title: Behavioral activation group therapy for reducing depressive symptoms and improving quality of life: a feasibility study.
abstract: BACKGROUND
  Depression is associated with a loss of productivity and noticeable personal, social, and economic decline; it affects more than 350 million people worldwide. Behavioral activation (BA), derived from cognitive behavioral therapy, has drawn increasingly more interest as a means of treatment for major depressive disorder due to its relative cost-effectiveness and efficacy. In this study, we disseminate findings from a feasibility study evaluating barriers to implementing a group BA program for major depressive disorder. The purpose of this feasibility study is to assess both patient and clinician perceptions on components of a group-based behavioral activation (BA) program. In particular, this feasibility study provides in-depth evaluation of the acceptability of BA prior to the design and implementation of a randomized trial to investigate BA effectiveness. Findings from this study directly informed decisions regarding the design and implementation of BA during the pilot trial. Specific components of BA were assessed and modified based on the results of this study.
  
  
  METHODS
  This qualitative study was completed through the Mood Disorders Program at St. Joseph's Healthcare Hamilton. The authors of this study used data from two focus group sessions, one consisting of an interdisciplinary group of clinicians working in the Mood Disorders Program, and the other of registered outpatients of the Mood Disorders Program with a confirmed clinical diagnosis of depression. The benefits of offering this program in a group format, mainly social skill development opportunities and the use of technology such as activity tracking device, smart phones, and tablets during the therapy sessions, are a major focus of both the clinician and patient groups. Both groups emphasized the importance of offering sustainable activation.
  
  
  RESULTS
  Differences in opinions existed between staff and patient groups regarding the use of technology in the program, though ultimately it was agreed upon that technology could be useful as a therapeutic aid. All participants agreed that behavioral activation was essential to the development of positive habits and routines necessary for recovery from depression. Patients agreed the program looked sustainable and stressed the potential benefit for improving depressive symptoms.
  
  
  CONCLUSIONS
  Discussions from clinician and patient-centered focus groups directly informed decisions regarding the design and implementation of BA during the pilot trial. Specific components of BA were assessed and modified based on the results of this study. These findings provide insight for clinicians providing behavioral activation programming, and will serve as a framework for the development of the Out of the Blues program, a group-based BA program to be piloted in the Mood Disorders Program at St. Joseph's Healthcare Hamilton.
  
  
  BACKGROUND
  Clinical Trials registration number NCT02045771.
authors.affiliation: Department of Psychiatry and Behavioural Neuroscience, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada.
authors.forename: Zainab
authors.initials: Z
authors.lastname: Samaan
authors.affiliation: St. George's University of London, Cranmer Terrace, London, UK ; Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W, Hamilton, ON Canada.
authors.forename: Brittany B
authors.initials: BB
authors.lastname: Dennis
authors.affiliation: Recreational Therapy Program, McMaster University, 1280 Main St. W, Hamilton, ON Canada.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Kalbfleisch
authors.affiliation: Faculty of Health Science, McMaster University, 1280 Main St. W, Hamilton, ON Canada.
authors.forename: Herman
authors.initials: H
authors.lastname: Bami
authors.affiliation: Department of Psychiatry and Behavioural Neuroscience, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Population Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W, Hamilton, ON Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Zielinski
authors.affiliation: Department of Psychiatry and Behavioural Neuroscience, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; St. George's University of London, Cranmer Terrace, London, UK.
authors.forename: Monica
authors.initials: M
authors.lastname: Bawor
authors.affiliation: Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Litke
authors.affiliation: Department of Psychiatry and Behavioural Neuroscience, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada.
authors.forename: Kathleen
authors.initials: K
authors.lastname: McCabe
authors.affiliation: Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada.
authors.forename: Jeff
authors.initials: J
authors.lastname: Whattam
authors.affiliation: Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Garrick
authors.affiliation: Department of Psychiatry and Behavioural Neuroscience, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: O'Neill
authors.affiliation: Department of Psychiatry and Behavioural Neuroscience, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada.
authors.forename: Terri Ann
authors.initials: TA
authors.lastname: Tabak
authors.affiliation: Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: Simons
authors.affiliation: Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Chalmers
authors.affiliation: Department of Psychiatry and Behavioural Neuroscience, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Mood Disorders Research Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ; Mood Disorders Program, St. Joseph's Healthcare Hamilton, 100 West 5th St., Hamilton, ON L8N 3K7 Canada.
authors.forename: Brenda
authors.initials: B
authors.lastname: Key
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W, Hamilton, ON Canada.
authors.forename: Meredith
authors.initials: M
authors.lastname: Vanstone
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W, Hamilton, ON Canada.
authors.forename: Feng
authors.initials: F
authors.lastname: Xie
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Department of Medicine, McMaster University, 1280 Main St. W, Hamilton, ON Canada.
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Biostatistics Unit, Centre for Evaluation of Medicine, ON, Canada ; System-Linked Research Unit, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Department of Anaesthesia, McMaster University, 1280 Main St. W, Hamilton, ON Canada ; Department of Paediatrics, McMaster University, 1280 Main St. W, Hamilton, ON Canada.
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
keywords: Behavioral activation; Behavioral group therapy; Depression; Depression severity; Quality of life; Randomized trial