Treating depressive symptoms among veterans in primary care: A multi-site RCT of brief behavioral activation

Funderburk, Jennifer S.; Pigeon, Wilfred R.; Shepardson, Robyn L.; Acker, John; Fivecoat, Hayley C.; Wray, Laura O.; Maisto, Stephen A.

doi:10.1016/j.jad.2021.01.033

Cited by 12 publications

(7 citation statements)

References 36 publications

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“…As an example, while exposure therapy could easily fill ten 50-min weekly sessions within specialty care, its essence can be distilled to the role of avoidance in maintaining anxiety and the utility of pushing oneself to do things that are anxiety-provoking, which can be conveyed within a single 30-min IPC visit. Helping BHPs to become aware of and comfortable with IPC treatment aims and corresponding abbreviated versions of evidence-based behavioral interventions designed specifically for use in IPC (e.g., Funderburk et al, 2021; Rauch et al, 2017) may increase utilization.…”

Section: Discussionmentioning

confidence: 99%

Barriers to and facilitators of using evidence-based, cognitive–behavioral anxiety interventions in integrated primary care practice.

Shepardson¹,

Fletcher²,

Funderburk³

et al. 2023

Psychological Services

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Section: Discussionmentioning

confidence: 99%

Barriers to and facilitators of using evidence-based, cognitive–behavioral anxiety interventions in integrated primary care practice.

Shepardson¹,

Fletcher²,

Funderburk³

et al. 2023

Psychological Services

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“…They found that patients with higher levels of mental health stigma preferred receiving treatment in a PC setting. There are also studies that found a significant number of patients demonstrating a significant decline in symptoms for a variety of presenting problems following the initial assessment in PC (Funderburk, Pigeon, et al, 2021; Klein et al, 2017; Stasiewicz et al, 2013; West et al, 2011). However, these studies did not examine the mechanisms that may have caused the change.…”

Section: Background and Definitionsmentioning

confidence: 99%

How do models of integrated primary care work? A proposed model for mechanisms of change using primary care behavioral health.

Funderburk,

Wray,

Martin

et al. 2024

Psychological Services

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Embedding a behavioral health consultant (BHC) into primary care settings is a common way to address the challenge of providing mental health services to primary care patients. Systematic research on the mechanisms of change that underlie the relationship between the active components of these integrated models of care delivery on patient outcomes is needed to help maximize effectiveness and, in turn, guide future implementation efforts. Using the existing primary care behavioral health (PCBH) literature, this article provides a conceptual framework using a common presenting problem, depression and identifies the active ingredients of PCBH and hypothesized mechanisms of patient change that result in decreased depressive symptoms and improved functioning within a patient. Eight hypothesized mechanisms (i.e., belief that PCBH services provided by BHC is a standard part of care within primary care; increased credibility of BHC and PCBH care provided; increased receptivity to the PCBH services offered; increased understanding of problem and options; realignment of patient expectations for care; increased readiness to change; decrease stigma; increase capacity to cope and manage symptoms) are proposed within this conceptual framework along with four potential mediators/moderators (i.e., team processes, PCBH factors, common factors, treatment engagement). The theoretical conceptualization included calls for future research to provide an evidence base to inform clinical practice. An increased understanding of the relationship between these active ingredients and the identified mechanisms of change is essential to maximize PCBH's effectiveness. Public Significance StatementEmbedding a BHC into primary care settings, such as within primary care behavioral health, is a popular way to increase access to mental health services. Greater systematic research and attention to the eight proposed mechanisms in this article can assist in maximizing effectiveness and optimizing implementation.

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“…Recent studies from developed countries have shown promising outcomes with the implementation of MBAT in primary care services for treating depression, with strong adherence to treatment and acceptability observed. [17][18][19] Despite the considerable potential of MBAT to aid rural elderly with depressive symptoms, there remains limited empirical evidence supporting its practical application in China. Furthermore, therapeutic manuals designed to address geriatric depressive symptoms are currently unavailable.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Effectiveness of a modified behavioural activation treatment training program for primary medical staff to manage depressive symptoms among rural elderly in Hunan Province, China: study protocol for a cluster randomised controlled trial

Qin,

Luo,

Wang

et al. 2024

BMJ Open

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IntroductionDepression is a major global health problem, with high prevalence rates of depressive symptoms observed among the elderly population in China, particularly exacerbating in rural areas. Due to a lack of professional mental health training and inadequate psychotherapy capacity within primary medical staff, rural elderly individuals grappling with depressive symptoms often encounter challenges in receiving timely diagnosis and treatment. In this landscape, the modified behavioural activation treatment (MBAT) emerges as a promising approach due to its practicality, ease of therapist training and application, patient acceptability, and broad applicability. However, existing evidence for MBAT mainly hails from developed countries, leaving a gap in its adaptation and implementation within rural China. This study aims to develop an MBAT training programme for primary medical staff to manage depressive symptoms among rural elderly and evaluate its effectiveness.Methods and analysisA cluster randomised controlled trial will be conducted in 10 randomly selected township hospitals in Lengshuijiang and Lianyuan, Hunan Province. We aim to recruit 150 participants, with 5 township hospitals selected for each group, each consisting of 15 participants. The intervention group will implement the MBAT training programme, while the control group will receive usual care training programme. Depressive symptoms, psychosocial functioning, quality of life and satisfaction will be measured at baseline, immediately post-intervention, and at 3 and 6 months post-intervention. Effectiveness will be assessed using linear or generalised linear mixed models.Ethics and disseminationThis study has obtained approval from the Institutional Review Board of the Third Xiangya Hospital, Centre South University (No.: 2022-S261). Results will be disseminated through publication in international peer-reviewed journals and presentations at national and international conferences.Trial registration numberChiCTR2300074544.

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Treating depressive symptoms among veterans in primary care: A multi-site RCT of brief behavioral activation

Cited by 12 publications

References 36 publications

Barriers to and facilitators of using evidence-based, cognitive–behavioral anxiety interventions in integrated primary care practice.

Barriers to and facilitators of using evidence-based, cognitive–behavioral anxiety interventions in integrated primary care practice.

How do models of integrated primary care work? A proposed model for mechanisms of change using primary care behavioral health.

Effectiveness of a modified behavioural activation treatment training program for primary medical staff to manage depressive symptoms among rural elderly in Hunan Province, China: study protocol for a cluster randomised controlled trial

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