Computer‐delivered behavioural activation and approach‐avoidance training in major depression: Proof of concept and initial outcomes

Abstract

Objectives Individuals with major depressive disorder (MDD) have problems with engaging in approach behaviour to potentially rewarding encounters, which contributes to the maintenance of depressive symptoms. Approach‐avoidance training (AAT) retrains implicit approach tendencies, and behavioural activation (BA) promotes explicit approach behaviour in MDD. As a novel MDD treatment strategy, this study aimed to implement a brief, computerized version of BA integrated with implicit AAT. Design Adults with a principal diagnosis of MDD (N = 25) were randomly assigned to complete one of two versions of AAT – approach‐positive faces (n = 12) or balanced approach of positive and neutral faces (n = 13) – concurrently with self‐guided BA twice weekly for 2 weeks. Methods Outcomes included treatment completion rates; bias scores for automatic approach towards positive social cues; and symptom scales for depression, positive affect, social relationship functioning, anhedonia, and anxiety. Results Feasibility and acceptability of computerized BA + AAT were supported by moderate pre‐treatment credibility and expectancy ratings and 80% treatment completion. Participants across both conditions displayed significant and large sized reductions in depression from pre‐ to post‐assessment (Cohen’s d = −1.23) that maintained three months later, as well as decreased anxiety and anhedonia and increased positive affect and social relationship functioning (medium to large effects). Conclusion Results support the feasibility and potential efficacy of brief, computerized BA + AAT. Research is needed to determine whether AAT is additive to BA, and what AAT parameters best enhance treatment outcomes. Practitioner Points Brief, computerized behavioral activation plus approach/avoidance training (BA + AAT) may be acceptable and beneficial for some patients with moderate‐to‐severe major depression. Computer‐delivered BA + AAT can be implemented as a largely self‐guided program for MDD and could be administered remotely and/or with minimal clinician interaction. As this was a small proof of concept study, it cannot be determined which treatment components – AAT, BA, or both – contributed to positive clinical outcomes. Because BA + AAT was implemented in a research clinic, it remains unknown what treatment engagement and response would look like in community settings.

Cognitive and behavioral avoidance.

“…An innovative computerized treatment of BA was recently used to target explicit avoidance behavior and to target implicit approach-avoidance behavior. This model yielded decreased depressive symptoms, anxiety scores, and anhedonia and increased positive affect and social relationship functioning (Sweet et al, 2021). Although the sample was small (N = 25) the results were promising in that a brief computerized version of BA, along with approach-avoidance training, could have a positive impact on these several areas.…”

Comparison of two reaction-time-based and one foraging-based behavioral approach-avoidance tasks in relation to interindividual differences and their reliability

“…In addition to our preregistered aims above and considering the underreporting of reliability measures in the literature, we also assessed internal consistencies for the outcome measures of all three tasks as Aim 3 of our study and hope this practice becomes more commonplace in future research. This appears especially relevant as clinical studies utilize approach-avoidance tasks as possible interventions to alter behavioral tendencies 31 – 33 , implying the need for consistent measurement tools that can reliably capture participants' approach-avoidance behaviors.…”