Behavioral activation therapy for depression and anxiety in cancer patients: a case series study

Abstract

Background Behavioral activation therapy (BAT) directly addresses activities that individuals value most highly, and may be easily applicable to cancer patients. However, there is no established evidence of the use of BAT in this population. In this study, we examined the possibility of a BAT program for depression and anxiety in cancer patients. Case presentation We retrospectively reviewed the medical records of cancer patients with each of the following characteristics: 1) were outpatients or inpatients visiting the psycho-oncology division of the National Cancer Center Hospital in Japan; 2) met criteria for Major Depressive Disorder or Adjustment Disorders; and 3) participated in a BAT program. The primary outcome was the program completion percentage. Secondary outcomes were self-reported depression severity (Patient Health Questionnaire-9 (PHQ-9) score), anxiety disorder status (Generalized Anxiety Disorder-7 (GAD-7) score), and clinical improvement (Clinical Global Impression-Improvement (CGI-I) score) after the program. We analyzed both depression and anxiety by the matched paired t-test. Ten patients participated in the program, and nine completed it. One dropped out due to cognitive impairment secondary to brain metastasis. Both the PHQ-9 scores (pre: 14.4 (SD, 6.1); post: 5.1 (SD, 5.8)) and the GAD-7 scores (pre: 11.9 (SD, 4.9); post: 4.7 (SD, 5.5)) significantly improved after the program (PHQ-9: P = 0.0014; GAD-7: P = 0.0004). CGI-I scores ranged from 1 to 3, and all subjects except the patient who dropped out improved clinically. Among the ten patients, three distinctive cases could be observed as follows. Case 1; a 45-year-old housewife with breast cancer who did not agree to take antidepressants because of concerns about the side effects achieved remission without antidepressants and began to live an active life. Case 4; a 66-year-old housewife was so shocked after endometrial cancer diagnosis that she was absent-minded and her compliance with the assigned homework was poor, therefore, her depression did not improve much. Case 9; a 62-year-old man with laryngeal cancer who had recurrent anxiety. Increased business activity, on which he put great value, gradually allowed him to be able to live his life actively without concerns. Conclusions This study suggests that BAT would be effective for the depression and anxiety of cancer patients.

Psychometric Properties of the Environmental Reward Observation Scale: Study on Its Internal Structure, Factor Invariance, and Method Effect Associated With Its Negative Items

“…The aim of this study was to adapt and evaluate the psychometric properties of the Spanish version of the EROS scale in Peruvian university students, because it is one of the most used instruments in the framework of behavioral activation (BA) as a treatment for depression (Barth et al., 2013; Richards et al., 2016) and other mental health problems (Fernández & Mairal, 2017; Hirayama et al., 2019).…”

Narrative review of anxiety and depression in patients with esophageal cancer: underappreciated and undertreated

“…Patients are commonly hesitant to confront death, symptom progression, and eventual loss of control. BAT seeks to alleviate depression symptoms by focusing on involvement in activities that patients enjoy, especially since participation is usually avoided (72).…”

“…As described by Hirayama … "(I) individuals suffering from depressive or anxiety conditions experience avoidance and decreased participation in normal activities; (II) this leads to decreased opportunities for them to experience joy; (III) they feel that they are overwhelmed by hardships; (IV) the value they place on their lives and themselves is diminished; (V) they pay more attention to negative information; (VI) they eventually experience more distress and depression; (VII) BAT facilitates activities they value and breaks this vicious cycle; and (VIII) this improves the depressive condition and (IX) leads to improvement in quality of life (72). "…”

Comparison of the Effects of the Choice Theory and Behavioral Activation Therapies with and Without Guided Imagery Rescripting on the Adversity Quotient and Cognitive Emotion Regulation of MS Patients in Ahvaz, Iran

“…This therapy highlights social functioning quality and improvement. Overall, BA is a type of behavioral therapy that offers easily implemented and tangible techniques and is cost-effective owing to the short period of the treatment (17,18).…”