Behavioral Activation + Medication for Depression & Anxiety in Aging Adults with Orthopedic Procedures
(CPMH Trial)
Recruiting in Palo Alto (17 mi)
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Waitlist Available
Sponsor: Washington University School of Medicine
Disqualifiers: Severe cognitive impairment, Acutely suicidal, others
No Placebo Group
Trial Summary
What is the purpose of this trial?This Hybrid 1 Study will test the effectiveness of a bundled intervention comprised of behavioral activation and medication optimization in reducing symptoms of depression and anxiety in older adults undergoing Orthopedic surgery (compared with usual care), while examining implementation outcomes.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.
What data supports the effectiveness of the treatment Behavioral Activation + Medication for Depression & Anxiety in Aging Adults with Orthopedic Procedures?
Research shows that Behavioral Activation (BA) is effective in reducing depressive symptoms among older adults, including those in geriatric psychiatry settings and veterans in primary care. BA is a simple and accessible treatment that helps improve depression by encouraging engagement in positive activities.
12345How is the treatment for depression and anxiety in aging adults with orthopedic procedures unique?
This treatment combines Behavioral Activation (BA), which encourages engaging in activities to boost mood, with medication optimization, making it unique by addressing both behavioral and pharmacological aspects of depression and anxiety in older adults undergoing orthopedic procedures.
12356Eligibility Criteria
This trial is for adults aged 60 or older who are about to have hip or knee replacement surgery and are experiencing noticeable symptoms of depression or anxiety. They must be able to communicate in English. Those with severe cognitive issues, a history of similar study participation, or acute suicidal thoughts cannot join.Inclusion Criteria
PHQ-ADS ≥ 10, indicating clinically significant depression or anxiety symptoms
I am 60 years old or older.
I am scheduled for a first-time hip or knee replacement surgery.
Exclusion Criteria
Barrier to communication (Unable to read, speak, and understand English)
Severe cognitive impairment screened by the SBT (Short Blessed Test) >10
Acutely suicidal
+1 more
Participant Groups
The study is examining the impact of combining behavioral activation (a therapy focusing on increasing engagement in valued activities) with medication adjustments versus usual care on reducing depression and anxiety in aging adults during orthopedic surgery recovery.
2Treatment groups
Experimental Treatment
Group I: Control (treatment as usual)Experimental Treatment1 Intervention
Participants in control arm will continue care as usual. They will receive printed resources for supporting sleep hygiene, stress reduction, cognitive and mental health exercises, as well as community resources for older adults.
Group II: Behavioral activation and medication optimizationExperimental Treatment2 Interventions
Behavioral activation (BA) will begin perioperatively and will span across 3 months postoperatively, with sessions approximately weekly or biweekly, depending on patient preference \& health condition.
Medications will be reviewed by a team of interventionists to minimize brain-toxic medications and optimize doses of antidepressants and other mental health medications. In-hospital and after discharge, the interventionists' role will include coordinating with the care teams to ensure that medication changes that were introduced preoperatively are maintained.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Washington University School of MedicineSaint Louis, MO
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Who Is Running the Clinical Trial?
Washington University School of MedicineLead Sponsor
National Institute of Mental Health (NIMH)Collaborator
References
The systematic activation method as a nursing intervention in depressed elderly: a protocol for a multi-centre cluster randomized trial. [2021]Depression in later life is a common mental disorder with a prevalence rate of between 3% and 35% for minor depression and approximately 2% for Major Depressive Disorder (MDD). The most common treatment modalities for MDD are antidepressant medication and psychological interventions. Recently, Behavioral Activation (BA) has gained renewed attention as an effective treatment modality in MDD. Although BA is considered an easy accessible intervention for both patients and health care workers (such as nurses), there is no research on the effectiveness of the intervention in inpatient depressed elderly.The aim of study, described in the present proposal, is to examine the effects of BA when executed by nurses in an inpatient population of elderly persons with MDD.
Behavioral activation strategies for major depression in transdiagnostic cognitive-behavioral therapy: An evidence-based case study. [2019]Behavioral activation (BA) is a treatment approach that uses functional analysis and context-dependent strategies to enhance environmental positive reinforcement for adaptive, healthy behavior, and decrease behavioral avoidance. BA has gained considerable support for the treatment of depression and can be broadly applied across a wide range of settings and clinical populations. In this article, we provide a brief description of BA as a therapeutic behavioral strategy for depression and present a clinical case example illustrating the integration of BA with other components of a transdiagnostic cognitive-behavioral treatment for emotional disorders. Implications for clinical practice and avenues for future research will be discussed. (PsycINFO Database Record
The effects of behavioral activation therapy with inpatient geriatric psychiatry patients. [2022]This study examined the effects of Behavioral Activation (BA) treatment on depressive symptoms and quality of life among older adult patients in a geriatric psychiatry facility. There were 50 participants with mild to moderate cognitive impairment, each being 65 years of age or older. A 2 (between)×3 (time of measurement) design was used in this study comparing control (treatment-as-usual) and experimental (BA) conditions at pre-, mid-, and posttreatment. BA consisted of eight 30- to 60-minute sessions across 4 weeks. Intent-to-treat analyses indicated a significant Group×Time interaction on depressive symptoms, with this effect remaining when only completer data were included. Further analyses indicated that this effect was due to significant change early in treatment in both the full and completer samples. There was no evidence of a significant effect on the quality-of-life measure. Cognitive status was not related to change in depressive symptoms, suggesting that BA may be useful across a range of older adults.
Does Amount and Type of Activity Matter in Behavioral Activation? A Preliminary Investigation of the Relationship between Pleasant, Functional, and Social Activities and Outcome. [2015]Accumulating evidence supports behavioral activation (BA) as an effective stand-alone treatment for improving depression and related conditions, though little is known about the factors that influence positive outcomes. Such research is ripe for future dissemination and implementation efforts, particularly among vulnerable older adult populations in need of such efficacious and transportable treatments.
Treating depressive symptoms among veterans in primary care: A multi-site RCT of brief behavioral activation. [2021]Behavioral activation is ideal for embedded behavioral health providers (BHPs) working in primary care settings treating patients reporting a range of depressive symptoms. The current study tested whether a brief version of Behavioral Activation (two 30-minute appointments, 2 boosters) designed for primary care (BA-PC) was more effective than primary care behavioral health treatment-as-usual (TAU) in reducing depressive symptoms and improving quality of life and functioning.
Behavioral activation: Is it the expectation or achievement, of mastery or pleasure that contributes to improvement in depression? [2019]Behavioral activation (BA) is receiving renewed interest as a stand-alone or as a component of cognitive-behavior therapy (CBT) for depression. However, few studies have examined which aspects of BA are most contributory to its efficacy.