Risk-Targeted Behavioral Activation for the Management of Work-Disability Associated with Co-Morbid Pain and Depression: A Feasibility Study

Purpose The purpose of the present study was to conduct a preliminary evaluation the feasibility and impact of a risk-targeted behavioral activation intervention for work-disabled individuals with co-morbid pain and depression. Methods The design of the study was a single arm non-randomized trial. The sample consisted of 66 work-disabled individuals with co-morbid pain and depression. The treatment program consisted of a 10-week standardized behavioral activation intervention supplemented by techniques to target two psychosocial risk-factors for delayed recovery, namely, catastrophic thinking and perceptions of injustice. Measures of pain severity, depression, catastrophic thinking, perceived injustice and self-reported disability were completed pre-, mid-, and post-treatment. Satisfaction with treatment was assessed at post-treatment. Return to work was assessed at 6-month follow-up. Results The drop-out rate was 18%. At treatment termination, 91% of participants indicated that they were ‘very’ or ‘completely’ satisfied with their involvement in the treatment program. Significant reductions in pain (d = .71), depression (d = .86), catastrophic thinking (d = 1.1) and perceived injustice (d = 1.0) were observed through the course of treatment. In multivariate analyses, treatment-related reductions in depression, catastrophic thinking, perceived injustice, but not pain, contributed significant unique variance to the prediction of return-to-work outcomes. Conclusions Risk-targeted behavioral activation was found to be an acceptable and effective intervention for work-disabled individuals with co-morbid pain and depression. The findings suggest that interventions targeting psychosocial risk factors for pain and depression might contribute to more positive recovery outcomes in work-disabled individuals with co-morbid pain and depression.

The link between the brain volume derived index and the determinants of social performance

Motivation, defined as the energizing of behavior in pursuit of a goal, is a fundamental element of our interaction with the world and with each other. Furthermore, as it is known that cooperation leads to higher levels of performance than do individual conditions, empathic concern is also crucial to all forms of helping relationships. A growing number of studies indicate that motivation and empathy are associated not only with organizational performance and study achievements, but also with the human brain. However, to date, no definite neuroimaging-derived measures are available to measure motivation and empathy objectively. The current research evaluated the association of motivation and empathy with the whole brain using the gray-matter brain healthcare quotient (GM-BHQ), an MRI-based quotient. Participants were 47 healthy adults. All subjects underwent structural T1-weighted imaging. Motivation levels were evaluated using four motivation scales: Behavioral Activation System (BAS), Self-Monitoring Scale (SMS), Self-Control Scale (SCS), and Behavioral Inhibition System (BIS). Interaction levels, including empathic concern, were evaluated using four subscales of the Interpersonal Reactivity Index (IRI). It was found that the GM-BHQ was most significantly sensitive to the BAS scale (p = 0.002). Furthermore, the GM-BHQ was moderately sensitive to the SMS (p = 0.028) and subscales of the IRI (p = 0.044 for Fantasy and p = 0.036 for Empathic Concern). However, no significant association was found between the GM-BHQ and other variables (BIS and SCS). These results suggest that the GM-BHQ might reflect motivation and empathic concern.

Comparison of the Effects of the Choice Theory and Behavioral Activation Therapies with and without Guided Imagery Rescripting on the Adversity Quotient and Cognitive Emotion Regulation of MS Patients in Ahvaz, Iran

Background: Complications of multiple sclerosis (MS) severely impact self-image and have debilitative effects on the adversity quotient. Objectives: The present study aimed to investigate the effects of the choice theory and behavioral activation therapies with and without guided imagery rescripting on the adversity quotient and cognitive emotion regulation of MS patients in Ahvaz, Iran. Methods: This quasi-experimental study was conducted with a pretest-posttest design and a control group. The sample population included the male and female MS patients visiting the Caspian Physiotherapy Center of Ahvaz, Iran in 2019. In total, 60 MS patients were selected via convenience sampling and randomly divided into three experimental groups and one control group (15 per each). Data were collected using the Adversity Response Profile Questionnaire (ARPQ) and the Cognitive Emotion Regulation Questionnaire (CERQ). Data analysis was performed using the multivariate analysis of covariance. Results: A significant difference was observed between the effects of the choice theory (CT) and behavioral activation (BA) therapies with and without guided imagery rescripting (ImRs) on the improvement of the adversity quotient (AQ) and positive cognitive emotion regulation (CER) of the MS patients, as well as the reduction of negative CER (P < 0.001). Compared to the CT and BA therapies without guided ImRs, the BA therapy with guided ImRs more effectively enhanced the AQ and positive CER of the MS patients and decreased their negative CER (P < 0.001). Conclusions: According to the results, BA with ImRs is a more effective method for enhancing the AQ and positive CER of MS patients and mitigating their negative CER compared to other approaches.

The Behavioral Inhibition System/Behavioral Activation System Scales: Measurement Invariance Across Gender in Chinese University Students

Objectives: To identify the optimal factor structure of the behavioral inhibition system/behavioral activation system (BIS/BAS) scales and to examine measurement invariance (MI) of the scales across gender among a sample of Chinese undergraduate students.Methods: Convenience sampling was employed to recruit 1,085 subjects. Participants completed the Chinese version of the BIS/BAS scales. A confirmatory factor analysis (CFA) of competing models was conducted to determine the optimal factor model, followed by a test of MI across gender based on the optimal model.Results: A single-group CFA indicated that the modified four-factor structure fits best in the total sample. Multiple-group CFAs demonstrated that configural invariance, weak invariance, strong invariance, and strict invariance models of the four-factor structure of the BIS/BAS scales were all acceptable.Conclusion: The four-factor structure of the Chinese version of the BIS/BAS scales possesses MI across gender.

Associations Between Interindividual Differences, Expectations and Placebo and Nocebo Effects in Itch

Introduction: Placebo and nocebo effects are positive and negative health outcomes that can be elicited by the psychosocial context. They can be mediated by expectations, and may emerge in somatic symptoms even when people are aware of these effects. Interindividual differences (e.g., in personality, affective states) could impact placebo and nocebo responding, but findings are inconsistent.Methods: The current work examined expectation as a mediator of the association between verbal placebo and nocebo suggestions (VSs) and histamine-induced itch across three experimental studies. Moreover, we examined whether interindividual differences (e.g., in optimism, neuroticism, behavioral activation system (BAS), body ignorance) modulated: (1) the direct association between VSs and itch (direct moderation), and (2) the indirect, expectation-mediated association between VSs and itch (moderated mediation). Positive VSs were compared to neutral instructions (Study 1; n = 92) or negative VSs (Studies 2+3; n = 203) in an open-label (i.e., explaining placebo and nocebo effects) or closed-label (concealed) context using PROCESS. First, mediation of VSs effects on itch by expectations was tested. Next, moderation by individual traits was explored using conditional process analyses.Results: The effects of VSs on itch were significantly mediated by expectation in Study 1 and in the open-label (but not closed-label) contexts of Studies 2 and 3. Ignorance of bodily signals marginally moderated the direct effects of VSs on itch when closed-label suggestions were given: at low levels of body ignorance, effects of positive and negative VSs were stronger. Moreover, moderated mediation was observed in the open-label groups of Studies 2 and 3: The expectation-mediated effects of VSs on itch were stronger when BAS drive was lower.Conclusion: Overall, the effects of VSs on itch were mediated by expectations in the open-label, but not the closed-label context. Moreover, the current work suggests that placebo and nocebo effects may be moderated by ignorance of bodily signals and the BAS. There was limited evidence that other interindividual differences modulated placebo and nocebo responding in itch.

Virtual Reality Behavioral Activation as an Intervention for Major Depressive Disorder: A Feasibility and Pilot Randomized Controlled Trial (Preprint)

UNSTRUCTURED Context: Major depressive disorder (MDD) is a global crisis with increasing incidence and prevalence. There are many established evidence-based psychotherapies (EBP’s) for depression, but they present with various limitations. Virtual reality (VR) may offer some solutions to these limitations of existing MDD EBP’s. Objective: To examine the feasibility, acceptability, and tolerability of using VR as a method of delivering behavioral activation (BA) for adults diagnosed with MDD during a global pandemic. To explore the degree of clinical efficacy of using VR to engage in BA compared to (1) a BA treatment as usual and (2) a non-treatment control group for individuals diagnosed with MDD. Design, Settings, Participants: We conducted a feasibility trial and a three-arm nonblinded between-subjects pilot randomized controlled trial. This study took place remotely via Zoom telehealth between April 8, 2020 and January 15, 2021. Intervention: This study employed a three week, four-session BA protocol, where the VR BA participants used a VR headset to complete their BA homework. Outcome Measures: The primary outcome was measured by dropout rates, serious adverse events, completion of homework, an adapted telepresence scale, a simulator sickness questionnaire, a brief agitation measure, and an adapted technology acceptance model. The secondary outcome was measured by the Patient Health Questionnaire-9 (PHQ-9). Results: Of the 35 participants assessed for eligibility, 13 were randomized to VR BA (n=5), BA TAU (n=4), or a non-treatment control (n=4). The mean age of the 13 participants (5 male, 7 female, 1 non-binary/third gender) was 35.4 (SD = 12.3). This study demonstrated that VR is a feasible, acceptable, and tolerable method of experiencing pleasurable activities in conjunction with a brief BA protocol for individuals diagnosed with MDD. No adverse events were reported. This study also illustrated that VR BA has potential clinical utility in treating symptoms of depression, as the average VR BA participant diagnosis changed from a moderate severity level to mild depression, with a clinically significant average decrease of 5.67 on the PHQ-9. Conclusion: The findings of this study demonstrate that VR BA is a feasible treatment for MDD. This study documented evidence of VR BA’s efficacy and further justification to explore its true effect in an adequately powered RCT. This pilot documented the potential utility that VR could offer patients with MDD, especially those who have difficulty accessing real-world pleasant activities. VR may also be a viable alternative to psychiatric medications for MDD, given its high tolerability and lack of side effects. Additionally, for those having difficulty accessing care, VR BA could be adapted as a first step to help people improve mood and increase motivation while waiting to connect with a healthcare professional for other EBP’s. INTERNATIONAL REGISTERED REPORT RR2-10.2196/24331