Behavioral Activation Therapy Helps Treat Chronic Depression

According to recent research, adding behavioral activation therapy to medication improves social function in individuals suffering from major depressive disorder.

Even in instances where medication successfully treats a person’s depression symptoms, social factors of life can still suffer, such as work and relationships.

David J. Hellerstein, who led the study, decided to tackle this problem by introducing behavioral activation therapy on top of medication for depressed patients. The small pilot study took place over the course of twelve weeks, at the end of which the facilitators noticed a significant improvement in the motivation and mobility of the participants.

Before this study, behavioral activation therapy was not considered for improving social function in depressive patients. "I’m enthusiastic about it as a treatment approach," Hellerstein said. "It could be the active component of cognitive behavioral therapy."

Hellerstein—who is a member of the department of clinical psychiatry at Columbia University, New York—and his colleagues from Columbia University and the New York State Psychiatric Institute focused on seventeen patients suffering from dysthymic disorder or major depression. The patients were already on antidepressants, but the researchers added behavioral activation therapy adapted to specifically improve social function.

Behavioral activation treats depression by encouraging a patient’s contact with sources of reward. This is usually done by increasing activation, improving problem solving, and decreasing avoidance and other barriers to activation.

According to the researchers, by the end of the twelve week study, all physician and patient-rated depression scales improved using this method. "Even in this small sample size, we showed improvement in the Hamilton Depression Rating Scale and the Beck Depression Inventory, and the Cornell Dysthymia Rating Scale," Hellerstein reported in an interview.

The participants also underwent considerable improvements on the Behavioral Activation for Depression Scale (t[9] = 2.517), which implies augmented behavioral activation toward the completion of the study.

Hellerstein reported one remarkable case he encountered during this study. One participant who reported to being depressed for seventeen years was experiencing muscle pain, suffering from multiple function problems, and remaining apartment-bound.

After this study, however, Hellerstein stated that they "got her depression into remission. After this totally isolated patient started behavioral activation therapy, she [got a job] marketing for an online business and started a Facebook group with 1,500-2,000 members." She met a guy through Facebook, started dating again, and said ‘I am feeling back to the way I was seventeen years ago.’”

"Medicine is the first step, [but they] must start to function again," continued Hellerstein. "About one-third to one-half of people with chronic depression respond to medication, but don’t get better psychosocially.

Prior functional MRI studies have shown behavioral activation therapy boosts the reward system in the brain. "This is consistent with what we are trying to do," Hellerstein stated. He reported that the next step in his research is to focus on a larger study group using fMRI to measure the results.

Hellerstein reported these findings at the annual meeting of the New Clinical Drug Evaluation Unitsponsored by the National Institute of Mental Health.