TY - JOUR
T1 - Examining the Theoretical Framework of Behavioral Activation for Major Depressive Disorder
T2 - Smartphone-Based Ecological Momentary Assessment Study
AU - van Genugten, Claire Rosalie
AU - Schuurmans, Josien
AU - Hoogendoorn, Adriaan W.
AU - Araya, Ricardo
AU - Andersson, Gerhard
AU - Baños, Rosa
AU - Botella, Cristina
AU - Pashoja, Arlinda Cerga
AU - Cieslak, Roman
AU - Ebert, David Daniel
AU - García-Palacios, Azucena
AU - Hazo, Jean-Baptiste
AU - Herrero, Rocío
AU - Holtzmann, J. rôme
AU - Kemmeren, Lise
AU - Kleiboer, Annet
AU - Krieger, Tobias
AU - Smoktunowicz, Ewelina
AU - Titzler, Ingrid
AU - Topooco, Naira
AU - Urech, Antoine
AU - Smit, Johannes H.
AU - Riper, Heleen
N1 - Funding Information: The European Comparative Effectiveness Research on Internet-based Depression Treatment versus treatment-as-usual (E-COMPARED) project is funded by the European Commission FP7-Health-2013-Innovation-1 program (grant no. 603098-2). Publisher Copyright: © Claire Rosalie van Genugten, Josien Schuurmans, Adriaan W Hoogendoorn, Ricardo Araya, Gerhard Andersson, Rosa Baños, Cristina Botella, Arlinda Cerga Pashoja, Roman Cieslak, David Daniel Ebert, Azucena García-Palacios, Jean-Baptiste Hazo, Rocío Herrero, Jérôme Holtzmann, Lise Kemmeren, Annet Kleiboer, Tobias Krieger, Ewelina Smoktunowicz, Ingrid Titzler, Naira Topooco, Antoine Urech, Johannes H Smit, Heleen Riper.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Background: Behavioral activation (BA), either as a stand-alone treatment or as part of cognitive behavioral therapy, has been shown to be effective for treating depression. The theoretical underpinnings of BA derive from Lewinsohn et al’s theory of depression. The central premise of BA is that having patients engage in more pleasant activities leads to them experiencing more pleasure and elevates their mood, which, in turn, leads to further (behavioral) activation. However, there is a dearth of empirical evidence about the theoretical framework of BA. Objective: This study aims to examine the assumed (temporal) associations of the 3 constructs in the theoretical framework of BA. Methods: Data were collected as part of the “European Comparative Effectiveness Research on Internet-based Depression Treatment versus treatment-as-usual” trial among patients who were randomly assigned to receive blended cognitive behavioral therapy (bCBT). As part of bCBT, patients completed weekly assessments of their level of engagement in pleasant activities, the pleasure they experienced as a result of these activities, and their mood over the course of the treatment using a smartphone-based ecological momentary assessment (EMA) application. Longitudinal cross-lagged and cross-sectional associations of 240 patients were examined using random intercept cross-lagged panel models. Results: The analyses did not reveal any statistically significant cross-lagged coefficients (all P>.05). Statistically significant cross-sectional positive associations between activities, pleasure, and mood levels were identified. Moreover, the levels of engagement in activities, pleasure, and mood slightly increased over the duration of the treatment. In addition, mood seemed to carry over, over time, while both levels of engagement in activities and pleasurable experiences did not. Conclusions: The results were partially in accordance with the theoretical framework of BA, insofar as the analyses revealed cross-sectional relationships between levels of engagement in activities, pleasurable experiences deriving from these activities, and enhanced mood. However, given that no statistically significant temporal relationships were revealed, no conclusions could be drawn about potential causality. A shorter measurement interval (eg, daily rather than weekly EMA reports) might be more attuned to detecting potential underlying temporal pathways. Future research should use an EMA methodology to further investigate temporal associations, based on theory and how treatments are presented to patients.
AB - Background: Behavioral activation (BA), either as a stand-alone treatment or as part of cognitive behavioral therapy, has been shown to be effective for treating depression. The theoretical underpinnings of BA derive from Lewinsohn et al’s theory of depression. The central premise of BA is that having patients engage in more pleasant activities leads to them experiencing more pleasure and elevates their mood, which, in turn, leads to further (behavioral) activation. However, there is a dearth of empirical evidence about the theoretical framework of BA. Objective: This study aims to examine the assumed (temporal) associations of the 3 constructs in the theoretical framework of BA. Methods: Data were collected as part of the “European Comparative Effectiveness Research on Internet-based Depression Treatment versus treatment-as-usual” trial among patients who were randomly assigned to receive blended cognitive behavioral therapy (bCBT). As part of bCBT, patients completed weekly assessments of their level of engagement in pleasant activities, the pleasure they experienced as a result of these activities, and their mood over the course of the treatment using a smartphone-based ecological momentary assessment (EMA) application. Longitudinal cross-lagged and cross-sectional associations of 240 patients were examined using random intercept cross-lagged panel models. Results: The analyses did not reveal any statistically significant cross-lagged coefficients (all P>.05). Statistically significant cross-sectional positive associations between activities, pleasure, and mood levels were identified. Moreover, the levels of engagement in activities, pleasure, and mood slightly increased over the duration of the treatment. In addition, mood seemed to carry over, over time, while both levels of engagement in activities and pleasurable experiences did not. Conclusions: The results were partially in accordance with the theoretical framework of BA, insofar as the analyses revealed cross-sectional relationships between levels of engagement in activities, pleasurable experiences deriving from these activities, and enhanced mood. However, given that no statistically significant temporal relationships were revealed, no conclusions could be drawn about potential causality. A shorter measurement interval (eg, daily rather than weekly EMA reports) might be more attuned to detecting potential underlying temporal pathways. Future research should use an EMA methodology to further investigate temporal associations, based on theory and how treatments are presented to patients.
KW - Behavior
KW - Behavioral activation
KW - Depression
KW - EMA
KW - Ecological momentary assessment
KW - Engagement
KW - Framework
KW - Mental health
KW - Mood
KW - Random-intercept cross-lagged panel model
KW - Smartphone
KW - Theoretical framework
KW - Treatment
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85122021305&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/34874888
UR - http://www.scopus.com/inward/record.url?scp=85122021305&partnerID=8YFLogxK
U2 - https://doi.org/10.2196/32007
DO - https://doi.org/10.2196/32007
M3 - Article
C2 - 34874888
SN - 2368-7959
VL - 8
SP - 1
EP - 14
JO - JMIR Mental Health
JF - JMIR Mental Health
IS - 12
M1 - e32007
ER -