Hopko, D.R., Armento, M.E., Robertson, S.M., Ryba, M.M., Carvalho, J.P., Colman, L.K., . . . Lejuez, C.W. (2011). Brief behavioral activation and problem-solving therapy for depressed breast cancer patients: Randomized trial. Journal of Consulting and Clinical Psychology, 79, 834–849.

To test the efficacy of behavioral activation for depression therapy (BADT) compared to problem-solving therapy (PST) in depressed breast cancer patients

Patients were randomly assigned to either BADT or PST. Each therapy was delivered in individual sessions over eight weeks. In the BADT group, patients engaged in self-monitoring exercises and identified the level of reward or pleasure for behaviors and activities. Then researchers emphasized identifying values and goals within multiple life areas and targeting behaviors for attention. The patient and therapist collaboratively set goals and activities each week, and patients progressed through activities, from easiest to hardest, aimed at reducing aversive experiences. Sessions included muscle relaxation, assertiveness training, and graduated exposure to anxiety-producing stimuli. PST involved therapy to increase patients' understanding of the connection between current depression and anxiety symptoms with everyday problems, to help patients define current problems, and to teach patients a specific problem-solving method. Therapists were experienced in providing the intervention they delivered. Sessions were recorded, and a 15% sample was independently evaluated to assess fidelity of the intervention. The principal investigator supervised all therapists weekly and individually.

• The sample was composed of 65 patients with breast cancer (100% female).
• Mean patient age was 55.4 years (SD = ±11.9 years).
• Average time since diagnosis was 3.1 years.
• Most patients had stage 0–II disease; 95% had had surgery, 74% had had chemotherapy, and 64% had had radiation therapy; 52% were currently taking antidepressants.
• Approximately 42% were working either full- or part-time.
• All patients had to meet screening criteria that demonstrate a diagnosis of major depression of at least moderate severity.

• Outpatient settings, specific sites unstated or unknown 
• Tennessee and Maryland

Late effects and survivorship

Randomized controlled trial design

• Beck Depression Inventory (BDI)
• Environmental Reward Observation Scale (EROS)
• Beck Anxiety Inventory (BAI)
• Quality of Life Inventory (QOLI)
• 36-item Short-Form Health Survey (SF-36)
• Multidimensional Scale of Perceived Social Support (MSPSS)
• Hamilton Rating Scale for Depression (HRSD)

BDI and HRSD sales demonstrated significant improvement in depression (p = 0.04). Mental health and general health scales on the SF-36 also improved (p = 0.02). Results revealed no significant difference between groups, and both interventions demonstrated a strong effect size.

Findings demonstrate that both the BADT and PST interventions were effective in reducing depression in the groups of patients studied.

• The study had a small sample size, with fewer than 100 participants.
• The study had risk of bias due to no blinding.
• Of all participants, 19% dropped out. Authors had determined sample size to accommodate this, given previous research.
• Findings relate to patients with major depression and may not relate to patients with symptoms of depression that is less severe than major depression.

Findings show that both of the interventions were effective in reducing the level of depression among patients with breast cancer with major depression. The drop-out rate over the eight-week study period suggests that participating in the target intervention may be difficult or impractical for many patients.