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Looking beyond depression: a meta-analysis of the effect of behavioral activation on depression, anxiety, and activation

Published online by Cambridge University Press:  06 March 2020

Aliza T. Stein Open the ORCID record for Aliza T. Stein [Opens in a new window] ,
Emily Carl ,
Pim Cuijpers ,
Eirini Karyotaki  and
Jasper A. J. Smits
Aliza T. Stein*
Affiliation:
University of Texas at Austin, Austin, TX, USA
Emily Carl
Affiliation:
University of Texas at Austin, Austin, TX, USA
Pim Cuijpers
Affiliation:
Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
Eirini Karyotaki
Affiliation:
Vrije Universiteit Amsterdam, Amsterdam, The Netherlands Harvard Medical School, Boston, MA, USA
Jasper A. J. Smits
Affiliation:
University of Texas at Austin, Austin, TX, USA
*
Author for correspondence: Aliza T. Stein, E-mail: [email protected]
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Abstract

Background

Depression is a prevalent and impairing condition. Behavioral activation (BA) is a parsimonious, cost-effective, and easily disseminated psychological intervention for depression. The current meta-analysis expands on the existing literature supporting the efficacy of BA for depression by examining the effects of BA on additional relevant outcomes for patients with depression, namely the reduction in anxiety symptoms and increase in activation.

Methods

Randomized controlled trials of BA for depression compared to active and inactive control were identified via a systematic review. Effect sizes using Hedges's g were calculated for each outcome compared to both active and inactive control using random effects models. Subgroup analyses were used to examine the inclusion of a discussion of values as a moderator of depression symptom outcome in BA.

Results

Twenty-eight studies were included. Meta-analyses of symptom change between groups from baseline-to-post intervention indicated that BA outperformed inactive control conditions for improvements in depression (g = 0.83), anxiety (g = 0.37), and activation (g = 0.64). The difference between BA and active control conditions was not significant for improvements in depression (g = 0.15), anxiety (g = 0.03), and activation (g = 0.04). There was no evidence for a discussion of values augmenting BA efficacy. Study quality was generally low, and there was evidence of publication bias.

Conclusions

In addition to improving depression, BA shows efficacy for reducing symptoms of anxiety and increasing activation. BA may not offer better outcomes relative to other active interventions. There is room for improvement in the quality of research in this area.

Keywords

Behavioral activationDepressionMeta-analysis
Type
Original Articles
Information
Psychological Medicine , Volume 51 , Issue 9 , July 2021 , pp. 1491 - 1504
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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