Behavioral activation interventions for well-being: A meta-analysis

Trevor G Mazzucchelli, Robert T Kane, Clare S Rees, Trevor G Mazzucchelli, Robert T Kane, Clare S Rees

Abstract

One of the most promising ways to increase well-being is to engage in valued and enjoyable activities. Behavioral activation (BA), an intervention approach most commonly associated with the treatment of depression, is consistent with this recommendation and can easily be adapted for non-clinical populations. This study reports on a meta-analysis of randomized controlled studies to examine the effect of BA on well-being. Twenty studies with a total of 1353 participants were included. The pooled effect size (Hedges's g) indicated that the difference in well-being between BA and control conditions at posttest was 0.52. This significant effect, which is comparable to the pooled effect achieved by positive psychology interventions, was found for non-clinical participants and participants with elevated symptoms of depression. Behavioral activation would seem to provide a ready and attractive intervention for promoting the well-being of a range of populations in both clinical and non-clinical settings.

Figures

Figure 1.
Figure 1.
Hedges's g effect sizes of behavioral activation interventions compared to control conditions at post-test.

References

    1. Addis M.E., Martell C.R. Oakland, CA: New Harbinger; 2004. Overcoming depression one step at a time: The new behavioral activation approach to getting your life back.
    1. Barlow J. A group treatment for depression in the elderly. Dissertation Abstracts International. 1986;46(12B):4389B. (UMI No. 8602302)
    1. Beck A.T. New York: International Universities Press; 1976. Cognitive therapy and the emotional disorders.
    1. Beck A.T., Rush J., Shaw B., Emery G. New York: Guilford; 1979. Cognitive therapy of depression.
    1. Besyner J.K. The comparative efficacy of cognitive and behavioral treatments of depression: A multi-assessment approach. Dissertation Abstracts International. 1979;39(09):4568B. (UMI No. 7904956)
    1. Borenstein M., Hedges L., Higgins J., Rothstein H. Englewood, NJ: Biostat Inc; 2007. Comprehensive meta-analysis: A computer program for meta-analysis [Computer software]
    1. Borenstein M., Hedges L.V., Higgins J.P.T., Rothstein H.R. Chichester, UK: Wiley; 2009. Introduction to meta-analysis.
    1. Bryant F.B., Veroff J. Mahwah, NJ: Lawrence Erlbaum Associates; 2007. Savoring: A new model of positive experience.
    1. Cantor N. From thought to behavior: ‘Having’ and ‘doing’ in the study of personality and cognition. American Psychologist. 1990;45:735–750.
    1. Chambless D.L., Hollon S.D. Defining empirically supported therapies. Journal of Consulting and Clinical Psychology. 1998;66:7–18.
    1. Cochran W. The combination of estimates from different experiments. Biometrics. 1954;10:101–129.
    1. Cuijpers P., van Straten A., Warmerdam L. Behavioral activation treatments of depression: A meta-analysis. Clinical Psychology Review. 2007;27:318–326.
    1. Deci E.L., Ryan R.M. The ‘what’ and ‘why’ of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry. 2000;4:227–268.
    1. Diener E. Subjective well-being. Psychological Bulletin. 1984;95:542–575.
    1. Diener E., Sandvik E., Pavot W. Strack F., Argyle M., Schwarz N. Oxford: Pergamon; 1991. Happiness is the frequency not the intensity of positive versus negative affect. Subjective well-being: An interdisciplinary perspective; pp. 119–140.
    1. Diener E., Suh E.M., Lucas R.E., Smith H.L. Subjective well-being: Three decades of progress. Psychological Bulletin. 1999;125:276–302.
    1. Dobson K.S., Joffe R. The role of activity level and cognition in depressed mood in a university sample. Journal of Clinical Psychology. 1986;42:264–271.
    1. Duval S., Tweedie R. Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56:455–463.
    1. Egger M., Davey-Smith G., Schneider M., Minder C. Bias in meta-analysis detected by a simple, graphical test. British Medical Journal. 1997;315:629–634.
    1. Ekers D., Richards D., Gilbody S. A meta-analysis of randomized trials of behavioural treatment of depression. Psychological Medicine. 2008;38:611–623.
    1. Ellis A. New York: Lyle Stuart; 1962. Reason and emotion in psychotherapy.
    1. Emmons R.A. Gollwitzer P.A., Bargh J.A. New York: Guildford Press; 1996. Striving and feeling: Personal goals and subjective well-being. The psychology of action: Linking cognition and motivation to behavior; pp. 313–337.
    1. Ferster C.B. A functional analysis of depression. American Psychologist. 1973;28:857–870.
    1. Fordyce M.W. Development of a program to increase personal happiness. Journal of Counseling Psychology. 1977;24:511–521.
    1. Fordyce M.W. A program to increase happiness: Further studies. Journal of Counseling Psychology. 1983;30:483–498.
    1. Fuchs C.Z., Rehm L.P. A self-control behavior therapy program for depression. Journal of Consulting and Clinical Psychology. 1977;45:206–215.
    1. Graf M.A. A mood-related activities schedule for the treatment of depression. Dissertation Abstracts International. 1977;38(03):1400B. (UMI No. 7717868)
    1. Green C.W., Reid D.H. Defining, validating, and increasing indices of happiness among people with profound multiple disabilities. Journal of Applied Behavior Analysis. 1996;29:67–78.
    1. Hammen C.L., Glass D.R. Depression, activity, and evaluation of reinforcement. Journal of Abnormal Psychology. 1975;84:718–721.
    1. Hedges L.V. Distribution theory for Glass's estimator of effect size and related estimators. Journal of Educational Statistics. 1981;6:107–128.
    1. Higgins J.P., Thompson S.G., Deeks J.J., Altman D.G. Measuring inconsistency in meta-analysis. British Medical Journal. 2003;327:557–560.
    1. Hopko D.R., Lejuez C.W. Oakland, CA: New Harbinger; 2007. A cancer patient's guide to overcoming depression & anxiety: Getting through treatment & getting back to your life.
    1. Hopko D.R., Lejuez C.W., Ruggiero K.J., Eifert G.H. Contemporary behavioral activation treatments for depression: Procedures, principles and progress. Clinical Psychology Review. 2003;23:699–717.
    1. Jacobson N.S. Contextualism is dead: Long live contextualism. Family Process. 1994;33:97–100.
    1. Jacobson N.S., Martell C.R., Dimidjian S. Behavioral activation treatment for depression: Returning to contextual roots. Clinical Psychologist. 2001;8:255–270.
    1. Klinger E. Consequences of commitment to and disengagement from incentives. Psychological Review. 1975;82:223–231.
    1. Lancioni G.E., Singh N.N., O'Reilly M.F., Sigafoos J., Didden R., Oliva D., et al. Effects of microswitch-based programs on indices of happiness of students with multiple disabilities: A new research evaluation. American Journal on Mental Retardation. 2007;112:167–176.
    1. Lejuez C.W., Hopko D.R., LePage J.P., Hopko S.D., McNeil D.W. A brief behavioral activation treatment for depression. Cognitive and Behavioral Practice. 2001;8:164–175.
    1. Lewinsohn P.M. Friedman R.J., Katz M.M. Washington, DC: Winston-Wiley; 1974. A behavioral approach to depression. The psychology of depression: Contemporary theory and research; pp. 157–185.
    1. Lewinsohn P.M. Thorensen C.E., Krumboltz J. New York: Holt, Rinehart & Winston; 1976. Activity schedules in the treatment of depression. Counseling methods; pp. 74–83.
    1. Lewinsohn P.M., Graf M. Pleasant activities and depression. Journal of Consulting and Clinical Psychology. 1973;41:261–268.
    1. Lewinsohn P.M., Libet J. Pleasant events, activity schedules, and depression. Journal of Abnormal Psychology. 1972;79:291–295.
    1. Lewinsohn P.M., Sullivan J.M., Grosscap S.J. Changing reinforcing events: An approach to the treatment of depression. Psychotherapy: Theory, research and practice. 1980;17:322–334.
    1. Light R.J., Pillemer D.B. Cambridge, MA: Harvard University Press; 1984. Summing up: The science of reviewing research.
    1. Lipsey M.W., Wilson D.B. Thousand Oaks, CA: Sage Publications; 2001. Practical meta-analysis.
    1. Little B. Personal projects: A rationale and method for investigation. Environment and Behavior. 1983;15:273–309.
    1. Lovett S., Gallagher D. Psychoeducational interventions for family caregivers: Preliminary efficacy data. Behavior Therapy. 1988;19:321–330.
    1. Lyubomirsky S. New York: Penguin; 2008. The how of happiness: A scientific approach to getting the life you want.
    1. Lyubomirsky S., King L., Diener E. The benefits of frequent positive affect: Does it lead to success? Psychological Bulletin. 2005a;131:803–855.
    1. Lyubomirsky S., Sheldon K.M., Schkade D. Pursuing happiness: The architecture of sustainable change. Review of General Psychology. 2005b;9:111–131.
    1. MacPhillamy D.J., Lewinsohn P.M. Depression as a function of levels of desired and obtained pleasure. Journal of Abnormal Psychology. 1974;83:651–657.
    1. MacPhillamy D.J., Lewinsohn P.M. The Pleasant Events Schedule: Studies on reliability, validity, and scale inter-correlation. Journal of Consulting and Clinical Psychology. 1982;50:363–380.
    1. Martell C.R., Addis M.E., Jacobson N.S. New York: W.W. Norton; 2001. Depression in context: Strategies for guided action.
    1. Mazzucchelli T.G., Kane R.T., Rees C.S. Behavioral activation treatments for depression in adults: A meta-analysis and review. Clinical Psychology: Science and Practice. 2009;16:383–411.
    1. McLean P.D., Hakstian A.R. Clinical depression: Comparative efficacy of outcome treatments. Journal of Consulting and Clinical Psychology. 1979;47:818–836.
    1. McLean P.D., Hakstian A.R. Relative endurance of unipolar depression treatment effects: Longitudinal follow-up. Journal of Consulting and Clinical Psychology. 1990;58:482–488.
    1. Meyer B., Berger T., Caspar F., Beevers C.G., Andersson G., Weiss M. Effectiveness of a novel integrative online treatment for depression (Deprexis): Randomized controlled trial. Journal of Medical Internet Research. 2009;11:e15. Retrieved May 13, 2009, from .
    1. Padfield M. The comparative effects of two counseling approaches on the intensity of depression among rural women of low socioeconomic status. Journal of Counseling Psychology. 1976;23:209–214.
    1. Pressman S.D., Cohen S. Does positive affect influence health? Psychological Bulletin. 2005;131:925–971.
    1. Rehm L.P., Kaslow N.J., Rabin A.S. Cognitive and behavioral targets in a self-control therapy program for depression. Journal of Consulting and Clinical Psychology. 1987;55:60–67.
    1. Reich J.W., Zautra A. Life events and personal causation: Some relationships with satisfaction and distress. Journal of Personality and Social Psychology. 1981;41:1002–1012.
    1. Rokke P.D. Processes of change in depression: A self-control perspective. Dissertation Abstracts International. 1985;46(12):4413B. (UMI No. 8602306)
    1. Rosenthal R. The ‘file drawer problem’ and tolerance for null results. Psychological Bulletin. 1979;86:638–641.
    1. Rosenthal R., DiMatteo M.R. Meta-analysis: Recent developments in quantitative methods for literature reviews. Annual Review of Psychology. 2001;52:59–82.
    1. Seligman M.E.P. New York: Free Press; 2002. Authentic happiness: Using the new positive psychology to realize your potential for lasting fulfillment.
    1. Seligman M.E.P., Rashid T., Parks A.C. Positive psychotherapy. American Psychologist. 2006;61:774–788.
    1. Seligman M.E.P., Steen T.A., Park N., Peterson C. Positive psychology progress: Empirical validation of interventions. American Psychologist. 2005;60:410–421.
    1. Sin N.L., Lyubomirsky S. Enhancing well-being and alleviating depressive symptoms with positive psychology interventions: A practice-friendly meta-analysis. Journal of Clinical Psychology: In Session. 2009;65:467–487.
    1. Stark K.D., Reynolds W.M., Kaslow N.J. A comparison of the relative efficacy of self-control therapy and a behavioral problem-solving therapy for depression in children. Journal of Abnormal Child Psychology. 1987;15:91–113.
    1. Teri L., Logsdon R.G., Uomoto J., McCurry S.M. Behavioral treatment of depression in dementia patients: A controlled clinical trial. Journal of Gerontology. Series B, Psychological Sciences Social Sciences. 1997;52:159–166.
    1. Turner R.W., Ward M.F., Turner J. Behavioral treatment for depression: An evaluation of therapeutic components. Journal of Clinical Psychology. 1979;35:166–175.
    1. van den Hout J.H.C., Arntz A., Kunkels F.H.J. Efficacy of a self-control therapy program in a psychiatric day-treatment center. Acta Psychiatrica Scandinavica. 1995;92:25–29.
    1. Weinberg L. Behaviorally and cognitively oriented approaches to the alleviation of depressive symptoms in college students. Dissertation Abstracts International. 1978;38(07):3422B. (UMI No. 7728140)
    1. Wilson P.H., Goldin J.C., Charbonneau-Powis M. Comparative efficacy of behavioral and cognitive treatments of depression. Cognitive Therapy and Research. 1983;7:111–124.
    1. Wright T.P. The effectiveness of behavioral activation group therapy: Treating comorbid depression on a specialized inpatient posttraumatic stress disorder unit for combat veterans. Dissertation Abstracts International. 2003;64(01):436B. (UMI No. 3077387)
    1. Yu D.C.T., Spevack S., Hiebert R., Martin T.L., Goodman R., Martin T.G., et al. Happiness indices among persons with profound and severe disabilities during leisure and work activities: A comparison. Education and Training in Mental Retardation and Developmental Disabilities. 2002;37:421–426.

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