Wednesday, July 24, 2019

Behavioral Activation Could Expand Treatment Options for Patients With PTSD

A form of cognitive-behavioral therapy known as “behavioral activation,” which focuses on engaging patients in activities that improve mood, may be a promising alternative treatment for patients with posttraumatic stress disorder (PTSD), according to a report published today in Psychiatric Services in Advance.

“Elements of behavioral activation are relatively straightforward and easy to implement in a range of health care settings by providers with varying backgrounds and training,” wrote Amy Wagner, Ph.D., of the Department of Veterans Affairs (VA), Portland Health Care System and colleagues. “[O]ur findings suggest that behavioral activation is a promising therapy that may expand the reach of PTSD treatment.”

Originally designed for depression, behavioral activation is based on the theory that as individuals become depressed, they tend to isolate and avoid activities they would normally enjoy, which may maintain or worsen their depressive symptoms. The goal of behavioral activation is to decrease avoidance and isolation and increase engagement in activities that have been shown to improve mood.

Wagner and colleagues randomized 80 Iraq and Afghanistan veterans with PTSD to either eight, 60-minute sessions of behavioral activation or standard treatment. Standard treatment included individual therapy (such as prolonged exposure therapy or cognitive processing therapy), group therapy, and/or pharmacotherapy.

In the eight-session protocol, the tenets of behavioral activation were adapted for PTSD. Sessions 1 and 2 focused on learning the treatment model, assessing and discussing PTSD avoidance and how it contributes to functional impairment, assessing values and goals, and identifying specific activities that will improve symptoms. Sessions 3 through 7 focused on assigning activation tasks, assessing the effects of activation, and promoting problem solving. The final session focused on reviewing progress, relapse prevention tactics, future activation targets, and additional treatment.

The researchers assessed PTSD symptoms using the Clinician-Administered PTSD Scale (CAPS) and depressive symptoms using the Beck Depression Inventory-II at baseline, 12 weeks, and 24 weeks.

Although both groups showed improvement over time on measures of PTSD (as measured by clinical interview and self-report), depression, and overall functioning, the behavioral activation group showed greater reductions on subjective measures of PTSD and depression relative to standard care, the authors noted.

“Behavioral activation may be a viable alternative treatment for PTSD for individuals who do not want or who are unable to access trauma processing therapy,” the researchers wrote. “With its focus on behavioral avoidance and increasing functionality, behavioral activation is also well-suited for the treatment of conditions commonly comorbid with PTSD, such as depression and chronic pain.”

For related news, see the Psychiatric Services article “Change in Patient Activation and Mental Illness Symptoms After Communication Training: A Multisite Study With a Diverse Patient Sample.”

(Image: iStock/asiseeit)


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