Behavioral Activation for Depressed Breast Cancer Patients: The Impact of Therapeutic Compliance and Quantity of Activities Completed on Symptom Reduction

Behavioral activation (BA) is an empirically validated treatment that reduces depression by increasing overt behaviors and exposure to reinforcing environmental contingencies. Although research has identified an inverse correlation between pleasant or rewarding activities and depression, the causal relation between increased structured activities and reduced depression has not directly been studied. In the context of a recent randomized trial (Hopko et al., 2011), this study used longitudinal data and growth curve modeling to examine relationships among the quantity of activities completed, proportion of activities completed (i.e., therapeutic compliance), environmental reward, and depression in breast cancer patients treated with BATD (n = 23). Results indicated that therapeutic compliance with assigned activities was causally related to depression reduction, whereas the specific quantity of completed activities was not systematically related. Logistic regression indicated that for patients completing all assigned activities, treatment response and remission were nearly certain. Neither therapeutic compliance nor the quantity of completed activities were directly associated with self-reported environmental reward during the BA interval (session three to post-treatment), and environmental reward did not mediate the relation between activation and depression. Study findings are discussed in the context of behavioral models of depression and BA therapy.