Behavioral activation (BA) group therapy has been shown to be a potential treatment approach for reducing depressive symptoms and improving quality of life (QoL) among adult patients with depression, according to the results of a parallel group, single cohort, pragmatic, pilot, randomized controlled trial published in Pilot and Feasibility Studies.

Originally a component of cognitive behavioral therapy, BA attempts to have patients eliminate behaviors that may reinforce depressive symptoms and develop links to positive reinforcers in their environment.

The investigators sought to evaluate the feasibility of implementing a full trial of BA group therapy in a large scale tertiary setting and to offer preliminary information with respect to mood symptoms and QoL among adults with depression. The study was carried out within the Mood Disorders Program at St. Joseph’s Healthcare Hamilton, an outpatient specialized mood disorders clinic located in Hamilton, Ontario, Canada, as part of the BehavioRal ActiVation for reducing dEpressive symptoms and improving quality of life in patients with depression (BRAVE) trial ( identifier: NCT02045771).

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A total of 20 patients (mean age, 48.8±9.7 years; 60% women) with a diagnosis of major depressive disorder were enrolled in the study and were allocated in a 1:1 fashion to 2 groups: 10 patients in the intervention group (BA in addition to usual care) and 10 in the control group (support group in addition to usual care). All 10 participants in the intervention arm completed the study, whereas 6 of those in the control arm completed the trial (3 patients were lost to follow-up and 1 withdrew from the study), yielding a moderate study completion rate of 80% of the total participants.

Over the course of the 18-week study period, a total of 8 measures were evaluated, including Beck Depression Inventory (BDI) and Health Survey Short-Form 12 (SF-12), among others. Follow-up interviews with the control and the intervention groups were also conducted.

The researchers noted that “preliminary data demonstrate no noticeable difference between intervention and control groups on all study measures.” The average completion rate for the study instruments was 86% in the BA intervention group vs 79% in the control group. The therapists who provided the BA study intervention considered a group size of between 8 and 12 participants to be ideal, in order to adequately manage the individuals at each of the sessions.

The loss to follow-up reported in the control group is a challenge that will need to be addressed, with modifications in the plans regarding selection of a comparator group needed. It has been proposed that the control condition will be changed to a waitlist followed by receiving the intervention, thus comparing the groups based on intervention vs waitlist conditions. Postintervention follow-up duration may need to be increased.

The researchers concluded, “Based on our feasibility criteria as well as our study design, methodology, and comprehensive assessment of outcomes, the full investigation is likely to be conducted to evaluate the effectiveness of BA group therapy as a potential therapeutic approach to the treatment of major depression in adults.”


D’Elia A, Bawor M, Dennis BB, et al. Feasibility of behavioral activation group therapy in reducing depressive symptoms and improving quality of life in patients with depression: the BRAVE pilot trial [published online May 7, 2020]. Pilot Feasibility Stud. doi: 10.1186/s40814-020-00596-z.