Journal of Behavior Therapy and Experimental Psychiatry最新文献

{"title":"Functional assessment of hikikomori behaviors: Functional types and psycho-behavioral factors","authors":"Shunsuke Nonaka ,&nbsp;Tomoya Takeda ,&nbsp;Motohiro Sakai","doi":"10.1016/j.jbtep.2025.102038","DOIUrl":"10.1016/j.jbtep.2025.102038","url":null,"abstract":"<div><div>Hikikomori is a condition of prolonged social withdrawal (at least six months) characterized by not working or attending school, not socializing outside one's home, and staying at home on most days except for solitary outings. Currently, there are no adequate tools for the assessment of individual differences in hikikomori functions. This study involved the development of the Hikikomori Functional Assessment Scale (HFAS), which quantitatively assesses the perceived functions of hikikomori. Three data samples were collected at different time periods and included 490 participants with hikikomori and 251 without hikikomori. An item pool was analyzed resulting in 17 items and three factors: intrapersonal-positive (pursuing activities and self-stimulatory behaviors), intrapersonal-negative (alleviating discomfort), and social-negative (avoiding social interactions) reinforcement. The HFAS showed good internal consistency reliability, moderate-to-good test-retest reliability, acceptable construct validity, and good criterion-related validity. Furthermore, social-negative reinforcement correlated positively with measures of depressive symptoms and subjective social functioning impairment and negatively with adaptive behavior and quality of life. Intrapersonal-negative reinforcement was weakly correlated with most of the related scales, and intrapersonal-positive reinforcement showed no significant correlations. Future studies are needed to confirm the consistency of functional assessment results with those of the HFAS, using behavioral observations by researchers and clinicians, and follow the changes in hikikomori functioning longitudinally.</div></div>","PeriodicalId":48198,"journal":{"name":"Journal of Behavior Therapy and Experimental Psychiatry","volume":"88 ","pages":"Article 102038"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A feasibility study of an add-on psychomotor body-image protocol during CBT-E in female patients with an eating disorder","authors":"Suzanne H.W. Mares ,&nbsp;Marjon Voskamp ,&nbsp;Elke Wezenberg ,&nbsp;Annemarie A. van Elburg","doi":"10.1016/j.jbtep.2025.102034","DOIUrl":"10.1016/j.jbtep.2025.102034","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Disturbed body image is a potential precursor and maintaining factor when it comes to eating disorders. One of the dominant treatment approaches for eating disorders, enhanced cognitive-behaviour therapy (CBT-E), includes the cognitive-affective body image dimension as a core treatment target. Adding a component that focuses on the lived body dimension, could improve body image. In the current study, the feasibility of a psychomotor body image treatment as an add-on to CBT-E was examined.</div></div><div><h3>Methods</h3><div>In this pilot study, 115 primarily female patients with different eating disorders in outpatient CBT-E treatment participated. They were asked to complete questionnaires examining body image before and after the psychomotor body image treatment.</div></div><div><h3>Results</h3><div>Results showed good satisfaction with the treatment, and a significant improvement in body attitude and body satisfaction after the psychomotor body image treatment, with large effect sizes and clinical relevance. Results also showed that, overall, pre-treatment levels and changes over the course of treatment in body attitude and body satisfaction did not differ between patients within anorexia nervosa, bulimia nervosa or binge eating disorder diagnostic subgroups.</div></div><div><h3>Limitations</h3><div>Limitations were lack of a control group, and the fact that the body image treatment was complementary to CBT-E. This means that it is unclear whether other factors contributed to the change in body image as shown in the current study.</div></div><div><h3>Conclusions</h3><div>These results indicate that an experiential psychomotor approach in addition to a more cognitive-behavioral approach is feasible, and warrants future research.</div></div>","PeriodicalId":48198,"journal":{"name":"Journal of Behavior Therapy and Experimental Psychiatry","volume":"88 ","pages":"Article 102034"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can an app designed to reduce repetitive negative thinking decrease depression and anxiety in young people? Results from a randomized controlled prevention trial","authors":"Julia Funk ,&nbsp;Johannes Kopf-Beck ,&nbsp;Keisuke Takano ,&nbsp;Edward Watkins ,&nbsp;Thomas Ehring","doi":"10.1016/j.jbtep.2024.102014","DOIUrl":"10.1016/j.jbtep.2024.102014","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Rates of mental health disorders are rising among adolescents and young adults. Therefore, scalable methods for preventing psychopathology in these age groups are needed. As repetitive negative thinking (RNT) is a risk factor for depression and anxiety disorders, targeting RNT via smartphone app promises to be an effective, scalable strategy. The current three-arm, parallel group, randomized controlled trial tested whether a self-help app designed to reduce RNT decreased psychopathological symptoms and RNT in adolescents and young adults at risk for mental disorders.</div></div><div><h3>Method</h3><div>A sample of 16–22-year-olds with elevated levels of RNT (<em>N</em> = 365) were randomly allocated to either use a one of two self-help apps designed to reduce RNT for 6 weeks or to a waitlist. The full RNT-focused intervention app encompassed a variety of RNT-reducing strategies, whereas the concreteness training app focused on one of these strategies, namely, concrete thinking.</div></div><div><h3>Results</h3><div>The apps did not decrease depressive symptoms, anxiety symptoms and RNT relative to the waitlist. However, exploratory analyses using a minimum dose criterion showed that participants who used the full-RNT-focused intervention app more often, reported greater baseline to follow-up decreases in depressive symptoms compared to waitlist.</div></div><div><h3>Limitations</h3><div>Include decreased power due to slightly more dropout than expected and limited generalizability due to the mostly female and highly educated sample.</div></div><div><h3>Conclusions</h3><div>RNT-focused prevention via a self-help app did not decrease depression and anxiety, presumably due to too little engagement with the app content provided.</div></div>","PeriodicalId":48198,"journal":{"name":"Journal of Behavior Therapy and Experimental Psychiatry","volume":"87 ","pages":"Article 102014"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Counterfactual thinking is associated with impoverished attentional control in women prone to self-critical rumination","authors":"Jens Allaert ,&nbsp;Rudi De Raedt ,&nbsp;Alvaro Sanchez-Lopez ,&nbsp;Marie-Anne Vanderhasselt","doi":"10.1016/j.jbtep.2025.102017","DOIUrl":"10.1016/j.jbtep.2025.102017","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Excessive engagement in counterfactual thinking (CFT), where individuals imagine alternative outcomes to past events, is associated with rumination, a process characterized by repetitive negative self-referential thoughts. Attentional control difficulties are closely linked with rumination, and negative thoughts can negatively impact attentional control among rumination-prone individuals. This study aimed to investigate the relationship between CFT and emotional and non-emotional attentional control among individuals with varying levels of self-critical rumination.</div></div><div><h3>Methods</h3><div>A sample of 100 female participants, characterized by varying levels of self-critical rumination, completed a choice task resulting in goal failure, during which they reported their levels of CFT. Subsequently, participants performed an attentional control task involving eye-tracking measures to assess emotional attentional engagement, emotional attentional disengagement, and emotional and non-emotional attentional shifting.</div></div><div><h3>Results</h3><div>Among women with high (but not low) self-critical rumination tendencies, increased levels of CFT were associated with slower attentional shifting from emotional stimuli of opposing valence, as well as between non-emotional stimuli.</div></div><div><h3>Limitations</h3><div>The correlational design of the study prevents causal interpretations of the findings. Additionally, the exclusive inclusion of female participants may limit the generalizability of the results.</div></div><div><h3>Conclusions</h3><div>This study underscores the association of CFT with subsequent attentional control among women prone to self-critical rumination, aligning with prior research suggesting a link between negative thoughts and attentional processes. Future research should explore these relationships in diverse populations and consider longitudinal designs to elucidate causal pathways.</div></div>","PeriodicalId":48198,"journal":{"name":"Journal of Behavior Therapy and Experimental Psychiatry","volume":"87 ","pages":"Article 102017"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143354865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Verification report: A critical reanalysis of Vahey et al. (2015) “A meta-analysis of criterion effects for the Implicit Relational Assessment Procedure (IRAP) in the clinical domain”","authors":"Ian Hussey","doi":"10.1016/j.jbtep.2024.102015","DOIUrl":"10.1016/j.jbtep.2024.102015","url":null,"abstract":"<div><div>The meta-analysis reported in Vahey et al. (2015) concluded that the Implicit Relational Assessment Procedure (IRAP) has high clinical criterion validity (meta-analytic <span><math><mrow><mover><mi>r</mi><mo>‾</mo></mover></mrow></math></span> = .45) and therefore “the potential of the IRAP as a tool for clinical assessment” (p. 64). Vahey et al. (2015) also reported power analyses, and the article is frequently cited for sample size determination in IRAP studies, especially their heuristic of <em>N</em> &gt; 37. This article attempts to verify those results. Results were found to have very poor reproducibility at almost every stage of the data extraction and analysis with errors generally biased towards inflating the effect size. The reported meta-analysis results were found to be mathematically implausible and could not be reproduced despite numerous attempts. Multiple internal discrepancies were found in the effect sizes such as between the forest plot and funnel plot, and between the forest plot and the supplementary data. 23 of the 56 (41.1%) individual effect sizes were not actually criterion effects and did not meet the original inclusion criteria. The original results were also undermined by combining effect sizes with different estimands. Reextraction of effect sizes from the original articles revealed 360 additional effect sizes that met inclusion criteria that should have been included in the original analysis. Examples of selection bias in the inclusion of larger effect sizes were observed. A new meta-analysis was calculated to understand the compound impact of these errors (i.e., without endorsing its results as a valid estimate of the IRAP's criterion validity). The effect size was half the size of the original (<span><math><mrow><mover><mi>r</mi><mo>‾</mo></mover></mrow></math></span> = .22), and the power analyses recommended sample sizes nearly 10 times larger than the original (<em>N</em> &gt; 346), which no published original study using the IRAP has met. In aggregate, this seriously undermines the credibility and utility of the original article's conclusions and recommendations. Vahey et al. (2015) appears to need substantial correction at minimum. In particular, researchers should not rely on its results for sample size justification. A list of suggestions for error detection in meta-analyses is provided.</div></div>","PeriodicalId":48198,"journal":{"name":"Journal of Behavior Therapy and Experimental Psychiatry","volume":"87 ","pages":"Article 102015"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurocognitive performance in obsessive-compulsive disorder before and after treatment with cognitive behavioral therapy","authors":"Michael G. Wheaton ,&nbsp;Eyal Kalanthroff ,&nbsp;Micha Mandel ,&nbsp;Rachel Marsh ,&nbsp;H. Blair Simpson","doi":"10.1016/j.jbtep.2025.102019","DOIUrl":"10.1016/j.jbtep.2025.102019","url":null,"abstract":"<div><h3>Background</h3><div>Cross-sectional studies have reported neurocognitive performance deficits in obsessive-compulsive disorder (OCD), particularly on tasks assessing response inhibition and proactive control over stimulus-driven behaviors (task control). However, it is not clear whether these deficits represent trait-like markers of OCD or are state-dependent.</div></div><div><h3>Methods</h3><div>This study examined performance on two neurocognitive tasks in OCD patients (N = 26) before and after cognitive behavioral therapy (CBT) and matched healthy controls (HCs, N = 19). Tasks included the stop-signal task (assessing response inhibition) and the Object Interference (OI) task (assessing a specific form of task control). OCD patients completed these tasks and clinical ratings before and after 17 sessions of CBT delivered by expert therapists over two months. HCs completed tasks before and after 2-months. This design used CBT as a tool to reduce OCD symptoms to determine whether neurocognitive performance similarly improves.</div></div><div><h3>Results</h3><div>Results showed that OCD patients and HCs did not significantly differ in their stop-signal performance at either time point. In contrast, OCD patients exhibited impaired performance on the OI task at baseline and their OI performance improved after treatment, resolving the deficit relative to HC.</div></div><div><h3>Limitations</h3><div>The sample size was small, particularly for the healthy control group. We also tested only two neurocognitive tasks. Future study with larger sample sizes and more tasks is warranted.</div></div><div><h3>Conclusions</h3><div>These results suggest that task control deficits in OCD may be sensitive to symptom state. The possibility that improving task control represents a neurocognitive mechanism of successful CBT represents an important direction for future research.</div></div>","PeriodicalId":48198,"journal":{"name":"Journal of Behavior Therapy and Experimental Psychiatry","volume":"87 ","pages":"Article 102019"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reappraising beliefs about losing control: An experimental investigation","authors":"Cailyn P.E.A. Fridgen,&nbsp;Adam S. Radomsky","doi":"10.1016/j.jbtep.2024.102004","DOIUrl":"10.1016/j.jbtep.2024.102004","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Beliefs about losing control over one's thoughts, emotions, behaviours, and/or bodily functions have been shown to cause obsessive-compulsive symptoms. The cognitive model of obsessive-compulsive disorder (OCD) suggests that catastrophic misappraisals of intrusions will lessen if underlying maladaptive beliefs are effectively reduced. The primary aim of this study was to experimentally investigate whether preexisting negative appraisals about losing control could be reduced by reappraising a previous perceived loss of control.</div></div><div><h3>Methods</h3><div>A sample of (<em>n</em> = 52) undergraduate participants underwent either a brief cognitive intervention or a control memory task. Negative appraisals about losing control and anxiety were measured before and after the manipulation.</div></div><div><h3>Results</h3><div>In comparison to participants in the control condition, participants in the experimental condition reported a significantly greater reduction in negative appraisals about having lost control (<em>F</em>(1, 50) = 10.79, <em>p</em> = .002, <em>η</em>_<em>p</em>^<em>2</em> = .18) and about losing control in the future (<em>F</em>(1, 50) = 7.82, <em>p</em> = .007, <em>η</em>_<em>p</em>^<em>2</em> = .14) but not anxiety <em>F</em>(1, 50) = .81, <em>p</em> = .37, <em>η</em>_<em>p</em>^<em>2</em> = .02). <em>Limitations</em>: The absence of an impact on anxiety may be attributed to an underpowered sample size or the lack of a more robust intervention.</div></div><div><h3>Conclusions</h3><div>Results suggest that pre-existing beliefs about losing control can be reduced via a brief cognitive reappraisal-based intervention. Findings are discussed with respect to clinical and phenomenological implications.</div></div>","PeriodicalId":48198,"journal":{"name":"Journal of Behavior Therapy and Experimental Psychiatry","volume":"87 ","pages":"Article 102004"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a brief self-compassion intervention on state emotion dysregulation in self-reported generalized anxiety disorder","authors":"Jordan M. De Herrera,&nbsp;Cynthia L. Turk","doi":"10.1016/j.jbtep.2024.102012","DOIUrl":"10.1016/j.jbtep.2024.102012","url":null,"abstract":"<div><h3>Background and objectives</h3><div>The current study examined emotion dysregulation and self-compassion as an intervention in individuals with generalized anxiety disorder (GAD) symptoms.</div></div><div><h3>Methods</h3><div>College students who met criteria for GAD according to questionnaires and non-anxious controls participated in an anxious mood induction. Subsequently, participants were randomized to a self-compassion or control intervention.</div></div><div><h3>Results</h3><div>Following the mood induction, the GAD group reported less self-compassion, more emotion dysregulation, more state anxiety, and more negative affect than the control group. In the intervention phase, for the self-compassion condition, all participants, irrespective of the presence or absence of GAD symptomatology, experienced a significant increase in state self-compassion and a significant decrease in state anxiety from pre-to post-intervention. Additionally, participants in the GAD group in the self-compassion condition also endorsed significantly less state emotion dysregulation and less negative affect. Participants in both groups assigned to the control intervention reported little change. Within the GAD group, the self-compassion manipulation produced more state self-compassion than the control intervention.</div></div><div><h3>Limitations</h3><div>Participants were undergraduate students; as a result, the findings might not generalize to individuals presenting for treatment of GAD. The demonstrated effects were on state measures following a brief writing intervention; additional research is needed to assess the impact of more extensive self-compassion interventions over a longer time frame.</div></div><div><h3>Conclusions</h3><div>The results align with theory and previous studies, revealing heightened emotion dysregulation among those with GAD symptoms. A self-compassion intervention led to significant improvements for both participants with GAD symptoms and those without.</div></div>","PeriodicalId":48198,"journal":{"name":"Journal of Behavior Therapy and Experimental Psychiatry","volume":"87 ","pages":"Article 102012"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A decade on: Reflecting on the limitations of the first meta-analysis of the Implicit Relational Assessment Procedure's (IRAP) criterion validity in the clinical domain","authors":"Nigel Vahey ,&nbsp;Emma Nicholson ,&nbsp;Dermot Barnes-Holmes","doi":"10.1016/j.jbtep.2024.102016","DOIUrl":"10.1016/j.jbtep.2024.102016","url":null,"abstract":"<div><div>Hussey (in press) recently conducted a detailed critical reanalysis of Vahey, Nicholson and Barnes-Holmes’ (2015) meta-analysis. Its stated purpose was to (a) examine the extent to which Vahey et al.’s (2015) meta-analysis contains errors; and (b) to test how computationally reproducible it is by current standards of best practice. Hussey identified a small number of minor numerical errors, but crucially was unable to exactly replicate the original meta-effect of <span><math><mrow><mover><mi>r</mi><mo>‾</mo></mover></mrow></math></span> = .45. Six different variations of the meta-analysis reported by Vahey et al. were used and obtained meta-effects that deviated from the original by <em>Δ</em> <span><math><mrow><mover><mi>r</mi><mo>‾</mo></mover></mrow></math></span> = .01-.02. Hussey also reported corresponding 95% credibility intervals that were all of zero width. These discrepancies prompted the present authors to conduct a detailed audit of the original meta-analysis. This revealed one minor transposing error in addition to three identified by Hussey. Once corrected this resulted in a marginally increased Hunter and Schmidt meta-analytic effect of <span><math><mrow><mover><mi>r</mi><mo>‾</mo></mover></mrow></math></span> = .46 without a credibility interval, and a Hedges-Vevea meta-effect of <span><math><mrow><mover><mi>r</mi><mo>‾</mo></mover></mrow></math></span> = .47 with 95% confidence interval (.40, .54). This correction was too small to have any bearing on Vahey et al.’s supplementary analyses regarding publication bias or statistical power. Vahey et al. contained a much lower proportion of transposing errors than is typical of meta-analyses even still (cf. Kadlec, Sainani, &amp; Nimphius, 2023; Lakens et al., 2016; Lakens et al., 2017). Nonetheless, Hussey highlighted important ambiguities about the theoretical and practical meaning of the meta-effect reported by Vahey et al. We clarify our position on these matters in summary, and in so doing explain why we believe that the wider IRAP literature would undoubtedly benefit from increased adoption of contemporary open science standards.</div></div>","PeriodicalId":48198,"journal":{"name":"Journal of Behavior Therapy and Experimental Psychiatry","volume":"87 ","pages":"Article 102016"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An online group behavioral activation therapy for major depressive disorder: Adaptation, effectiveness, and trajectories of change in a lower-middle income country","authors":"Sara Sardashti ,&nbsp;Maryam Farhadian ,&nbsp;Ali Ghaleiha ,&nbsp;Fritz Renner ,&nbsp;Sara Ahsani-Nasab ,&nbsp;Latif Moradveisi","doi":"10.1016/j.jbtep.2024.102013","DOIUrl":"10.1016/j.jbtep.2024.102013","url":null,"abstract":"<div><h3>Background and objective</h3><div>Depressive disorders are common mental illnesses associated with high burden of disease. In this study, the effects of an online group behavioral activation on depressive symptoms and rumination were evaluated, and trajectories of change in patients with major depressive disorder adapted for a lower-middle income context investigated.</div></div><div><h3>Methods</h3><div>This study was an online single-group non-randomized trial. Patients were recruited from various parts of the country through social media and medical university clinics. In total, 79 women with major depressive disorder were included. We measured Beck Depressive Inventory-II (BDI-II) scores, depressive rumination and behavioral activation scores, sudden gains, depression spikes, early response, and clinical change. Patients attended an online weekly ten-session behavioral activation therapy. K-nearest neighbor was used to impute missing data and estimate the importance of candidate predictors of clinical change. However, due to a high attrition rate, paired tests were performed using per-protocol analysis without data imputation.</div></div><div><h3>Results</h3><div>The mean difference (SD) of the BDI-II score from the beginning to the end of the study was 21.10 (10.21), <em>P</em> &lt; 0.001. Improvement was observed for depressive rumination (<em>P</em> &lt; 0.001), and for behavioral activation (<em>P</em> &lt; 0.001). Clinical change and early response were significantly related to BDI-II change (both <em>P</em> &lt; 0.001). Favorable changes in behavioral activation, depressive symptoms, or rumination showed linear patterns. Clinical change (<em>P</em> = 0.453) and BDI-II (<em>P</em> = 0.050) were not statistically different between patients with moderate versus severe symptoms.</div></div><div><h3>Limitations</h3><div>Participants were solely women. Some patients did not attend all sessions, and participants were not followed in the post-treatment period.</div></div><div><h3>Conclusion</h3><div>online group behavioral activation therapy is suggested as an appropriate and accessible front-line treatment for moderate to severe major depressive disorder in lower-middle income countries.</div></div>","PeriodicalId":48198,"journal":{"name":"Journal of Behavior Therapy and Experimental Psychiatry","volume":"87 ","pages":"Article 102013"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}