group and were significantly higher than those in the usual care group (resilient coping: Group*T1 Wald X2 = 19.49, P < 0.001; Group*T2 Wald X2 = 66.19, P < 0.001; quality of life: Group*T1 Wald X2 = 19.86, P < 0.001; Group*T2 Wald X2 = 64.46, P < 0.001). Furthermore, negative emotions (depression and anxiety), as well as resilient coping, were found to mediate the effect of BA on changes in FCR. The BA intervention can alleviate FCR symptoms and improve the quality of life in NSCLC patients by reducing negative emotions (depression and anxiety) and enhancing resilient coping.

The impact of behavioral activation on depressive symptoms in colorectal cancer patients within a medical environment: the mediating role of physical activity

Colorectal cancer (CRC) treatment often affects patients' quality of life, leading to depressive symptoms. Behavioral activation (BA) therapy, which increases engagement by enhancing positive reinforcement and reducing avoidance, has shown potential in managing these symptoms. Physical activity (PA) is also known to alleviate depression, though its role as a mediator in BA's effectiveness remains unclear. This clinical trial was retrospectively registered in ClinicalTrials.gov on April 5, 2024 (Effects of Behavioral Activation on Negative Emotions, Cancer-related Symptoms and Clinical Indicators in Cancer Patients, NCT06348940). This study explores PA's mediating effect within BA interventions. A total of 109 CRC patients with depressive symptoms were randomly assigned to a BA group (n=52) or a Usual Care (UC) group (n=57). Assessments occurred at baseline (T0), after the fourth session (T1), and post-intervention (T2). The BA group showed significant improvement compared to the UC group. Repeated measures ANOVA confirmed BA's effectiveness in reducing depressive symptoms, improving quality of life, alleviating psychological distress, increasing activation, and raising PA levels. PA changes accounted for 36.91% of the intervention's total effect on depression reduction. BA effectively reduces depression and enhances life quality in CRC patients. Changes in PA intensity are significantly associated with depression reduction, suggesting PA's mediating role in BA's impact. Incorporating PA into BA may enhance therapeutic outcomes for CRC patients with depression.

Behavioral activation program for reducing depressive symptoms among the bereaved of cancer patients: A feasibility and preliminary effectiveness study in Japan

OBJECTIVES

This study aimed to examine the feasibility and preliminary effectiveness of a behavioral activation (BA) program for the bereaved of cancer patients toward reducing depressive symptoms.

METHODS

The BA program for the bereaved was a partially modified version for cancer patients. This program encompassed a preinterview and seven 50-minute sessions every 1-2 weeks, using worksheets, with homework assignments each day. To examine feasibility, the completion rates of intervention and 3 months of follow-up were examined. To examine the preliminary effectiveness, psychological symptoms were assessed with the Patient Health Questionnaire (PHQ-9; primary outcome) and Beck Depression Inventory-II (BDI-II) for depression and the Generalized Anxiety Disorder-7 (GAD-7) for anxiety. These were evaluated 3 times: before, immediately after, and 3-month post-intervention. Non-parametric tests were used for comparison of scores at 3 time points and calculation of effect size.

RESULTS

Of the 42 bereaved who were contacted, 21 were eligible and 20 were participated, while 19 and 18 were in the completed intervention and completed 3-month post-intervention categories (intervention completion rate was 95% and follow-up completion rate was 90%). PHQ-9, BDI-II, and GAD-7 showed significant reductions immediately and 3 months after the intervention compared to pre-intervention, and the effect sizes were all large after 3 months, although they were less than immediately after (PHQ-9: 0.89, 0.71; BDI-II: 0.88, 0.67; GAD-7: 0.57, 0.53).

SIGNIFICANCE OF RESULTS

This study indicated that the BA program for the bereaved of cancer patients was feasible and effective vis-à-vis reducing depressive symptoms.

Impacts and Pathways of Behavioral Activation on Psychological Distress Among Patients Diagnosed With Esophageal and Gastric Cancer in China: A Randomized Controlled Trial

OBJECTIVE

The objective of this study is to investigate the efficacy of behavioral activation (BA), a novel psychological intervention, in ameliorating psychological distress and anxiety symptoms among patients diagnosed with esophageal and gastric cancer, as well as the mediating role of self-efficacy between BA and psychological distress.

METHODS

A total of 139 patients diagnosed with esophageal and gastric cancer were recruited in China from March 2023 to October 2023 and randomly assigned to either the BA plus care as usual group (BA+CAU group) or the care as usual group (CAU group). Pre- and post-intervention questionnaires, including the Psychological Distress Thermometer (DT), Generalized anxiety disorder 7-item (GAD-7) Scale, General Self-Efficacy Scale (GSES) and the activation subscale of Behavioral Activation for Depression Scale (BADS-A), were administered.

RESULTS

Generalized estimating equation analyses revealed that, compared to usual care alone, combining BA with usual care significantly ameliorated psychological distress, anxiety as well as improved self-efficacy and activation. The mediation analysis revealed that self-efficacy served as a mediator in the relationship between activation and psychological distress.

CONCLUSIONS

BA primarily based on telephone or WeChat can not only directly ameliorates psychological distress and anxiety symptoms in patients with esophageal cancer and gastric cancer but also indirectly alleviates psychological distress by enhancing self-efficacy. The study also demonstrates the potential of BA in cancer patients, a skill that can be effectively acquired by primary care workers without specialized training and implemented more flexible.

TRIAL REGISTRATION

NCT06348940.

The effectiveness of cognitive behavioral therapy in women with gynecological cancer: A systematic review and meta-analysis of randomized controlled trials

Objective

This study aimed to perform a meta-analysis of randomized control trials to evaluate the effects of cognitive behavioral therapy on depression, anxiety, fatigue, distress, the fear of cancer recurrence, and the quality of life in gynecological cancer patients.

Methods

An extensive literature search of PubMed, Web of Science, Scopus, and CINAHL was performed, and a meta-analysis was conducted on ten studies that included 1027 patients. The quality of the data was evaluated using the Cochrane Risk of Bias tool. The effect size of the mean difference and standardized mean difference were computed using Revman 5.4.1.

Results

Gynecological cancer patients receiving cognitive behavioral therapy showed decreases in depression (P < 0.001), anxiety (P = 0.01), fatigue (P < 0.001), distress (P = 0.03), and the fear of cancer recurrence (P = 0.01) compared to those receiving no treatment, whereas no improvement in quality of life was seen in the cognitive behavioral therapy group (P = 0.05).

Conclusions

Cognitive behavioral therapy was shown to be a useful treatment for the symptoms experienced by women with gynecological cancer, with significant effect sizes. However, more research is required to validate the efficacy of cognitive behavioral therapy in patients with gynecological cancer, considering the limitations of this study's small sample size and statistical heterogeneity.

Systematic review registration

PROSPERO- CRD42024516039.

Feasibility and Preliminary Effectiveness of Behavioral Activation for Patients with Cancer and Depression in Japan

Background

Though the effectiveness of behavioral activation (BA) for patients with cancer and depression were reported, there is no evidence in Japan.

Objectives

This study aimed at examining the feasibility and preliminary effectiveness of BA for patients with cancer and depression in Japan.

Methods

This pre-post study without a control group was conducted in patients with cancer and depression in Japan. The program completion rate was compared with those of previous studies to examine feasibility. To examine the preliminary effectiveness, outcomes were evaluated four times: before and immediately after the program, and two weeks and three months after the program ended. The primary outcome was the remission rate of depression using the 17-item version of the GRID Hamilton Rating Scale for Depression (HAMD₁₇). Secondary outcomes were self-reported depression, anxiety, quality of life, changes in behavior, values, and perceived reward of activity and environmental factors. Pre- and post-program data were compared using paired-samples t-tests, and data obtained at four time points were analyzed using one-way repeated-measures analysis of variance.

Results

Of the 68 patients recruited from February 2018 to January 2022, 32 were registered. The completion rate was 75% (24/32), which was similar to previous studies. The total HAMD₁₇ score significantly improved after the program. The remission rate of depression was 62.5% (20/32), which was above the defined threshold value (30%). All but two secondary outcomes significantly improved after the program (p < 0.05).

Conclusions

The feasibility and preliminary effectiveness of BA for patients with cancer and depression in Japan were suggested.

The Clinical Trial Registration number: UMIN 000036104.

Behavioral activation for depression in patients with advanced cancer: study protocol for a multicenter randomized controlled trial

BACKGROUND

Though behavioral activation (BA) has been shown to be effective for depression, evidence in patients with advanced cancer has not been established. This study aimed to examine the effectiveness of a BA program on depression in this population.

METHODS

A randomized controlled trial with a wait-list control group (waiting group) of 38 patients with advanced cancer and depression will be conducted at three sites in Japan. The BA program consists of seven sessions. Outcome measures will be evaluated at three times in the intervention group; at the entry, at the end of the intervention and 4 months after the end of the intervention and four times in the waiting group: at the entry, before the intervention, at the end of the intervention, and 4 months after the end of the intervention. Primary outcome is Beck Depression Inventory-II (BDI-II) score. To examine the main effect of the intervention, two-way repeated measures analysis of variance (ANOVA) will be conducted, with timing and intervention status as the independent variables and BDI-II score as the dependent variable. One-way repeated measures ANOVA will be conducted to combine data from the intervention and control groups and examine changes in BDI-II scores by timing in both groups. Secondary endpoints (anxiety, quality of life, spirituality, degree of behavioral activation, value, and pain) will be evaluated with rating scales. Two-way repeated measures ANOVA will be conducted to examine whether there are differences between the groups before and after the intervention, with timing and intervention status as the independent variables and scores on each rating scale as the dependent variables.

DISCUSSION

This multicenter randomized controlled trial is the first study to assess the effectiveness of BA on depression in patients with advanced cancer. Our findings will provide evidence about the effectiveness of BA on depression and provide an intervention option that is acceptable and feasible for the treatment of depression in this population. The results of this study will lead to improved mood and rebuilding to regain life purpose and value in this vulnerable population.

TRIAL REGISTRATION NUMBER

jRCT, jRCT1030210687, Registered 22 March 2022, https://jrct.niph.go.jp/en-latest-detail/jRCT1030210687 .

Community-Based Intervention Targeting Depressive Symptomatology in Indian Women: An Exploration of Its Efficacy in a Non-Specialized Healthcare Setting

Depressive symptomatology casts a more adverse impact on the well-being of women in countries with unfavourable societal norms. The prevalence of depressive symptomatology in Indian women and the treatment gap in case of mental health issues are alarming and thus may require interventions at a community level. The present study tested the efficacy of a psychosocial community-based intervention in managing depressive symptomatology and associated factors like rumination, reappraisal, psychological resilience, and self-efficacy using a pre-test post-test control group design. A total of 114 (M_age=23.03, SD = 5.29) and 37 (M_age=24.89, SD = 6.44) adult females were there in the experimental and the control group, respectively. A series of ANOVAs showed that participants' scores on depressive symptomatology and associated vulnerabilities and defences improved as compared to the baseline and the control group. The findings support the use of psychosocial community-based intervention in a non-specialized healthcare setting to manage depressive symptomatology, associated vulnerability and defences.

Behavioral Activation Therapy for Subthreshold Depression in Stroke Patients: An Exploratory Randomized Controlled Trial

Background

Subthreshold depression (SD) is known to be a major risk factor for the development of post-stroke depression (PSD). Appropriate intervention to prevent the transition from SD to PSD is thus imperative. As a form of short-term psychotherapy adapted for individuals with cognitive and communication impairments, behavioral activation therapy (BAT) may be a suitable choice. However, the effects of BAT on psychological outcomes in stroke patients with SD has not been established. This study investigated the feasibility and effectiveness of BAT in reducing the development of depressive symptoms in this patient population.

Methods

A double-blind, randomized controlled trial was performed. Seventy participants were randomized to either a BAT group (n=35) or a control group (n=35). Participants in the BAT group received a six-week BAT intervention. The feasibility of BAT was assessed by the number of sessions attended by participants, and the acceptability of BAT to participants and the incidence of adverse events were recorded. The primary clinical outcome measure was the Center for Epidemiological Studies Depression Scale (CES-D) and the 17-item Hamilton Depression Scale (HAMD-17) at baseline, six weeks, and three months after the group allocation. Secondary outcomes included behavioral activation and the incidence of depression.

Results

The intervention was feasible and acceptable, with 94.3% of participants in the BAT group (33 of 35) attending at least five sessions. No adverse events were reported in either group. Compared with the control group, the BAT group showed significant improvements in the CES-D (F=67.689, P<0.05), HAMD-17 (F=4.170, P<0.05), and behavioral activation (F=25.355, P<0.05) scores after intervention, and these differences were maintained at the three-month assessment.

Conclusion

BAT appears to be feasible and efficacious for reducing depressive symptoms and increasing behavioral activation among stroke patients with SD. The findings of this study may contribute to the primary prevention of PSD.

Narrative review of anxiety and depression in patients with esophageal cancer: underappreciated and undertreated

Depression and anxiety are emotional disorders that commonly affect patients with esophageal cancer. As a result of its high morbidity, mortality, and complication rates, this population is at particularly high risk for developing or exacerbating affective disorders; even when compared to patients with other forms of cancer. Many of the medical conditions and social behaviors that predispose patients to this disease are also independently associated with affective disorders, and likely compound their effects. Unfortunately, in the existing literature, there is wide variability in study design and diagnostic criteria. There is no standard method of evaluation, many studies are limited to written surveys, and widespread mental health screening is not included as a part of routine care. As a result, the prevalence of these illnesses remains elusive. Additionally, psychiatric and psychosocial illness can affect compliance with surveillance and treatment, and gaps in knowledge may ultimately influence patient outcomes and survival. This review will discuss the existing literature on depression and anxiety in patients with esophageal cancer. It will highlight current methods of psychological evaluation, the prevalence of affective disorders in this population, and their effects on treatment, compliance, and outcomes. It will also discuss possible screening tools, treatments and interventions for these comorbid illnesses that may improve oncologic outcomes as well as quality of life.

Psychometric Properties of the Environmental Reward Observation Scale: Study on Its Internal Structure, Factor Invariance, and Method Effect Associated With Its Negative Items

The aim of this study was to assess the factorial structure of the scale, the method's effect associated with its negative items, its temporal invariance, and factorial invariance according to sex. For this purpose, three samples were collected, an initial sample of 200 participants, a second sample of 461 participants and a third sample of 107 participants; making a total of 768 Peruvian university students. Other instruments were applied together with the EROS scale in order to measure satisfaction with life, anxiety, stress and depression. Regarding the results, in the initial sample it was found that the original scale containing positive and negative items does adequately fit the data (RMSEA = .19; CFI = .77; TLI = .71) and also evidence was found supporting the existence of a methodological effect associated with the negative items. It was also found that version B of the scale which only has positive items data fits the data (RMSEA = .13; CFI = .96; TLI = .95). In the second sample it was found that version B still had a good fit to the data in a larger sample (RMSEA = .07; CFI = .98; TLI = .98). In addition, it was found that the scale can be considered invariant according to sex and presents validity based on other constructs. In the third sample it was found that the test-retest reliability of the scale was adequate (.70 [CI95% .593-.788]) and also evidence was found in favor of the temporal invariance of the scale. It is concluded that the scale formed only by positive items presents more robust psychometric properties and constitutes a better alternative to measure the level of reward provided by the environment.