Examining the Theoretical Framework of Behavioral Activation for Major Depressive Disorder: Smartphone-Based Ecological Momentary Assessment Study Article Swipe
Claire van Genugten
,
Josien Schuurmans
,
Adriaan W. Hoogendoorn
,
Ricardo Araya
,
Gerhard Andersson
,
Rosa Baños
,
Cristina Botella
,
Arlinda Cerga Pashoja
,
Roman Cieślak
,
David Daniel Ebert
,
Azucena García‐Palacios
,
Jean‐Baptiste Hazo
,
Rocío Herrero
,
Jérôme Holtzmann
,
Lise Kemmeren
,
Annet Kleiboer
,
Tobias Krieger
,
Ewelina Smoktunowicz
,
Ingrid Titzler
,
Naira Topooco
,
Antoine Urech
,
Johannes H. Smit
,
Heleen Riper
·
YOU?
·
· 2021
· Open Access
·
· DOI: https://doi.org/10.2196/32007
YOU?
·
· 2021
· Open Access
·
· DOI: https://doi.org/10.2196/32007
Background Behavioral activation (BA), either as a stand-alone treatment or as part of cognitive behavioral therapy, has been shown to be effective for treating depression. The theoretical underpinnings of BA derive from Lewinsohn et al’s theory of depression. The central premise of BA is that having patients engage in more pleasant activities leads to them experiencing more pleasure and elevates their mood, which, in turn, leads to further (behavioral) activation. However, there is a dearth of empirical evidence about the theoretical framework of BA. Objective This study aims to examine the assumed (temporal) associations of the 3 constructs in the theoretical framework of BA. Methods Data were collected as part of the “European Comparative Effectiveness Research on Internet-based Depression Treatment versus treatment-as-usual” trial among patients who were randomly assigned to receive blended cognitive behavioral therapy (bCBT). As part of bCBT, patients completed weekly assessments of their level of engagement in pleasant activities, the pleasure they experienced as a result of these activities, and their mood over the course of the treatment using a smartphone-based ecological momentary assessment (EMA) application. Longitudinal cross-lagged and cross-sectional associations of 240 patients were examined using random intercept cross-lagged panel models. Results The analyses did not reveal any statistically significant cross-lagged coefficients (all P>.05). Statistically significant cross-sectional positive associations between activities, pleasure, and mood levels were identified. Moreover, the levels of engagement in activities, pleasure, and mood slightly increased over the duration of the treatment. In addition, mood seemed to carry over, over time, while both levels of engagement in activities and pleasurable experiences did not. Conclusions The results were partially in accordance with the theoretical framework of BA, insofar as the analyses revealed cross-sectional relationships between levels of engagement in activities, pleasurable experiences deriving from these activities, and enhanced mood. However, given that no statistically significant temporal relationships were revealed, no conclusions could be drawn about potential causality. A shorter measurement interval (eg, daily rather than weekly EMA reports) might be more attuned to detecting potential underlying temporal pathways. Future research should use an EMA methodology to further investigate temporal associations, based on theory and how treatments are presented to patients. Trial Registration ClinicalTrials.gov, NCT02542891, https://clinicaltrials.gov/ct2/show/NCT02542891; German Clinical Trials Register, DRKS00006866, https://tinyurl.com/ybja3xz7; Netherlands Trials Register, NTR4962, https://www.trialregister.nl/trial/4838; ClinicalTrials.Gov, NCT02389660, https://clinicaltrials.gov/ct2/show/NCT02389660; ClinicalTrials.gov, NCT02361684, https://clinicaltrials.gov/ct2/show/NCT02361684; ClinicalTrials.gov, NCT02449447, https://clinicaltrials.gov/ct2/show/NCT02449447; ClinicalTrials.gov, NCT02410616, https://clinicaltrials.gov/ct2/show/NCT02410616; ISRCTN registry, ISRCTN12388725, https://www.isrctn.com/ISRCTN12388725
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.2196/32007
- https://mental.jmir.org/2021/12/e32007/PDF
- OA Status
- gold
- Cited By
- 8
- References
- 63
- Related Works
- 10
- OpenAlex ID
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All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4200323417Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.2196/32007Digital Object Identifier
- Title
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Examining the Theoretical Framework of Behavioral Activation for Major Depressive Disorder: Smartphone-Based Ecological Momentary Assessment StudyWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
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2021Year of publication
- Publication date
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2021-12-06Full publication date if available
- Authors
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Claire van Genugten, Josien Schuurmans, Adriaan W. Hoogendoorn, Ricardo Araya, Gerhard Andersson, Rosa Baños, Cristina Botella, Arlinda Cerga Pashoja, Roman Cieślak, David Daniel Ebert, Azucena García‐Palacios, Jean‐Baptiste Hazo, Rocío Herrero, Jérôme Holtzmann, Lise Kemmeren, Annet Kleiboer, Tobias Krieger, Ewelina Smoktunowicz, Ingrid Titzler, Naira Topooco, Antoine Urech, Johannes H. Smit, Heleen RiperList of authors in order
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https://doi.org/10.2196/32007Publisher landing page
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https://mental.jmir.org/2021/12/e32007/PDFDirect link to full text PDF
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YesWhether a free full text is available
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goldOpen access status per OpenAlex
- OA URL
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https://mental.jmir.org/2021/12/e32007/PDFDirect OA link when available
- Concepts
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Ecology, Psychology, Smartphone application, Behavioral activation, Major depressive disorder, Clinical psychology, Psychiatry, Computer science, Mood, Biology, Cognition, MultimediaTop concepts (fields/topics) attached by OpenAlex
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8Total citation count in OpenAlex
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2025: 2, 2024: 1, 2023: 3, 2022: 2Per-year citation counts (last 5 years)
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| abstract_inverted_index.activation. | 69 |
| abstract_inverted_index.activities, | 151, 161, 214, 227, 285, 291 |
| abstract_inverted_index.assessments | 143 |
| abstract_inverted_index.conclusions | 306 |
| abstract_inverted_index.depression. | 24, 37 |
| abstract_inverted_index.experienced | 155 |
| abstract_inverted_index.experiences | 257, 287 |
| abstract_inverted_index.identified. | 220 |
| abstract_inverted_index.investigate | 343 |
| abstract_inverted_index.measurement | 315 |
| abstract_inverted_index.methodology | 340 |
| abstract_inverted_index.pleasurable | 256, 286 |
| abstract_inverted_index.significant | 203, 209, 300 |
| abstract_inverted_index.stand-alone | 7 |
| abstract_inverted_index.theoretical | 26, 80, 100, 269 |
| abstract_inverted_index.“European | 112 |
| abstract_inverted_index.(behavioral) | 68 |
| abstract_inverted_index.Longitudinal | 179 |
| abstract_inverted_index.NCT02361684, | 376 |
| abstract_inverted_index.NCT02389660, | 373 |
| abstract_inverted_index.NCT02410616, | 382 |
| abstract_inverted_index.NCT02449447, | 379 |
| abstract_inverted_index.NCT02542891, | 359 |
| abstract_inverted_index.Registration | 357 |
| abstract_inverted_index.application. | 178 |
| abstract_inverted_index.associations | 93, 183, 212 |
| abstract_inverted_index.coefficients | 205 |
| abstract_inverted_index.cross-lagged | 180, 192, 204 |
| abstract_inverted_index.experiencing | 55 |
| abstract_inverted_index.DRKS00006866, | 365 |
| abstract_inverted_index.Effectiveness | 114 |
| abstract_inverted_index.Statistically | 208 |
| abstract_inverted_index.associations, | 345 |
| abstract_inverted_index.relationships | 279, 302 |
| abstract_inverted_index.statistically | 202, 299 |
| abstract_inverted_index.underpinnings | 27 |
| abstract_inverted_index.Internet-based | 117 |
| abstract_inverted_index.ISRCTN12388725, | 386 |
| abstract_inverted_index.cross-sectional | 182, 210, 278 |
| abstract_inverted_index.smartphone-based | 173 |
| abstract_inverted_index.ClinicalTrials.Gov, | 372 |
| abstract_inverted_index.ClinicalTrials.gov, | 358, 375, 378, 381 |
| abstract_inverted_index.treatment-as-usual” | 121 |
| abstract_inverted_index.https://tinyurl.com/ybja3xz7; | 366 |
| abstract_inverted_index.https://www.isrctn.com/ISRCTN12388725 | 387 |
| abstract_inverted_index.https://www.trialregister.nl/trial/4838; | 371 |
| abstract_inverted_index.https://clinicaltrials.gov/ct2/show/NCT02361684; | 377 |
| abstract_inverted_index.https://clinicaltrials.gov/ct2/show/NCT02389660; | 374 |
| abstract_inverted_index.https://clinicaltrials.gov/ct2/show/NCT02410616; | 383 |
| abstract_inverted_index.https://clinicaltrials.gov/ct2/show/NCT02449447; | 380 |
| abstract_inverted_index.https://clinicaltrials.gov/ct2/show/NCT02542891; | 360 |
| cited_by_percentile_year.max | 97 |
| cited_by_percentile_year.min | 90 |
| countries_distinct_count | 11 |
| institutions_distinct_count | 23 |
| citation_normalized_percentile.value | 0.78013364 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | False |