Hopko, D.R., Funderburk, J.S., Shorey, R.C., McIndoo, C.C., Ryba, M.M., File, A.A., . . . & Vitulano, M. (2013). Behavioral activation and problem-solving therapy for depressed breast cancer patients: Preliminary support for decreased suicidal ideation. Behavior Modification, 37, 747–767. 

To examine efficacy of eight weeks of behavioral activation and problem-solving therapies toward reducing depression and suicidal ideation

Patients who had breast cancer and met the Harvard National Depression scale criteria for symptoms of major depression were randomized to behavioral activation or problem-solving psychotherapy interventions. Sessions were provided by clinical psychology doctoral students who were skilled in both interventions. All sessions were one on one and audiotaped, and 15% of tapes were randomly selected for review of competence and adherence by an independent therapist.

• N = 80 in ITT analysis, 65 completed treatment  
• MEAN AGE: 55.4 years (SD = 11.9 years)
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Breast cancer; average time since diagnosis was 3.2 years
• OTHER KEY SAMPLE CHARACTERISTICS: 43% had prior psychotherapy and, on average, had moderate level depression and mild to moderate suicidal ideation at baseline; 93% were Caucasian; and research included people taking antidepressants, but the number of those on antidepressants was not reported.

• SITE: Single site  
• SETTING TYPE: Not specified  
• LOCATION: New York, NY

PHASE OF CARE: Transition phase after active treatment

• Randomized trial

• Hamilton Rating Scale for Depression (HRSD) 
• Beck Depression Inventory (BDI)
• Center for Epidemiological Studies Depression scale (CES-D)

For all measures, there was a significant main effect for time (p < 0.05), showing decline in depression; but there were no differences between groups. There was a significant linear reduction in suicidal ideation and an increase in hopefulness at post-treatment and at the 12-month follow-up.

Both types of psychotherapy examined here were associated with reduced depression and suicidal ideation.

• Small sample (less than 100)
• Unintended interventions or applicable interventions not described that would influence results
• Key sample group differences that could influence results
• Subject withdrawals of 10% or greater 
• Proportion of the sample on antidepressants is not described, and there is no subgroup analysis of outcomes between those on or not on antidepressants

Psychotherapy can be helpful for patients with cancer who also suffer from depression and may have suicidal ideation. This study adds to the body of evidence on efficacy of psychotherapy for these patients. Psychotherapy should be considered as part of treatment options for individuals who have clinically relevant depression or a major depressive disorder.