The roles of goal cognitions and goal achievement in behavioural activation treatment for depression

Abstract

Background: Behavioural activation (BA) is an evidence-based and NICE-recommended low-intensity treatment for mild to moderate depression, wherein patients pursue goals related to re-engaging in pleasurable, routine and necessary activities. BA is assumed to alleviate depression through this goal striving process, but to date, the mechanisms behind BA’s effectiveness have not been investigated quantitatively. This study aimed to draw parallels between goal striving in behavioural theories and clinical BA treatment for depression, by investigating whether goal achievement and self-regulation theory-based goal cognitions predict response to BA. Methods: Patients referred to clinical BA treatment for depression (n=112) received treatment as usual, and set three goals in each of three BA sessions. For each goal set, patients completed items from the Self-regulation Skills Battery to assess goal cognitions and goal achievement at the beginning of the next session. Depressive symptoms were assessed with the PHQ-9 before each treatment session and post-treatment. Findings: BA significantly reduced depressive symptoms curve-linearly over the course of treatment (B=.41, p<0.001). Achievement of patients’ most important goals was significantly associated with improvement in depressive symptoms (r=-0.14). The goal cognitions ownership, planning, attention control, emotion control and problem solving all predicted goal achievement (all p<.005). Discussion: This study provides quantitative evidence for the importance of goal achievement in BA treatment for depression, and demonstrates that links between goal cognitions and achievement from behavioural theories also apply to clinical settings. Future investigations may examine specific goal content to identify the types of goals which, when achieved, best alleviate depressive symptoms.