Behavioral Activation for a Breast Cancer Patient with Major Depression and Coexistent Personality Disorder
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Behavioral activation is an empirically validated treatment for depression, with recent applications toward other psychological and medical conditions. However, modification to the treatment protocol may be necessary when symptoms, environment, or personality necessitate. This feasibility study applied Behavioral Activation Treatment for Depression (BATD) in a case of a woman with recurrent major depression and obsessive–compulsive personality disorder (OCPD) undergoing breast cancer treatment. A quasi-experimental design was used, comparing supportive psychotherapy (while she received radiation therapy) followed by eight sessions of BATD. Treatment was designed in accordance with patient and therapist goals of increasing exercise, decreasing fatigue, and reducing interference due to perfectionistic behaviors. The patient exhibited resistance to initiation of BATD, related to symptoms of OCPD, which necessitated modification of treatment strategies and scheduling. Following BATD, the patient reported a significant reduction in depressive symptoms, physical problems, and role limitations—gains not observed following supportive therapy. In addition, she demonstrated less psychological rigidity and interference due to OCPD symptoms within the therapeutic relationship and other interpersonal relationships. Consistent with previous research, results indicate BATD may effectively treat individuals with complex clinical presentations that include personality disorder pathology. In addition, methods of modification to BATD are discussed, as well as future directions for research in this area.
KeywordsBehavioral activation Depression OCPD Cancer Flexibility within fidelity
Compliance with Ethical Standards
Conflict of interest
All authors declare that there are no conflicts of interest with this study.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in this study.
- Beck, A. T., Steer, R. A., & Brown, G. (1996). Manual for the beck depression inventory–II. San Antonio, TX: Psychological Corporation.Google Scholar
- Ferrari, A. J., Charlson, F. J., Norman, R. E., Patten, S. B., Freedman, G., Murray, C. J. L., et al. (2013a). Burden of depressive disorders by country, sex, age, and year: Findings from the Global Burden of Disease study 2010. PLoS Medicine, 10(11), e1001547.CrossRefPubMedPubMedCentralGoogle Scholar
- Ferrari, A. J., Somerville, A. J., Baxter, A. J., Norman, R., Patten, S. B., Vos, T., & Whiteford, H. A. (2013b). Global variation in the prevalence and incidence of major depressive disorder: A systematic review of the epidemiological literature. Psychological Medicine, 43, 471–481.CrossRefPubMedGoogle Scholar
- Hopko, D. R., Armento, M. E. A., Robertson, S. M. C., Ryba, M., Carvalho, J. P., Johanson, L., … Lejuez, C. W. (2011). Brief behavioral activation and problem-solving therapy for depressed breast cancer patients: Randomized trial. Journal of Consulting and Clinical Psychology, 79, 834–839.CrossRefPubMedGoogle Scholar
- Hopko, D. R., McIndoo, C. C., & File, A. A. (2015). Depressive syndromes and medical comorbidities. In R. DeRubeis, & D. Strunk (Eds.), The Oxford handbook of mood disorders. New York: Oxford University Press.Google Scholar
- Keller, M. B., Gelenberg, A. J., Hirschfeld, R. M. A., Rush, A. J., Thase, M. E., Kocsis, J. H., … Harrison, W.M. (1998). The treatment of chronic depression, part 2: A double-blind, randomized trial of sertraline and imipramine. Journal of Clinical Psychiatry, 59, 598–607CrossRefPubMedGoogle Scholar
- Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., … Wang, P. S. (2003). The epidemiology of major depressive disorder: Results from the National Comorbidity Survey Replication (NCS-R). Journal of the American Medical Association, 289, 3095–3105.CrossRefPubMedGoogle Scholar
- Lewinsohn, P. M. (1974). A behavioral approach to depression. In R. M. Friedman & M. M. Katz (Eds.), The psychology of depression: Contemporary theory and research. New York: Wiley.Google Scholar
- Loberiza, F. R., Rizzo, J. D., Bredeson, C. N., Antin, J. H., Horowitz, M. M., Weeks, J. C., & Lee, S. J. (2002). Association of depressive syndrome and early deaths among patients after stem-cell transplantation for malignant diseases. Journal of Clinical Oncology, 20(8), 2118–2126.CrossRefPubMedGoogle Scholar
- MacPherson, L., Tull, M. T., Matusiewicz, A., Rodman, S., Strong, D. R., Kahler, C. W., … Lejuez, C. W. (2010). Randomized controlled trial of behavioral activation smoking cessation treatment for smokers with elevated depressive symptoms. Journal of Consulting and Clinical Psychology, 78, 55–71.CrossRefPubMedPubMedCentralGoogle Scholar
- Nezu, A., Ronan, G., Meadows, E., & McClure, K. (Eds.). (2000). Practitioner’s guide to empirically-based measures of depression (Vol. XIII). New York, NY: Kluwer Academic/Plenum.Google Scholar
- Scheel, M. J., Hanson, W. E., & Razzhavaikina, T. I. (2004). The process of recommending homework in psychotherapy: A review of therapist delivery methods, client acceptability, and factors that affect compliance. Psychotherapy: Theory, Research, Practice, Training, 41(1), 38–55.CrossRefGoogle Scholar
- Skinner, B. F. (1953). Science and human behavior. New York: Free Press.Google Scholar
- Stafford, L., Judd, F., Gibson, P., Komiti, A., Mann, G. B., & Quinn, M. (2015). Anxiety and depression symptoms in the 2 years following diagnosis of breast or gynaecologic cancer: Prevalence, course and determinants of outcome. Supportive Care in Cancer, 23(8), 2215–2224.CrossRefPubMedGoogle Scholar
- Vodermaier, A., Linden, W., Rnic, K., Young, S. N., Ng, A., Ditsch, N., & Olson, R. (2014). Prospective associations of depression with survival: A population-based cohort study in patients with newly diagnosed breast cancer. Breast Cancer Research and Treatment, 143, 373–384.CrossRefPubMedGoogle Scholar
- Ware, J. E., Snow, K. K., Kosinski, M., & Gandek, B. (1993). SF-36 health survey manual and interpretation guide. Boston, MA: Health Institute.Google Scholar