An Open Trial of Behavioral Activation in Veterans With Major Depressive Disorder or Posttraumatic Stress Disorder in Primary Care

Objective: Integrated behavioral health programs provide brief evaluations and interventions to patients with psychiatric symptoms in primary care. These programs seek to decrease stigma and improve access to mental health services. Several psychotherapeutic interventions are available to providers, each with its own strengths and weaknesses. One treatment with particular promise is behavioral activation treatment for depression (BATD) due to its potential clinical efficacy, transdiagnostic potential, and ease of dissemination and implementation in primary care settings. The objective of this study was to investigate the efficacy of BATD across 2 DSM-5 diagnoses: major depressive disorder (MDD) and posttraumatic stress disorder (PTSD).

Methods: Participants were recruited from October 2014 to December 2017. Thirty-one participants were referred from primary care and consented to receive a 12-session trial of BATD. Participants endorsed criteria consistent with a principal diagnosis of either MDD (n = 20) or PTSD (n = 11). Self-report measures were completed at baseline and immediately posttreatment to monitor treatment progress in symptoms of PTSD and MDD.

Results: Twelve of the 31 participants completed all 12 sessions of BATD, although over 70% completed at least 4 sessions. Participants demonstrated significant symptom improvement across symptoms of MDD and PTSD (all P < .004). No disorder group differences were evidenced for symptom reduction, treatment completion, or treatment satisfaction.

Conclusions: The present study provides support for the efficacy of BATD for patients with MDD and PTSD. These findings may have implications for the dissemination and implementation efforts for psychotherapies in integrated primary care settings.

Trial Registration: ClinicalTrials.gov identifier: NCT01947647