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

50 Participants Needed

Trial Summary

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 data supports the effectiveness of the treatment Behavioral Activation (BA) for geriatric depression?

Research shows that Behavioral Activation (BA) is effective in reducing depression and increasing healthy behavior in older adults. It involves structured increases in enjoyable activities, which help improve mood by increasing positive experiences. ^{1 2 3 4 5}

Is Behavioral Activation safe for humans?

Behavioral Activation (BA) is generally considered a safe treatment for depression and related conditions, as it is a psychological intervention that involves engaging in activities to improve mood. There is no specific safety data mentioned in the research articles, but BA is described as easily accessible and cost-effective, suggesting it is safe for use in humans. ^{3 5 6 7 8}

How is Behavioral Activation treatment different from other treatments for geriatric depression?

Behavioral Activation (BA) is unique because it focuses on helping patients engage in activities that align with their values and goals, which can improve mood by increasing exposure to positive experiences. Unlike medication or traditional talk therapy, BA is often more accessible and can be delivered by nurses or through self-help, making it a low-cost and scalable option for treating depression in older adults. ^{3 6 8 9 10}

What is the purpose of this trial?

The purpose of this study is to test the feasibility and acceptability of an evidence-based treatment for depression delivered over an ipad, computer, or smartphone can help Adult Protective Services (APS) clients with their activities of daily living to evaluate whether reductions on measures of depression and apathy (a) mediate reduced Elder Neglect/Self Neglect (EN/SN) behaviors; and (b) whether secondary posited mediating mechanisms are also active in impacting depression and apathy

Research Team

Leila Wood, PhD, MSSW

Principal Investigator

The University of Texas Health Science Center, Houston

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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) 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]

References

1. England pubmed.ncbi.nlm.nih.gov

Behavioral Activation in Nursing Homes to Treat Depression (BAN-Dep): Results From a Clustered, Randomized, Single-Blinded, Controlled Clinical Trial. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

A Multi-Stakeholder Process to Transform a Community-based Screening and Referral Program to Implement Evidence-Based Depression Care. [2018]

3. England 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. [2021]

4. Switzerland pubmed.ncbi.nlm.nih.gov

Behavioral activation for depression in older adults: theoretical and practical considerations. [2019]

5. United States 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. [2015]

6. United States pubmed.ncbi.nlm.nih.gov

Treatment failure in behavior therapy: focus on behavioral activation for depression. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Looking beyond depression: a meta-analysis of the effect of behavioral activation on depression, anxiety, and activation. [2022]

8. Netherlands pubmed.ncbi.nlm.nih.gov

Behavioral activation: Is it the expectation or achievement, of mastery or pleasure that contributes to improvement in depression? [2019]

9. England pubmed.ncbi.nlm.nih.gov

Can We Prevent Depression in At-Risk Older Adults Using Self-Help? The UK SHARD Trial of Behavioral Activation. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

What is behavioral activation? A review of the empirical literature. [2022]