Maria E. A. Armento

Brief Behavioral Activation and Problem-Solving Therapy for Depressed Breast Cancer Patients: Randomized Trial

OBJECTIVE Major depression is the most common psychiatric disorder among breast cancer patients and is associated with substantial impairment. Although some research has explored the utility of psychotherapy with breast cancer patients, only 2 small trials have investigated the potential benefits of behavior therapy among patients with well-diagnosed depression. METHOD In a primarily Caucasian, well-educated sample of women (age = 55.4 years, SD = 11.9) diagnosed with breast cancer and major depression (n = 80), this study was a randomized clinical trial testing the efficacy of 8 sessions of behavioral activation treatment for depression (BATD) compared to problem-solving therapy. Primary outcome measures assessed depression, environmental reward, anxiety, quality of life, social support, and medical outcomes. RESULTS Across both treatments, results revealed strong treatment integrity, excellent patient satisfaction with treatment protocols, and low patient attrition (19%). Intent-to-treat analyses suggested both treatments were efficacious, with both evidencing significant pre-post treatment gains across all outcome measures. Across both treatments, gains were associated with strong effect sizes, and based on response and remission criteria, a reliable change index, and numbers-needed-to-treat analyses, approximately ¾ of patients exhibited clinically significant improvement. No significant group differences were found at posttreatment. Treatment gains were maintained at 12-month follow-up, with some support for stronger maintenance of gains in the BATD group. CONCLUSIONS BATD and problem-solving interventions represent practical interventions that may improve psychological outcomes and quality of life among depressed breast cancer patients. Study limitations and future research directions are discussed.

Behavior therapy for depressed cancer patients in primary care

Major depression is a common psychiatric disorder among cancer patients and is associated with psychosocial impairment and decreased quality of life. Although some research has explored psychological interventions with cancer patients, outcome studies investigating the benefits of behavior therapy among cancer patients with well diagnosed depression are nonexistent. The present study was a preliminary clinical trial (n 6) used to assess the effectiveness of a Brief Behavioral Activation Treatment for Depression (BATD) among depressed cancer patients in primary care. Results revealed strong treatment integrity, good patient compliance, excellent patient satisfaction with the BATD protocol, and significant pre‐post treatment gains across measures assessing depression, quality of life, and medical outcomes. These gains were associated with strong effect sizes and were maintained at 3-month follow up. BATD may represent a practical primary care treatment that may remedy problems associated with traditional psychosocial interventions. Study limitations and future research directions are discussed.

The Phenomenology and Screening of Clinical Depression in Cancer Patients

Abstract Clinical depression is the most common psychiatric disorder among cancer patients and is associated with significant functional impairment. Unfortunately, depression in cancer patients is often under-diagnosed and untreated, and studies examining the predictive utility of assessment instruments in detecting clinically depressed cancer patients are sparse. Using a structured interview, thirty-three patients with various cancer types were diagnosed as having major depression (n = 24) or no psychiatric diagnosis (n = 9). All patients were administered the Beck Depression Inventory-II (BDI-II), the Center for Epidemiological Studies in Depression Scale (CES-D), Hamilton Rating Scale for Depression (HRSD), Quality of Life Inventory (QOLI), a medical and psychosocial functioning questionnaire (SF-36), and given co-morbidity of depression with anxiety disorders, the Beck Anxiety Inventory (BAI). Depressed and non-depressed cancer patients were compared and contrasted across all assessment measures and accuracy of instruments was based on evaluating their sensitivity, specificity, and positive predictive values. Depressed cancer patients exhibited more severe depressive symptoms and poorer quality of life, increased anxiety and bodily pain, and decreased vitality and social functioning. All instruments exhibited strong predictive properties, with the CES-D and BDI-II considered most feasible given their time efficiency, administrative simplicity, and strong psychometric properties.

The use of daily diaries to assess the relations among mood state, overt behavior, and reward value of activities

Recent data has sparked renewed interest in behavioral treatments for depression; however several fundamental questions remain regarding the mechanisms of such approaches. To this end, the current study directly tested the assumption that non-clinical mildly depressed individuals receive less response-contingent positive reinforcement than non-depressed individuals, indicated by less engagement in behaviors perceived as rewarding in terms of both immediate pleasure and potential for these behaviors to result in more distal rewards. The data presented support this assumption and provide support for the role of reinforcement-based strategies such as behavioral activation in the treatment of depression.

Cognitive-behavior therapy for depressed cancer patients in a medical care setting.

Major depression is the most common psychiatric disorder among cancer patients and is associated with decreased quality of life, significant deterioration in recreational and physical activities, relationship difficulties, sleep problems, more rapidly progressing cancer symptoms, and more metastasis and pain relative to nondepressed cancer patients. Although some research has explored the utility of psychological interventions with cancer patients, only one study to date has explored the potential benefits of cognitive-behavior therapy among cancer patients with well-diagnosed depression. Addressing this gap in the literature, this study represents an open clinical trial to assess the effectiveness of a brief Cognitive-Behavioral Treatment for Depression (CBTD) among depressed cancer patients in a medical care setting. Results revealed strong treatment integrity, good patient compliance, excellent patient satisfaction with the CBTD protocol, and significant pre-post treatment gains across a breadth of outcome measures assessing depression, anxiety, quality of life, and medical outcomes. These gains also were associated with strong effect sizes and generally maintained at 3-month follow-up. Behavioral activation interventions, especially when paired with cognitive techniques, may represent a practical medical care treatment that may improve psychological outcomes and quality of life among cancer patients. Study limitations and future research directions are discussed.

Psychometric Properties of the Revised Cheek and Buss Shyness Scale

Although the Revised Cheek and Buss Shyness Scale (RCBS; Cheek, 1983) is widely used, its psychometric properties largely are unknown. In this investigation, we examined the normative data, factor structure, internal consistency, test-retest reliability, and convergent/discriminant validity of the RCBS using a sample of 261 university students. Results provided strong support for the stability of normative data over time, reliability of the measure, and its predicted associations with contemporary measures of shyness, social anxiety, and related constructs. Although support was obtained for a unifactorial conceptualization of shyness, an exploratory factor analysis revealed an alternative 3-factor solution that was supportive of a previously proposed meta-analytic model of shyness (Jones, Briggs, & Smith, 1986) and was consistent with other prominent shyness theories (Buss, 1980; Pilkonis, 1977a, 1977b; Zimbardo, 1977). This factor model was replicable on a holdout sample, and there were some data to support the discriminant validity of factors.

Behavioral Activation of a Breast Cancer Patient With Coexistent Major Depression and Generalized Anxiety Disorder

Recently developed behavioral activation interventions have shown promise in effectively treating depression through increasing value-based activity levels that elicit response-contingent reinforcement. This case study highlights the implementation of behavioral activation to a breast cancer patient with major depression and generalized anxiety disorder, applied within the context of a medical center oncology clinic. Following an eight-session behavioral activation protocol, the patient demonstrated notable decreases in self-reported depressive and anxious symptoms and an overall increase in quality of life and medical functioning. These treatment gains were maintained through 6-month follow-up. Consistent with an accumulating literature, these data support behavioral activation as an effective and parsimonious intervention for individuals with depression and concurrent medical problems such as breast cancer.

The Relation of Psychopathic Characteristics and Anxiety in Noncriminals: Physiological and Cognitive Responses to Guided Imagery

In response to a paucity of research examining the phenomenology of psychopathy among nonforensic samples, the present study explored the relations among psychopathic traits, self-reported anxiety, and physiological reactivity to experimental stimuli. Undergraduate students with no history of criminal behavior listened to four audiotaped vignettes designed to elicit affective responses. Imagery and anxiety ratings, as well as physiological indices supported the utility of the experimental manipulation. Consistent with data obtained among forensic samples, participants with greater psychopathic characteristics exhibited electrodermal hyporeactivity in response to guided imagery. However, inconsistent with previous findings, hyporeactivity was primarily related to high emotional detachment rather than elevated levels of deviant behavior. Results also suggested certain psychopathic qualities (emotional detachment) may be more associated with somatic and trait anxiety than other characteristics (deviant behavior), although anxiety did not moderate the effects of psychopathic characteristics on physiological responding. Theoretical implications are addressed, including the possible generalizability of psychophysiological models of diagnosed psychopaths to individuals with more benign psychopathic characteristics.

Adaptation level effects in discrimination of flicker frequency.

Pigeons accustomed to food reinforcement for responding in the presence of a 25-Hz flickering light were exposed to several sets of flicker-frequency stimuli arranged as increasing and decreasing series. In the first experiment, food was occasionally delivered for key pecks during 30-s periods of 25-Hz flicker appearing at the beginning, midway, and at the end of an ascending and descending series of nine frequencies, ranging from 13 to 37 Hz. These stimuli appeared for 15-s periods with no food available (extinction). Gradients of responding to flicker values in the ascending series differed from those in the descending series, showing displacements in peak responding toward the lower and higher frequency values, respectively. The same effects occurred when the sequence was changed so that a descending series was followed by an ascending series of frequencies. These effects are consonant with an adaptation level (AL) interpretation and were replicated in a second experiment in which durations of the extinction presentations were increased to 30s. In a final condition, only a descending series was presented and displacement of peak responding from 25 Hz to a higher frequency stimulus, 28 Hz, was observed.