Review articleBehavioral activation treatments of depression: A meta-analysis
Introduction
It is already more than three decades ago that research showed that there is a significant relationship between mood and the number of pleasant activities engaged in (Lewinsohn and Graf, 1973, Lewinsohn and Libet, 1972, Gallagher, 1981); that depressed individuals find fewer activities pleasant, engage in pleasant activities less frequently, and obtain therefore less positive reinforcement than other individuals (MacPhillamy & Lewinsohn, 1974).
Based on these premises, Lewinsohn, Biglan and Zeiss (1976) developed a behavioral treatment of depression, in which patients learn techniques to monitor their mood and daily activities, and to see the connection between these. Then the patients learn how to develop a plan to increase number of pleasant activities and to increase positive interactions with their environment. In this approach, specific attention is paid to social skills and interactions with other people.
In the seventies and eighties, several trials were conducted in which the effects of this approach were examined (Barrera, 1979, McNamara and Horan, 1986, Zeiss et al., 1979). Most of these studies found promising results. Other cognitive behavioral treatments developed in that period integrated activity scheduling into their manual as one of the basic elements. The most important examples of these treatments include cognitive therapy as developed by Beck, Rush, Shaw and Emery (1979), and the “Coping with Depression” course, as developed by Lewinsohn, Antonuccio, Steinmetz and Teri (1984). Both treatment modalities have been examined in dozens of studies, and there is no doubt that these treatments are effective. However, it is not clear what the contribution of activity scheduling is to these effects.
Since that period, activity scheduling has not received much attention by researchers, except for an important dismantling study (Jacobson et al., 1996), and the use of activity scheduling in specific patient groups in which other psychological treatments are less feasible. In the dismantling study by Jacobson and colleagues in the nineties the core elements of cognitive behavioral treatment were compared to each other and to the full package (Jacobson et al., 1996). Although this study indicated that activity scheduling is an effective treatment for depression on its own, this has not prompted researchers to further examine the effects of this approach.
Other more recent approaches have used activity scheduling in difficult target populations, in which more complex approaches are not feasible. For example, it has been used with success in dementia patients, after the training of their caregivers in the principles of activity scheduling (Teri, Logsdon, Uomoto & McCurry, 1997). Because activity scheduling is a relatively uncomplicated and time-efficient method for treating depression, it has also been used recently with success in a pilot project with psychiatric inpatients (Hopko, Lejuez, Lepage, Hopko & McNeil, 2003).
Although activity scheduling seems to be an interesting treatment approach for depression, and recent studies show that it is a useful method for specific target populations, no formal meta-analysis of activity scheduling has been conducted until now (NICE, 2004). We decided, therefore, to conduct a meta-analysis to examine the effects of activity scheduling on depression, on the relative effects of activity scheduling compared to other treatments, and on the longer term effects.
Section snippets
Identification and selection of studies
Studies were traced by means of several methods. First, we used a large database of 777 papers on the psychological treatment of depression in general. This database was developed through a comprehensive literature search (from 1966 to March 2005) in which we examined 5178 abstracts in Pubmed (1224 abstracts), Psycinfo (1336), Embase (1118) and the Cochrane Central Register of Controlled Trials (1500). We identified these abstracts by combining terms indicative of psychological treatment
Description of studies
Sixteen studies, with a total of 780 subjects (241 in the Activity scheduling conditions, 367 in other intervention conditions, and 172 in the control conditions) met the inclusion criteria and were included in the current study. Selected characteristics of the included studies are described in Table 1.
In 10 studies, subjects were recruited from the community, while in four studies subjects were recruited from clinical settings (in the two other studies, a mixed recruitment method was used or
Discussion
We found clear indications that activity scheduling is effective in the treatment of depression in adults. The overall effect size of 0.87 is large (Lipsey & Wilson, 1993), and comparable to effect sizes found for other psychological treatments and treatment with antidepressants (Churchill et al., 2001, Gloaguen et al., 1998). The low heterogeneity in our meta-analyses indicated that the studies, target populations and interventions are probably highly comparable to each other.
Several of the
References (35)
- et al.
A meta-analysis of the effects of cognitive therapy in depressed patients
Journal of Affective Disorders
(1998) - et al.
Efficacy of psychotherapy in the treatment of late-life depression
Advances in Behavior Research Therapy
(1984) Combined pharmacological and behavioural treatment of depression
Behavior Research and Therapy
(1982)An evaluation of a brief group therapy for depression
Journal of Consulting and Clinical Psychology
(1979)- et al.
Cognitive therapy of depression
(1979) - et al.
A systematic review of controlled trials of the effectiveness and cost-effectiveness of brief psychological treatments for depression
Health Technology Assessment
(2001) The combination of estimates from different experiments
Biometrics
(1954)Effects of cognitive and behavioral group treatment on the depressive symptomatology of Puerto Rican women
Journal of Consulting and Clinical Psychology
(1981)- et al.
Psychologische behandeling van depressie: Een systematisch overzicht van meta-analyses
Nederlands Tijdschrift voor Geneeskunde
(2005)
Behavioral group therapy with elderly depressives: An experimental study
Treatment of major depressive disorder in older adult outpatients with brief psychotherapies
Psychotherapy
Statistical methods for meta-analysis
Cochrane handbook for systematic reviews of interventions 4.2.5 [updated May 2005]
Measuring inconsistency in meta-analyses
British Medical Journal
A brief behavioral activation treatment for depression; a randomized pilot trial within an inpatient psychiatric hospital
Behavior Modification
A component analysis of cognitive-behavioral treatment for depression
Journal of Consulting and Clinical Psychology
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