A Comparative Study of Group Behavioral Activation and Cognitive Therapy in Reducing Subsyndromal Anxiety and Depressive Symptoms

  • Mehdi Soleimani Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
  • Parvaneh Mohammadkhani University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
  • Behroz Dolatshahi University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
  • Hamid Alizadeh Allameh Tabataba’i University, Tehran, Iran
  • Karenleigh A Overmann Department of Psychology, University of Colorado, Colorado Springs, USA
  • Frederick L Coolidge Department of Psychology, University of Colorado, Colorado Springs, USA
Keywords: Behavioral Activation Therapy, Cognitive Therapy, Subsyndromal Anxiety and Depressive Symptoms, Functional Impairment

Abstract

Objective: This study compared the effectiveness of two group treatments, behavioral activation (BA) and cognitive therapy (CT), in reducing subsyndromal anxiety and depressive symptoms in a sample of Iranian university students.
Method: Twenty-seven Iranian university students who scored 18 or higher on the depression subscale and 16 or higher on the anxiety subscale of the Depression, Anxiety, and Stress Scale (DASS-42) were randomly assigned into treatment groups. One group received 8 sessions of BA (n = 14), and the other received 8 sessions of group CT (n = 13).
Result: Analysis of covariance revealed that the BA group had a significantly greater reduction in depressive symptoms than the CT group. However, there were no significant differences between the two groups in the levels of anxiety, stress symptoms or functional impairment after treatment.
Conclusion: This study found evidence for the effectiveness of BA in reducing anxiety, depressive and stress symptoms and functional impairment compared to CT. BA was more effective than CT in improving depressive symptoms and was as effective as CT in decreasing anxiety, stress and functional impairment. BA is also a cost-effective intervention, particularly in group formats.

References

Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiat 2005; 62: 617–627.

Lambert KG. Rising rates of depression in today’s society: consideration of roles of effort-based rewards and enhanced resilience in day-to-day functioning. Neurosci Biobehav R 2006; 30: 497–510.

Brown TA, Campbell LA, Lehman CL, Grisham JR, Mancill RB. Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. J Abnorm Psychol 2001; 110: 585–599.

Cox BJ, Clara IP, Enns MW. Posttraumatic stress disorder and the structure of common mental disorders. Depress Anxiety 2002; 15: 168–171.

Mineka S, Watson D, Clark LA. Comorbidity of anxiety and unipolar mood disorders. Annu Rev Psychol 1998; 49: 377–412.

Dozois DJA, Westra HA. The nature of anxiety and depression: implications for prevention. In: Dozois DJA, Dobson KS, eds. The prevention of anxiety and depression: the theory, research, and practice. Washington, DC: American Psychological Association; 2004.

Goldney RD, Fisher LJ, Dal Grande E, Taylor AW. Subsyndromal depression: prevalence, use of health services and quality of life in an Australian population. Soc Psych Psych Epid 2004; 39: 293–298.

Lavretsky H, Kumar A. Clinically significant non-major depression: old concepts, new insights. Am J Geriat Psychiat 2002; 10: 239–255.

Rivas-Vazquez RA, Saffa-Biller D, Ruiz I, Blais MA, Rivas-Vazquez A. Current issues in anxiety and depression: comorbid, mixed, and subthreshold disorders. Professional Psychology: Research and Practice 2004; 35: 74–83.

Katon W, Roy-Byrne P. Mixed anxiety and depression. J Abnorm Psychol 1991; 100: 337–345.

Amini F, Farhadi A. The prevalence of anxiety and depression, and their effects on educational performance among university students of Lorestan medical university. Abstract Collection of First Seminar on Mental Health of University Students. Tehran: University of Tehran; 2001.

Mosayebi A, Verhram F, Behbahani AA, Shamloo F, Javadi M. The study of personality type, depression and anxiety rate with self-report questionnaires in medical, dental, & nursing students. Thesis for medical degree. Ghazvin: Ghazvin Medical University; 1995.

Narimani M. The prevalence and causes of anxiety in Mohaghghegh Ardabili’s university students. Abstract Collection of First Seminar on Mental Health of University Students. Tehran: University of Tehran; 2001.

Sohrabi F, Nobakht M. The relationship between mental health and educational achievement in Tehran university students. Abstract Collection of First Seminar on Mental Health of University Student. Tehran: University of Tehran; 2001.

Chambless DL, Baker MJ, Baucom DH, Beutler LE, Calhoun KS, Crits-Christoph P, et al. Update on empirically validated therapies, II. The Clinical Psychologist 1998; 51: 3–16.

Chambless DL, Ollendick TH. Empirically supported psychological interventions: controversies and evidence. Annu Rev Psychol 2001; 52: 685–716.

Task Force on Promotion and Dissemination of Psychological Procedures. Training in and dissemination of empirically-validated psychological treatments. The Clinical Psychologist 1995; 48: 3–23.

Barkham M, Shapiro DA, Hardly GE, Rees A. Psychotherapy in two-plus-one sessions: outcomes of a randomized controlled trial of cognitive–behavioral and psychodynamic–interpersonal therapy for subsyndromal depression. J Consult Clin Psych 1999; 67: 201–211.

Norton PJ. An open trial of transdiagnostic cognitive-behavioral group therapy for anxiety disorders. Behav Ther 2008; 39: 242–250.

Norton PJ, Hayes SA, Hope DA. Effects of a transdiagnostic group treatment for anxiety on secondary depressive disorders. Depress Anxiety 2004; 20: 198–202.

Allen BA, McHugh RK, Barlow DH. Emotional disorders: a unified approach. In: Barlow DH, ed. Clinical handbook of psychological disorders: a step-by-step treatment manual. 4th ed. New York: Guilford; 2007.

Clark DA, Taylor S. The transdiagnostic perspective on cognitive-behavioral therapy for anxiety and depression: new wine for old wineskins? Journal of Cognitive Psychotherapy 2009; 23: 60–66.

Dozois DA, Seeds PM, Collins KA. Transdiagnostic approaches to the prevention of depression andanxiety. Journal of Cognitive Psychotherapy 2009; 23: 44–59.

Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev 2006; 26: 17–31.

Echeburua E, Salaberria K, Corral P, Cenea R, Berasategui T. Treatment of mixed anxiety–depression disorder: long-term outcome. Behav Cogn Psychoth 2006; 34: 95–101.

Erickson DH. Group cognitive behavioural therapy for heterogeneous anxiety disorders. Cognitive Behaviour Therapy 2003; 32: 179–186.

Konnert C, Dobson K, Stelmach L. The prevention of depression in nursing home residents: a randomized clinical trial of cognitive-behavioral therapy. Aging Ment Health 2009; 13: 288–299.

Stice E, Burton E, Bearman SK, Rohde P. Randomized trial of a brief depression prevention program: an elusive search for a psychosocial placebo control condition. Behav Res Ther 2007; 45: 863–876.

Carrasco JL, Díaz-Marsá M, Sáiz-Ruiz J. Sertraline in the treatment of mixed anxiety and depression disorder. J Affect Disorders 2000; 59: 67–69.

Rousch JL, MacHobby H, Shendarkar N, Johnson ME, Li J. Fluvoxamine treatment of mixed anxiety and depression: evidence for serotonergically mediated anxiolysis. Journal of Clinical Psychopharmachology 2001; 21: 139–142.

Martell CR, Addis ME, Jacobson NS. Depression in context: strategies for guided action. New York: Norton; 2001.

Jacobson NS, Martell CR, Dimidjian S. Behavioral activation treatment for depression: returning to contextual roots. Clin Psychol—Sci Pr 2001; 8: 255–270.

Dimidjian S, Hollon SD, Dobson KS, Schmaling KB, Kohlenberg RJ, Addis ME, et al. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. J Consult Clin Psych 2006; 74: 658–670.

Syzdek MR, Addis ME, Martell CR. Working with emotion and emotion regulation in behavioral activation treatment for depressed mood. In: Kring AM, Sloan DM, eds. Emotion regulation and psychopathology: a transdiagnostic approach to etiology and treatment. New York: Guilford; 2010.

Ferster CB. A functional analysis of depression. Am Psychol 1973; 28: 857–870.

Mowrer OH. Two-factor learning theory: versions one and two. In: Mowrer OH, ed. Learning theory and behavior. Hoboken: Wiley; 1960.

Foa E, Franklin M. Obsessive–compulsive disorder. In: Barlow DH, ed. Clinical handbook of psychological disorders: a step-by-step treatment manual. 3rd ed. New York: Guilford Press; 2001.

Hopko DR, Robertson SMC, Lejuez CW. Behavioral activation for anxiety disorders. The Behavior Analyst Today 2006; 7: 212–224.

Jakupack M, Roberts LJ, Yoshimoto D, Mulick PS, Martell C, Balsam KF, et al. Behavioral activation for the treatment of PTSD. J Trauma Stress 2006; 19: 387–391.

Turner AP, Jakupcak M. Behavioral activation for treatment of PTSD and depression in an Iraq combat veteran with multiple physical injuries. Behav Cogn Psychoth 2010; 38: 355–361.

Hopko DR, Lejuez CW, Hopko SD. Behavioral activation as an intervention for coexistent depressive and anxiety symptoms. Clinical Case Studies 2004; 3: 37–48.

Turner JS, Leach JD. Brief behavioral activation treatment of chronic anxiety in an older adult. Behav Change 2009; 26: 214–222.

Chu BC, Colognori D, Weissman AS, Bannon K. An initial description and pilot of group behavioral activation therapy for anxious and depressed youth. Cogn Behav Pract 2009; 16: 408–419.

Kazdin AE. Research design in clinical psychology. 2nd ed. Boston: Allyn & Bacon; 1992.

McRoberts C, Burlingame GM, Hoag MJ. Comparative efficacy of individual and group psychotherapy: a meta-analytic perspective. Group Dyn–Theory Res 1998; 2: 101–117.

Jacobson NS, Dobson KS, Truax PA, Addis ME, Koerner K, Gollan JK, et al. A component analysis of cognitive-behavioral treatment for depression. J Consult Clin Psych 1996; 64: 295–304.

Masterson C, Ekers D, Gilbody S, Richards D, Toner-Clewes B, McMillan D. Sudden gains in behavioural activation for depression. Behav Res Ther 2014; 60; 34–38.

Kanter JW, Santiago-Rivera AL, Santos MM, Nagy G, López M, Hurtado GB, et al. A randomized hybrid efficacy and effectiveness trial of behavioral activation for Latinos with depression. Behav Ther (in press); Available online 28 September 2014.

Folke F, Hursti T, Tungström S, Söderberg P, Ekselius L, Kanter JW. Behavioral activation between acute inpatient and outpatient psychiatry: description of a protocol and a pilot feasibility study. Cogn Behav Pract (in press); Available online 2 May 2014.

Chartier IS, Provencher MD. Behavioural activation for depression: efficacy, effectiveness and dissemination. J Affect Disorders 2013; 145: 292–299.

Chen J, Liu X, Rapee RM, Pillay P. Behavioural activation: a pilot trial of transdiagnostic treatment for excessive worry. Behav Res Ther 2013; 51: 533–539.

Mewton L, Andrews G. Cognitive behaviour therapy via the internet for depression: a useful strategy to reduce suicidal ideation. J Affect Disorders 2015; 170: 78–84.

Newby JM, Williams AD, Andrews G. Reductions in negative repetitive thinking and metacognitive beliefs during transdiagnostic Internet cognitive behavioural therapy (iCBT) for mixed anxiety and depression. Behav Res Ther 2014; 59: 52–60.

Vaziri S, Jamshidifar Z, Darbani SA. The effectiveness of cognitive group therapy decreasing the symptoms of depression. Procedia—Social and Behavioral Sciences 2011; 30: 2173–2179.

Macrodimitris S, Wershler J, Hatfield M, Hamilton K, Backs-Dermott B, Mothersill K, et al. Group cognitive-behavioral therapy for patients with epilepsy and comorbid depression and anxiety. Epilepsy Behav 2011; 20: 83–88.

Hynninen MJ, Bjerke N, Pallesen S, Bakke PS, Nordhus AH. A randomized controlled trial of cognitive behavioral therapy for anxiety and depression in COPD. Resp Med 2010; 104: 986–994.

Christensen LB. Experimental methodology. 8th ed. Boston: Allyn and Bacon; 2001.

Sahebi A, Asghari MJ, Salari RS. Validation of depression anxiety and stress scale (DASS-21) for an Iranian population. Journal of Iranian Psychologists 2005; 1: 299–312.

Brown TA, Di Nardo PA, Barlow DH. Anxiety disorders interview schedule. 4th ed. Boulder: Graywind; 1994.

Gollan J, Atlis M, Marlow-O’Connor M. Behavioral activation: Group treatment for depression (pilot version). Unpublished manual. Chicago: University of Chicago; 2003.

Martell CR, Dimidjian S, Herman-Dunn R. Behavioral activation for depression: a clinician’s guide. New York: Guilford; 2010.

Rachman S. Psychological treatment of anxiety: the evolution of behavioral therapy and cognitive behavioral therapy. Annu Rev Clin Psychol 2009; 5: 97–119.

Akhond-Makkeie Z, Sanaiezaker B. The effect of group cognitive therapy based on Beck’s procedure to treat depressed 15–17 year-old teen girls at ShahinShahr in Isfehan city Unpublished master’s thesis. Tehran: University of Tarbiat Moallem; 1997.

Izadi M, Sanaie B, Kianmanesh A. The effect of developmental-cognitive therapy on trait and state anxiety in two groups of 19–29 year-old boys and girls at Ahvaz city. Unpublished master’s thesis. Tehran: University of Tarbiat Moallem 2002.

Joharifard R. The effect of group cognitive-behavioral therapy in patients with generalized anxiety disorder. Unpublished master’s thesis. Shiraz: Shiraz University; 2005.

Komeili-Sani H, Dejkam M. Effect of cognitive therapy in depression rate of nursing students at Abadan nursing and obstetrics faculty at academic year 1995–96. Unpublished master’s thesis. Tehran: University of Tarbiat Modarres; 1996.

Mundt JC, Marks IM, Shear MK, Greist JH. The work and social adjustment scale: a simple measure of impairment in functioning. Brit J Psychiat 2002; 180: 461–464.

Free ML. Cognitive therapy in groups: guidelines and resources for practice. Chichester: Wiley; 1999.

Lovibond SM, Lovibond PFM. Manual for the Depression Anxiety Stress Scales. 2nd ed. Sydney: Psychology Foundation; 1995.

Bakhshipour A, Dejkam M. Confirmatory factor analysis of the Positive and Negative Affect Scale. J Psychol 2006; 9: 351–365.

Brown TA, Di Nardo, PA, Lehman CL, Campbell LA. Reliability of DSM-IV anxiety and mood disorders: implications for the classification of emotional disorders. J Abnorm Psychol 2001; 110: 49–58.

Borenstein M. Effect sizes for continuous data. In: Cooper H, Hedages LV, Valentine JC, eds. The handbook of research synthesis and meta-analysis. New York: Russell Sage Foundation; 2009.

Jacobson NS, Truax PA. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psych 1991; 59; 12–19.

Published
2016-02-06
How to Cite
1.
Soleimani M, Mohammadkhani P, Dolatshahi B, Alizadeh H, Overmann K, Coolidge F. A Comparative Study of Group Behavioral Activation and Cognitive Therapy in Reducing Subsyndromal Anxiety and Depressive Symptoms. Iran J Psychiatry. 10(2):71-78.
Section
Original Article(s)