Depression (Studies)

Question 1

APA, 2013

Answer 1

• DSM-V criteria for depression (American psychological association, 2013)
o The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.
 1. Depressed mood most of the day, nearly every day.
 2. Markedly diminished interest or pleasure in all, or almost all, activities
 3. Significant weight loss when not dieting or weight gain or decrease or increase in appetite nearly every day.
 4. A slowing down of thought and a reduction of physical movement (observable by others)
 5. Fatigue or loss of energy nearly every day.
 6. Feelings of worthlessness or excessive or inappropriate guilt
 7. Diminished ability to think or concentrate, or indecisiveness,
 8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

Question 2

Williams, 2001

Answer 2

Negative cycle (less ops for pleasure/rewarding experiences, everyday problems pile up, may enjoy previous tasks less, feel trapped in low mood) effort to break this cycle is overwhelming = hopelessness and avoidance

Question 3

Papworth and Marrinan (2018)

Answer 3

If there are comorbidity of other mental health disorders e.g. anxiety, BA should be used first as clients are more likely to engage due to uplifted mood from being active

Question 4

Jacobson et al (2001)

Answer 4

BA aims to break this cycle of negativity and tackle the avoidance in a structured way to avoid overwhelming the client

Question 5

Papworth and Marrinan et al 2018

Answer 5

4 stages of BA
o	Orientate the client to the treatment
o	Identify different types of activity
o	Devise a hierarchy
o	Plan some R, N, and P activities

Question 6

Williams, 2014

Answer 6

 Case studies helpful to validate difficulties

Question 7

Veale, 2008

Answer 7

 Helpful to include activities that they did before/new activities that relate to their goals.
 Rating their mood while completing the activity can help outline the impact being active can have on mood

Question 8

Beck et al 1979

Answer 8

• Pleasurable (increases likelihood of experiencing positive events/emotions)

Question 9

Jacobson et al, 2001

Answer 9

• Routine (disruptions to routines are thought to contribute to low mood),

Question 10

Richards (2010a)

Answer 10

– can be difficult to differentiate between activities

Question 11

Cuijpers et al (2007a)

Answer 11

Activity scheduling is an attractive treatment for depression, not only because it is relatively uncomplicated, time-efficient and does not require complex skills from patients or therapist, but also because this meta-analysis found clear indications that it is effective

Question 12

Ekers et al (2014)

Answer 12

The results in this meta-analysis support and strengthen the evidence base indicating Behavioural Activation is an effective treatment for depression. Further research with longer term follow-up is needed to strengthen the evidence base.

Question 13

Jacobson et al (1996)

Answer 13

Improvements from BA were maintained for six months

Question 14

Longmore & Worrell (2007)

Answer 14

o A comprehensive review of whether there is a need for CR in treatment of low mood, found that behavioural activation alone was as effective in treating depression as BA combined with cognitive interventions

Question 15

Hopko et al (2003)

Answer 15

even in inpatient psychiatric hospitals results demonstrate effectiveness and superiority of BA as compared with the standard supportive treatment provided within the hospital

Question 16

Richards et al (2016)

Answer 16

more work needs to be done than has been done so far to find ways to effectively treat the 20–23% of patients whose depression was unchanged by BA or CBT, our findings suggest that BA should be a front-line treatment for depression, with substantial potential to improve reach and access to psychological therapy globally

Question 17

Pentecost et al. (2015)

Answer 17

– Combining Behavioural Activation and physical activity. They reported willingness to increase their physical activity. Several feasibility issues were identified, the under-use of BA as a treatment for depression, the difficulty that PWPs had in adapting their existing procedures for study purposes and the instability of the IAPT PWP workforce

Question 18

Jacobson et al (2001)

Answer 18

o client may feel that they must feel less tired before they engage in BA

Question 19

Michie et al (2011)

Answer 19

o Explore carefully and explain activity will increase energy – this increases motivational/psychological capability

Question 20

Statt et al 2010.

Answer 20

can be overcome with metaphors e.g. kickstarting a car with a flat battery

Question 21

Kinsella and Garland, 2008

Answer 21

think ahead and plan alternatives

Question 22

Veale 2008

Answer 22

o Ensure the client understands the rationale and make activities meaningful, manage expectations and explore obstacles with the client following the implementation of the tasks.