Feasibility and preliminary effectiveness of behavioral activation for cancer patients with depression

BackgroundBehavioral activation (BA) is a psychotherapy that directly approaches patients most valued daily activities. BA may be particularly useful for treating depression in patients with cancer, but there is insufficient evidence in this population. This study aimed to verify the feasibility and preliminary effectiveness of BA for patients with depression with all types and stages of cancer. MethodsThis pre-post study without a control group was conducted in patients with cancer and depression. The program completion rate was compared with those of previous studies to verify feasibility. To examine the preliminary effectiveness of BA, outcomes were evaluated four times: before and immediately after the program, and 2 weeks and 3 months after the program ended. The primary outcome was the remission rate of depression determined using a binomial test and 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. Hedges g was computed for calculating effect sizes. ResultsParticipants were recruited from February 2018 to January 2022. Of the 68 patients who were initially recruited, 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 with large effect sizes (Hedges g =1.95). 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). ConclusionsThis study suggested the feasibility and preliminary effectiveness of BA for patients with depression. To establish further evidence for the use of BA in patients with cancer, randomized controlled trials are needed. Trial RegistrationUniversity Hospital Medical Information Network (UMIN CTR) UMIN000036104. Registered 6 March 2019 - Retrospectively registered, https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000041129