Behavioral Activation for Depression After Traumatic Brain Injury Among Veterans: Feasibility & Outcomes of an OT Intervention

Depression is a common and serious consequence of traumatic brain injury (TBI), particularly among Veterans1. Behavioral activation (BA) is a therapeutic approach designed to treat post-TBI depression. An occupational therapy (OT) intervention incorporating BA (OT-BA) was implemented in a VA Rehabilitation Service with 4 trained occupational therapists. The study aims were to: (1) assess feasibility, through acceptability ratings from Veterans (Acceptability Scale) and interventionists (through focus groups) and (2) assess preliminary treatment response in three outcomes through a pilot randomized trial (RCT), by comparing OT-BA to a control group on depressive symptoms (Center for Epidemiology Studies-Depression 2), QOL (Quality of Life after Brain Injury 3) and CR (Community Integration Questionnaire 4). Forty-six veterans with mild to moderate TBI and depression were enrolled. Among the Veterans receiving BA, 89.5% completed at least 4 intervention sessions; 84.2% completed the follow-up interview; and 75% reported high acceptability. Focus group themes reflected high acceptability among interventionists. All three outcomes showed the benefits of BA in the expected directions. In the treatment group, depressive symptoms decreased 7.2 points, QOL increased from 1.72 to 1.95, and CR improved from .07 to .13. In conclusion, OT-BA is feasible to implement in a VA setting and is highly acceptable to both Veterans and interventionists.

IMPACT: The pilot RCT results provide evidence of treatment response in the 3 outcomes. OT-BA is a promising intervention for Veterans with post-TBI depression. A larger OT-BA study with sufficient statistical power would be highly feasible in a rehabilitation setting. This study was funded by VA Office of Research Development, Rehabilitation Research & Development Service, Award Number: 1I21RX003578-01A1. (July 1, 2021 - June 30, 2024).

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