Behavioral Activation for Geriatric Depression

Overseen By Jason Burnett

Age: 65+

Sex: Any

Trial Phase: Academic

Sponsor: The University of Texas Health Science Center, Houston

Disqualifiers: Bipolar, Psychotic disorders, Dementia, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 8 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests whether a digital treatment called Behavioral Activation (BA) can reduce depression and neglect in older adults receiving help from Adult Protective Services. Participants will either receive this new digital treatment or continue with usual care to evaluate the new method's effectiveness. The trial targets individuals with an open APS case who show symptoms of depression, as indicated by a specific score on the PHQ-9 questionnaire. The researchers aim to determine if improving mood and motivation also reduces self-neglect behaviors. As an unphased trial, it offers participants the chance to contribute to innovative research that could enhance mental health care for older adults.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It might be best to discuss this with the trial coordinators or your doctor.

What prior data suggests that this method is safe for geriatric depression?

Research has shown that Behavioral Activation (BA) is a safe and effective treatment for depression, particularly in older adults. Studies have found that it reduces symptoms such as loss of interest in activities and lack of motivation. These improvements facilitate participation in daily life. Importantly, BA is generally well-tolerated, with few reports of serious side effects. Evidence suggests it is a reliable option for managing depression, with minimal negative effects reported. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Behavioral Activation (BA) for geriatric depression because it offers a unique approach compared to traditional treatments like antidepressant medications and cognitive-behavioral therapy. Unlike these standard options, which often focus on altering brain chemistry or challenging thought patterns, BA directly targets the patient's engagement in positive and rewarding activities. This method empowers older adults by helping them reconnect with pleasurable activities and social interactions, potentially leading to an improvement in mood and overall well-being. Moreover, BA can be particularly appealing as it minimizes reliance on medications, which can have various side effects, and provides a more active, empowering role for the patient in their own treatment.

What evidence suggests that this trial's treatments could be effective for geriatric depression?

Research shows that Behavioral Activation (BA), which participants in this trial may receive, effectively treats depression in older adults. Studies have found that BA reduces depression and encourages healthy behaviors in this age group. For instance, one study reported that 71% of participants experienced a decrease in depression levels after using BA. Another review of multiple studies confirmed that BA is easy to use for managing depression. These findings suggest that BA could be a promising way to improve mental health in older adults. ^{1 6 7 8 9}

Who Is on the Research Team?

Leila Wood, PhD, MSSW

Principal Investigator

The University of Texas Health Science Center, Houston

Are You a Good Fit for This Trial?

This trial is for Adult Protective Services (APS) clients who are experiencing depression and may be neglecting themselves or others. Participants should be able to use an iPad, computer, or smartphone.

Inclusion Criteria

APS Case in APS Region VI- Must have open case

PHQ 9 score- Must have score of nine (9) or more

Exclusion Criteria

Current Alcohol and Drug Dependency- As evidenced by Cut down, Annoyed, Guilty, and Eye-opener (CAGE) score of 3 or more

Previous mental health diagnosis of bipolar disorder, psychotic disorders, and moderate to severe dementia

Assessment of Consent Proxy- Those who need assessment of consent proxy

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive evidence-based treatment for depression delivered over an iPad, computer, or smartphone

8 weeks

Virtual sessions

Follow-up

Participants are monitored for changes in depression, apathy, and social connection

3 months

What Are the Treatments Tested in This Trial?

Interventions

• Intervention-Behavioral Activation (BA)

Trial Overview The study is testing if a treatment for depression called Behavioral Activation (BA), delivered through digital devices like iPads, can help improve daily activities and reduce symptoms of elder neglect/self-neglect.

How Is the Trial Designed?

Group I: Intervention-Behavioral Activation (BA) Experimental Treatment 1 Intervention

Group II: APS Treatment as Usual Active Control 1 Intervention

Who Is Running the Clinical Trial?

The University of Texas Health Science Center, Houston

Lead Sponsor

Trials

974

Recruited

361,000+

National Institute on Aging (NIA)

Collaborator

Trials

1,841

Recruited

28,150,000+

Published Research Related to This Trial

Behavioral Activation (BA) is a well-supported psychotherapy for depression that has evolved over the years, incorporating various techniques such as activity monitoring, scheduling, and skills training, which have empirical support as effective components.

While some techniques like activity scheduling and relaxation training have been validated as effective on their own, others are more effective when used as part of a comprehensive treatment package, highlighting the importance of a tailored approach in BA interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

What is behavioral activation? A review of the empirical literature. Kanter, JW., Manos, RC., Bowe, WM., et al.[2022]

Behavioral activation (BA) is an effective treatment for depression, but many patients still experience treatment failure due to various factors, such as difficulty understanding the treatment rationale and behavioral noncompliance.

A case study of a depressed breast cancer patient highlights these challenges and suggests that improving patient awareness of life values and enhancing contingency management could help reduce failure rates in BA.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment failure in behavior therapy: focus on behavioral activation for depression. Hopko, DR., Magidson, JF., Lejuez, CW.[2022]

This study aims to evaluate the effectiveness of Behavioral Activation (BA) as a nursing intervention for elderly patients with Major Depressive Disorder (MDD) in inpatient settings, marking the first research of its kind in this population.

The trial will include 102 participants across ten mental health care units in the Netherlands, comparing BA to Treatment as Usual (TAU) over an eight-week period, with depression levels assessed using the Beck Depression Inventory.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The systematic activation method as a nursing intervention in depressed elderly: a protocol for a multi-centre cluster randomized trial. Clignet, F., van Meijel, B., van Straten, A., et al.[2021]

In a 9-week randomized controlled trial involving 78 patients with major depression, the study found that both expected mastery and pleasure from behavioral activation tasks were strongly correlated with improvements in depression severity.

The results suggest that the anticipation of pleasure from planned activities may be more important for the effectiveness of behavioral activation than the actual pleasure experienced, highlighting the role of meaningful engagement in treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Behavioral activation: Is it the expectation or achievement, of mastery or pleasure that contributes to improvement in depression? Furukawa, TA., Imai, H., Horikoshi, M., et al.[2019]

Behavioral activation (BA) was effective in reducing symptoms of depression in a preliminary study involving 20 older adults over 5 weeks, indicating its potential as a treatment for vulnerable populations.

Interestingly, the specific types or amounts of activities (functional, pleasurable, or social) did not significantly correlate with symptom improvement, suggesting that simply engaging in activities to counter avoidance may be key to the treatment's effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Does Amount and Type of Activity Matter in Behavioral Activation? A Preliminary Investigation of the Relationship between Pleasant, Functional, and Social Activities and Outcome. Hershenberg, R., Paulson, D., Gros, DF., et al.[2015]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11552036/

Behavioral Activation Therapy for Depression Led by Health ... Overall, these findings support the effectiveness and applicability of behavioral activation therapy in treating depression in older adults.

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3640887/

Behavioral Activation for Depression in Older Adults Behavioral activation has been demonstrated to be effective in reducing depression and increasing healthy behavior in older adults.

3. sciencedirect.com sciencedirect.com/science/article/pii/S1064748121003584

Can We Prevent Depression in At-Risk Older Adults Using ... Behavioral activation (BA) has been shown to be effective in the treatment of depression8, 9, 10 and recent meta-analyses show that it can be readily applied ...

4. tandfonline.com tandfonline.com/doi/abs/10.1080/07317110802478016

Behavioral Activation as a Treatment for Geriatric Depression Overall, participants' Geriatric Depression Scale and Hamilton Rating Scale for Depression scores decreased from pre- to post-treatment, and 71% of participants ...

5. cambridge.org cambridge.org/core/journals/the-british-journal-of-psychiatry/article/behavioural-activation-for-depression-in-older-people-systematic-review-and-metaanalysis/A249F7731AFB559019E5503A1A9D569A

Behavioural activation for depression in older people Behavioural activation is an effective treatment for depression in the general adult population but it is unclear whether it is effective for older people.

6. researchprotocols.org researchprotocols.org/2020/9/e18259/

Guided Self-Help Behavioral Activation Intervention for ... Behavioral activation treatment, an evidence-based guided self-help treatment, is effective in reducing anhedonia and amotivation in depression; ...

7. nationalelfservice.net nationalelfservice.net/mental-health/depression/behavioural-activation-depression-older-adults/

Is behavioural activation cost-effective for depression in ... This study suggests that behavioural activation (BA) is, at least, clinically effective in reducing depressive symptoms in older adults.

8. mdpi.com mdpi.com/2076-328X/15/4/462

Impact of Collaborative Care on Depression in Patients ... This study analysed the planned and implemented activities as part of behavioural activation in the intervention group of the GermanIMPACT study, aiming to ...

9. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0005789410001097

The Effects of Behavioral Activation Therapy With Inpatient ... This study examined the effects of Behavioral Activation (BA) treatment on depressive symptoms and quality of life among older adult patients in a geriatric ...