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Table 3 Intervention descriptions and main outcomes

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
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.
  1. ACS Acute Coronary Syndrome, BA-RR Behavioural Activation Therapy and Risk Reduction Counselling Intervention, BAT-CS Behavioural Activation Treatment for Cardiac Smokers, BATS Behavioural Activation Treatment for Smoking, BTDD Behavioural Therapy for Depression in Drug Dependence, BZ Benzodiazepine, CDAT Community Drugs and Alcohol Treatment, CM Contingence Management, GSH Guided Self-help, HAMD Hamilton Depression Scale, LETS ACT Life Enhancement Treatment for Substance Use, PDA Percentage of Days Abstinent, REL Relaxation, SC Standard Care, ST Standard Treatment