An Application of Behavioral Activation Therapy for Major Depressive Disorder in the Context of Complicated Grief, Low Social-Economic Status, and Ethnic Minority Status

Abstract

Behavioral activation (BA) has been shown to be an effective treatment for depression, especially for severe and/or chronic depression; however, there is little empirical guidance on how BA can be effectively utilized to treat chronic Major Depressive Disorder (MDD) in the context of complicated grief, low socioeconomic status, and ethnic minority status. This case study focuses on the treatment of Ms. X, a 51-year-old African American woman with chronic depression that was exacerbated by complicated grief. This case describes an effective course of a standard BA protocol for MDD in the context of complicated grief, low socioeconomic status, and ethnic minority status and illustrates how a BA protocol can be applied while incorporating important cultural considerations.

A Systematic Review of Culturally Adapted Behavioral Activation Treatments for Depression

“…Posttraumatic stress and complicated grief were also present in the case study conducted by Vergara-Lopez and Roberts (2015). The client reported several past traumatic events, for example, childhood and domestic abuse and the unexpected death of her daughter, resulting in various forms of avoidance behavior, feelings of detachment from others, intrusive thoughts, and difficulty accepting the loss.…”

“…Mir et al (2015) point out that while therapists from a similar religious and cultural background are more likely to understand cultural and religious references, they might also evoke concerns about confidentiality and induce guilt in the client. The professional background of the therapists involved in the studies varied widely, ranging from doctoral-level therapists (Benson-Flórez et al, 2017; Moradveisi et al, 2013) and mental health practitioners with a master’s degree in varying fields (e.g., Collado et al, 2016; Gitlin et al, 2013; Kanter et al, 2015; Moradveisi et al, 2013) to students of differing degrees (e.g., Collado et al, 2014; Kanter et al, 2010; Vergara-Lopez & Roberts, 2015; Xie et al, 2019) and even lay counselors without professional qualification in mental health care (Chowdhary et al, 2016; Patel et al, 2017). In several studies, treatment was delivered by social workers (Gitlin et al, 2013; Kanter et al, 2008; Kanter et al, 2010; Kanter et al, 2015).…”

“…Related to the theoretical model used in treatment, the dimension of concepts includes the way in which the problem is presented to the client. In several studies, the straightforward rationale of BA was highlighted, focusing on environmental causes of depression and on action steps to address these issues, which might help to reduce stigma and prevent premature termination (Chowdhary et al, 2016; Kanter et al, 2008; Kanter et al, 2010; Kanter et al, 2015; Santiago-Rivera et al, 2008; Vergara-Lopez & Roberts, 2015). In both adapted treatment manuals, the treatment rationale was simplified, and culturally and contextually appropriate examples for difficult life events and common responses were included (Kanter, Santiago-Rivera et al, 2014; Mir et al, 2016).…”

“…According to Bernal and Sáez-Santiago (2006), goals as the sixth dimension should represent an agreement between therapist and client and consider cultural values. The cases described in Benson-Flórez et al (2017), Kanter et al (2008), or Vergara-Lopez and Roberts (2015) illustrate how the formulation of goals in behavioral activation is guided by an individual assessment of values and by sociocultural considerations, for example, when the therapist refrained from suggesting a direct confrontation with the husband.…”

Cognitive-Behavioral Therapy for a Refugee Mother With Depression and Anxiety

“…Behavioral activation (BA; Dimidjian et al, 2014) has been incorporated into CBT and has emerged as one of the leading evidence-based treatments for individuals diagnosed with depression (Vergara-Lopez & Roberts, 2015) and anxiety (Boswell et al, 2017). BA asserts that people's behavioral responses to struggles or hardship may reduce one's ability to fully experience positive rewards from the environment, highlights the importance of contingencies between behaviors and environments in which occur, and focuses on these contingencies rather than presenting issues per se during the treatment.…”