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Depressed Breast Cancer Patients:

The Impact of Therapeutic

Compliance and Quantity of
Activities Completed on
Symptom Reduction
M. Ryba, M.M., Lejuez, C. W., & R.
Hopko. (2014)
Journal of Consulting and Clinical
Keywords: behavioral82, (2), 325335
activation, depression,
breast cancer, process of change, mediation
This study examined relationships among the quantity of activities
completed, proportion of activities completed (i.e., therapeutic
compliance), environmental reward, and depression reduction in
breast cancer patient treated with eight sessions of BATD(Behavioral
Activation Treatment for Depression).
Participants were 23 breast cancer patients with a diagnosis of
major depression who were treated at the University of Tennessee
Medical Centers Cancer Institute as part of a randomized clinical
Patients were recruited through clinic screening, clinic brochures,
and oncologist referral.
The majority of these
Principle (and primary)
patients were White Diagnosed with breast
Older than age 18. diagnosis of major
(91.3%); 8.7% were cancer.
African American.

The average length of

Not psychotic or Mean age was 57 Marital status was
education was 15.2
cognitively impaired. years mostly married (56.5&)

Only BATD patients

The average time since who completed and
Patients of all cancer
breast cancer returned all behavioral
stages were included
diagnosis was 2.7 years activation monitoring
logs were included.
Hypothesis 1: As BATD progressed, the overall quantity of activities
assigned was predicted to increase.
Hypothesis 2: As BATD progressed, treatment compliance (i.e.,
proportion of activities completed) was predicted to increase.
Hypothesis 3: The proportion of activities completed and reduced
depression would be mediated by increased environmental reward.
Hypothesis 4: The quantity of activities completed and reduced
depression would be mediated by increased environmental reward.
Hypothesis 5: Individuals completing a greater quantity of activities
and greater proportion of assigned activities were predicted to
achieve treatment response and remission at posttreatment.
Assessment Measures
Behavioral monitoring.
In BATD, the master activity log is used by the clinician to track weekly patient
Including the number of times the patient eventually would like to complete the
activity in a 1-week period (ideal frequency) and the duration of the activity.

Beck Depression InventoryII.

Consists of 21 items rated on a 4-point Likert scale.
The BDIII has excellent reliability and validity in depressed adults

Environmental Reward Observation Scale.

10-item measure assessing exposure to environmental rewards deemed essential
for increasing response-contingent positive reinforcement
Higher scores on the EROS suggest increased environmental reward.
Eligible participants
Recruitment and subsequently
were administered the
screening engaged in their 8-
ADISIV and all self-
procedures. week (one-on-
report measures.
one) treatment

At the beginning of each Activity logs and behavioral

session, the BDIII and EROS checkouts were reviewed to assess
were completed to assess the number of activities assigned
depression and and the proportion of activities
environmental reward. completed by each patient.
The number of assigned activities and number of completed activities significantly
increased over time.

Patients who initially had fewer assigned activities had more substantial
increases throughout treatment.

Significant patient improvement was evident across behavioral activation

sessions, whereby during the first week, the average BDIII score was 14.83,
decreasing to 10.04 by the final week of BATD.

Theres a trend for increased environmental reward over time as a function of

behavioral activation, with initial environmental reward of 26.13 increasing to 29.22
by the final week of treatment.
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 achieved for all patients.

Neither therapeutic compliance nor the quantity of completed activities was

directly associated with self-reported environmental reward during the BA
interval (Session 3 to posttreatment).

Environmental reward did not mediate the relation between activation and
Patient compliance with BA assignments is causally associated
with depression reduction, whereas the quantity of completed
activities is less relevant toward conceptualizing positive
treatment outcomes. Study findings are discussed in the
context of behavioral models of depression and BA therapy.

Findings demonstrate that while the average number of

assigned and completed activities systematically increased
over time, there was no progressive change in therapeutic
compliance, with overall compliance being exceptionally high
throughout psychotherapy.

Results suggest patient adherence to behavioral assignments is

more critical in reducing depression relative to simply
completing a greater number of activities