NIMH and Susan Komen Research
Grants
C.W. Lejuez, Sandra D. Hopko, Derek R.
Hopko
Co-Developers of BATD
2003-2004
The "Behavioral Activation Treatment of Cancer Patients with Depression" was a 1-Year grant project funded by the National Institute of Mental Health. Among cancer patients, major depression is the most common psychiatric disorder, with as many as 50-85% of patients considered clinically depressed, the majority of which present to a primary care environment for treatment (cf. Stevens, et al., 1995). Among primary care patients with depression, treatment satisfaction is moderate to low and response rates are lower than those anticipated based on the Agency for Health Care Policy and Research Guidelines (Wells et al., 1999). Accordingly, the need to focus on quality improvement has been highlighted (Coyne, 2000). The primary objective of this study was to explore the effectiveness and feasibility of a brief behavioral activation treatment for depression (BATD; Lejuez, Hopko, & Hopko, 2001) for clinically depressed cancer patients within primary care.
The BATD protocol may be a viable means to improve quality of care and quality of life of cancer patients in that the treatment addresses primary symptoms often associated with cancer and depression (e.g., reduced activity) and may reduce practical problems associated with mainstream psychosocial treatments for depression in primary care (Coyne, 2000). This research was important considering the paucity of psychosocial treatment outcome work focused on depressed cancer patients, methodological limitations of studies, lack of effectiveness research in "real-world" (primary care) settings where most patients present with depressive symptoms, and limitations of existing psychosocial treatments in this context. The design involved the collection of pilot data within a small open trial (N = 12). Using a heterogenous sample, the effects of BATD at post-treatment were evaluated using clinical, functional, and satisfaction outcome measures. Clinical outcomes included measurement of target symptoms (depression) and potentially coexistent clinical conditions (i.e., anxiety). Functional outcomes assessed functional status and quality of life. Satisfaction outcome assessed patient satisfaction with BATD. Longer-term effects of BATD were assessed at 3-month follow-up. Results indicated that depressed cancer patients seemed to benefit from BATD, with decreased symptoms of depression, improved qaulity of life, and improved medical functioning evident at post-treatment and 3 month follow-up. This project was an important first step toward developing a larger-scale, randomized hybrid efficacy-effectiveness study that would further assess the clinical utility of BATD in treating depressed cancer patients within primary care.
2004-2007
As a follow up to the first NIMH grant titled "Behavioral Activation Treatment of Cancer Patients with Depression (FINAL OUTCOME DATA), the National Cancer Institute funded a two-year project titled "Cognitive-Behavioral Activation Treatment for Depressed Cancer Patients" (CBATD). The primary objective of this study was to explore the effectiveness and feasibility of a more "comprehensive" form of behavioral activation that included sessions of brief cognitive therapy, problem-solving therapy, sleep hygiene and stimulus control, and relaxation training. The design involved the collection of pilot data within a small open trial (n = 20) at the University of Tennessee Cancer Institute. Using a heterogenous sample, the effects of CBATD at post-treatment were evaluated using clinical, functional, and satisfaction outcome measures. Longer-term effects of CBATD were assessed at 3-month follow-up. Results revealed strong treatment integrity, good patient compliance, excellent patient satisfaction with the CBTD protocol, and significant pre-post treatment gains across a breadth of outcome measures assessing depression, anxiety, quality of life, and medical outcomes. These gains also were associated with strong effect sizes and generally were maintained at 3-month follow-up. This project represented an important final step toward justifying a larger-scale, randomized control trial that would assess the eficacy of behavioral activation relative to a well-established psychosocial intervention for depression.
2007-2010
As a follow up to the first two completed grants, the Susan G. Komen Breast Cancer Foundation funded a three-year grant project titled "Behavior Activation for Depressed Breast Cancer Patients: Randomized Trial. The research project began in August, 2007, and aims to examine: (1) the efficacy of both Behavioral Activation (BA) and Problem Solving Therapy (PST) with breast cancer patients, (2) whether BA + usual care is more effective than PST + usual care, and (3) demographic, clinical, and medical predictors (e.g., cancer-specific variables) of positive treatment outcome. As with the first two grant projects, outcome measures included clinical, functional (medical status, social support and quality of life), satisfaction, and service utilization variables. Long-term effects of BA and PST will be assessed over a 12-month follow up period. Our goal is to improve quality of care and longevity of life for depressed breast cancer patients through efficient interventions like BA and PST.