Is Activation the Active Ingredient of Transdiagnostic Therapies? A Randomized Clinical Trial of Behavioral Activation, Acceptance and Commitment Therapy, and Transdiagnostic Cognitive-Behavioral Therapy for Emotional Disorders.

Studying the usefulness of contextual and cognitive transdiagnostic therapies calls for an analysis of both their differential efficacy and their specificity when acting on the transdiagnostic conditions on which they focus. This controlled trial compares the post-treatment and 3- and 6-month follow-up effects of Behavioral Activation (BA), Acceptance and Commitment Therapy (ACT) and Cognitive-Behavioral Transdiagnostic Therapy (TD-CBT) on emotional symptomatology, and analyses the role played by Experiential Avoidance, Cognitive Fusion, Activation and Emotion Regulation in the clinical change. One hundred twenty-eight patients who fulfilled diagnostic criteria for anxiety and/or depression (intention-to-treat sample) were randomly assigned to three experimental group-treatment conditions (BA, n = 34; ACT, n = 27; TD-CBT n = 33) and one control group (WL, n = 34). Ninety-nine (77.34%) completed the treatment (per-protocol sample). In the post-treatment, all therapies reduced anxiety and depression symptomatology. In the follow-ups, the reduction in emotional symptomatology was greater in the condition which produced greater and more prolonged effects on Activation. Activation appears to be the principal condition in modifying all the transdiagnostic patterns and BA was the most efficacious and specific treatment. The trial was registered at ClinicalTrials.gov NCT04117464. Raw data are available online http://dx.doi.org/10.17632/krj3w2hfsj.1.

Behavioral Activation and Acceptance and Commitment Therapy in the Treatment of Anxiety and Depression in Cancer Survivors: A Randomized Clinical Trial.

Behavioural Activation (BA) and Acceptance and Commitment Therapy (ACT) aim to reduce the inflexible avoidance of painful thoughts, feelings and memories and to encourage involvement in relevant activities, objectives which are clearly relevant to the situation of cancer survivors with emotional problems. With a view to evaluating and comparing the efficacy of both therapies, applied on a group basis, a randomized controlled trial was developed. Cancer survivors (age 18-65 years) with anxiety and/or depression were assigned at random to two experimental groups (BA; ACT) and a waiting list control group (WL). Of the 66 cancer survivors randomized to trial (intention-to-treat sample), 46 participants (M = 51.49; SD = 6.88) completed the intervention (BA, n = 17; ACT, n = 12; WL, n = 17) (per-protocol sample). The emotional state, experiential avoidance and behavioural activation of the participants was evaluated in the pre- and post-treatment and in a 3-month follow-up using standardized instruments. Both treatment groups showed statistically significant changes, indicating an improvement in all the result variables in the post-treatment and follow-up as compared to the pre-treatment. BA showed better results than ACT regarding impact on anxiety and activation. This greater efficacy may have been due to factors such as the emphasis placed in BA on behavioural activation and the central role played in it by functional analysis. The key role played by experiential avoidance and behavioral activation in the maintenance and treatment of emotional problems in cancer survivors is discussed. Raw data are available online (http://dx.doi.org/10.17632/m7w688khs8.1).

Activación Conductual en formato grupal para ansiedad y depresión: una revisión sistemática / Behavioral Activation in group format for anxiety and depression: a systematic review

Resumen Dada la alta prevalencia de los Trastornos Mentales Comunes (TMC), la aplicación grupal de la Activación Conductual (AC) puede ser un abordaje eficaz, efectivo y más eficiente. El objetivo del presente trabajo es revisar los estudios publicados sobre la utilidad de la AC grupal para el tratamiento de la ansiedad y/o depresión. Método: Revisión sistemática. Resultados: Se incluyeron 17 estudios. Los pacientes que recibieron AC experimentaron mejoras en ansiedad y/o depresión y se informa de una mayor eficacia de AC frente a grupos control sin intervención. Conclusiones: La AC es útil para la prevención y el tratamiento de trastornos emocionales. No obstante, la heterogeneidad y limitaciones de los estudios impiden determinar los ingredientes terapéuticos exactos, y si éstos son específicos del enfoque y procedimiento de esta terapia. Sería necesario más investigación, de mayor calidad metodológica, y que evalúe los cambios en los patrones de activación/evitación objeto de intervención.

Abstract Given the high prevalence of Common Mental Disorders (CMD), group-based Behavioral Activation (BA) could be an efficacious, effective and more efficient approach. The objective of this work is to review the published studies about the usefulness of group-based BA for the treatment of anxiety and/or depression. Method: Systematic review. Results: 17 studies were included in the review. Patients who received BA experienced improvements in anxiety and/or depression and studies reported a greater efficacy of BA compared with no-intervention control groups. Conclusions: BA is useful for the prevention and treatment of emotional disorders. However, heterogeneity and limitations of the studies make it impossible to determine the exact therapeutic elements, and if they are specific to the approach and procedure of this therapy. More research would be necessary of a higher methodological quality to evaluate changes in the activation/avoidance patterns, which are the object of the intervention.

Psychometric validation of the Environmental Reward Observation Scale (EROS) in breast cancer survivors / Validación psicométrica de la Environmental Reward Observation Scale (EROS) en supervivientes de cáncer de mama

The loss of rewards resulting from oncological disease has been associated with emotional problems in cancer survivors. The Environmental Reward Observation Scale (EROS) evaluates environmental reinforcement and is based on behavioral models which show the relationship between environmental reinforcement and emotional state. The aim of this study is to analyze the psychometrical properties of this scale in breast cancer survivors and its usefulness in discriminating between survivors with and without emotional disorders. A total of 219 women survivors (Mage= 52.97; SDag= 7.50) completed measures of environmental reinforcement, behavioral activation and avoidance, and emotional state. Data fit an essentially unidimensional structure, showing high internal consistency and correlations, varying from moderate to high, with all the measures used. In the EROS scores, statistically significant differences were found between participants with and without emotional disorders. Optimum cut-off point to discriminate between anxiety and depression was established via Receiver Operating Characteristic curve. Using the framework of the Item Response Theory model, all the items were found to have a power of discrimination for measuring environmental reinforcement ranging from moderate to high. The EROS is a psychometrically sound instrument, which can be used to improve assessment of emotional state in breast cancer survivors

La pérdida de gratificaciones, como resultado de la enfermedad y tratamiento oncológico, se relaciona con problemas emocionales en supervivientes. Environmental Reward Observation Scale (EROS) es una escala para evaluar reforzamiento ambiental, desarrollada a partir de modelos conductuales que muestran la relación entre reforzamiento ambiental y estado emocional. Este estudio valida esta escala con supervivientes de cáncer de mama y analiza su utilidad para discriminar entre supervivientes con y sin trastornos emocionales. Un total de 219 mujeres supervivientes (Medad = 52.97; DTedad= 7.50) completaron medidas de reforzamiento ambiental, activación y evitación conductual, y estado emocional. Los datos se ajustan a una estructura esencialmente unidimensional, mostrando una consistencia interna elevada y de moderadas a altas con todas las medidas empleadas. Fueron estadísticamente significativas las diferencias en las puntuaciones entre participantes con y sin trastorno emocional. Mediante curvas ROC se estableció el punto de corte óptimo para discriminar ansiedad y depresión. Aplicando la Teoría de Respuesta al Ítem, se encontró que todos los ítems muestran un poder de discriminación de moderado a alto para evaluar reforzamiento ambiental. La EROS se presenta como una medida fiable y válida que puede emplearse para mejorar la evaluación del estado emocional de supervivientes oncológicos

Acceptance and Commitment Therapy in group format for anxiety and depression. A systematic review.

BACKGROUND: Emotional disorders, such as anxiety and depression, are one of the main causes of disability worldwide. Recent reviews suggest that Acceptance and Commitment Therapy is effective in treating emotional disorders. However, they appraise mainly individual approaches. This review aimed to analyze published studies regarding the usefulness of Acceptance and Commitment Therapy, applied on a group basis, in the treatment of anxiety and depression. METHODS: A systematic review of the literature was conducted using the Web of Science, from 2008 to 2019. Fifteen articles fulfilled the inclusion criteria. RESULTS: Those patients who received interventions based on Acceptance and Commitment Therapy showed a better emotional state and greater psychological flexibility than patients in control groups without treatment. No differences are found with Cognitive Therapy and Cognitive-Behavioral Therapy. LIMITATIONS: the studies reviewed show limitations, principally regarding sample characteristics, study design and manner in which mechanisms responsible for changes are evaluated. CONCLUSION: Group-based Acceptance and Commitment Therapy proved to be useful in the psychological treatment of emotional disorders. However, the heterogeneity and limitations of the studies, make it impossible to determine the exact therapeutic elements, and if they are specific to the approach and procedure of this therapy. More research would be necessary to ascertain what patient and/or intervention characteristics might improve results and what the active and specific ingredients of the therapy are. This has clinical relevance because group-based interventions could be more cost-efficient, and it would help facilitate health-care decisions aimed at giving the public access to useful treatments.

Effects of Behavioral Activation on the Quality of Life and Emotional State of Lung Cancer and Breast Cancer Patients During Chemotherapy Treatment.

Research suggests that the progressive abandonment of activities in cancer patients are related to depression and worse quality of life. Behavioral activation (BA) encourages subjects to activate their sources of reinforcement and modify the avoidance responses. This study assesses the effectiveness of BA in improving quality of life and preventing emotional disorders during chemotherapy treatment. One sample of lung cancer patients and another of breast cancer patients were randomized into a BA experimental group (E.G.lung/4sess.n = 50; E.G.breast/6sess.n = 33) and a control group (C.G.lung/4sess.n = 40; C.G.breast/6sess.n = 35), respectively. In each session and in follow-ups (3/6/9 months), all participants completed different assessment scales. The results converge to show the effectiveness of BA, encouraging cancer patients to maintain rewarding activities which can activate their sources of day-to-day reinforcement and modify their experience avoidance patterns. BA appears to be a practical intervention which may improve social and role functioning and the emotional state of cancer patients during chemotherapy treatment.

Acceptance and Commitment Therapy in Cancer: Review of Applications and Findings.

This study aimed to analyze published studies regarding the usefulness of Acceptance and Commitment Therapy in the treatment of oncological patients. A systematic review of the literature was conducted using the Web of Science, Google Scholar and Dialnet (2000-2016). Nineteen articles fulfilled the inclusion criteria. Those patients who received interventions based on Acceptance and Commitment Therapy showed a better emotional state and quality of life and greater psychological flexibility. Acceptance and Commitment Therapy proved to be useful in the psychological treatment of oncological patients. However, the heterogeneity and limitations of the studies, principally with regard to sample characteristics, study design and manner in which mechanisms responsible for changes are evaluated, make further studies necessary with a view to ascertaining what patient and/or intervention characteristics might improve results. Randomized controlled trials comparing the efficacy of Acceptance and Commitment Therapy with no treatment, with treatment with placebo and with other efficacious therapies, including a study of medium- and long-term results, would be of particular interest.

Activation vs. Experiential Avoidance as a Transdiagnostic Condition of Emotional Distress: An Empirical Study.

Background: From a contextual transdiagnostic approach, this study focuses on the importance of the processes of Experiential Avoidance and Activation in explaining and treating psychological problems. There exists widespread empirical evidence to suggest that the response pattern known as Experiential Avoidance, a general unwillingness to remain in contact with particular private experiences through the use of maladaptive avoidance strategies, acts as a functional dimension in various psychological problems. Activation, that is, maintaining contact with experiences/conditions of life and consequently with associated sources of reward, is a condition present in most therapeutic processes. Although a great deal of research has analyzed the relationship of the value of reward with the etiology and maintenance of psychological problems, Activation, as a transdiagnostic factor, has been studied less. The aim of this paper is to carry out an empirical study of the relationship between Activation, EA and emotional state and analyze the capacity of these two conditions to discriminate the intensity and symptomatology type in subjects with emotional distress. Methods: The Hospital Anxiety and Depression Scale (HADS), Environmental Reward Observation Scale (EROS) and Behavioral Activation for Depression Scale (BADS) were completed by 240 health center users. Results: Of the participants, 55% showed clinically relevant emotional distress. All cases of depression showed clinical anxiety. To discriminate between subjects without (n = 109) and with emotional distress (n = 131), analyses of the ROC curves and logistic regression analysis identified the BADS-Avoidance/Rumination followed by the EROS. To discriminate between subjects with anxiety but without depression (n = 61) and with anxiety and depression (n = 70), the most efficient scales were EROS followed by BADS-Social Impairment. Conclusion: It was shown that people with no emotional complaints maintained greater contact with life experiences and with environmental sources of reward than those with emotional distress. Response patterns showing Experiential Avoidance and a reduction in Activation responses were associated with clinical distress. A reduction in Activation was the condition which distinguished those people with the greatest distress and also the greatest comorbidity of symptoms of depression and anxiety. These data support the transdiagnostic nature of Activation and suggest greater attention should be paid to this concept.

Treating anxiety and depression of cancer survivors: Behavioral activation versus acceptance and commitment therapy / Tratamiento de ansiedad y depresión en supervivientes de cáncer: activación conductual versus terapia de aceptación

Background: Behavioral activation (BA) and acceptance and commitment therapy (ACT) are considered particularly useful treatments when dealing with emotional problems of cancer survivors. The efficacy of these two treatments, applied on a group basis, were evaluated and compared. Method: An analysis was carried out of pre-post treatment changes in the emotional state and patterns of activation/avoidance of 52 cancer patients, with anxiety and/or depression, randomly assigned to three groups (BA/ACT/waiting list control). Results: Both therapies were superior to no treatment in all the variables evaluated. Significant differences were found between the two treatments in favor of ACT in social impairment and avoidance/rumination. Conclusions: BA and ACT, applied on a group basis, are efficacious in the treatment of those emotional difficulties most prevalent in cancer survivors. Results suggest that activation and avoidance are the mechanisms responsible for the changes (AU)

Antecedentes: la activación conductual (AC) y la terapia de aceptación y compromiso (ACT) se plantean como tratamientos especialmente útiles para los problemas emocionales de los supervivientes de cáncer. Se evaluó y comparó la eficacia de ambas terapias aplicadas en formato grupal. Método: se analizaron los cambios pre-post tratamiento en el estado emocional y los patrones de activación/evitación de 52 supervivientes de cáncer con ansiedad y/o depresión que se asignaron aleatoriamente a tres grupos (AC/ACT/control de lista de espera). Resultados: ambas terapias fueron superiores al no tratamiento en todas las variables evaluadas. Se encontraron diferencias significativas entre tratamientos a favor de la ACT en deterioro social y evitación/rumia. Conclusiones: la AC y la ACT, en formato grupal, son eficaces para el tratamiento de las dificultades emocionales más prevalentes en supervivientes de cáncer. Los resultados apuntan a la activación y la evitación como mecanismos responsables de los cambios (AU)

Treating anxiety and depression of cancer survivors: Behavioral activation versus acceptance and commitment therapy.

BACKGROUND: Behavioral activation (BA) and acceptance and commitment therapy (ACT) are considered particularly useful treatments when dealing with emotional problems of cancer survivors. The efficacy of these two treatments, applied on a group basis, were evaluated and compared. METHOD: An analysis was carried out of pre-post treatment changes in the emotional state and patterns of activation/avoidance of 52 cancer patients, with anxiety and/or depression, randomly assigned to three groups (BA/ACT/waiting list control). RESULTS: Both therapies were superior to no treatment in all the variables evaluated. Significant differences were found between the two treatments in favor of ACT in social impairment and avoidance/rumination. CONCLUSIONS: BA and ACT, applied on a group basis, are efficacious in the treatment of those emotional difficulties most prevalent in cancer survivors. Results suggest that activation and avoidance are the mechanisms responsible for the changes.

Emotional state and psychological flexibility in breast cancer survivors.

PURPOSE: This study analyses the premise that less time spent carrying out valuable activities and inflexible avoidance of thoughts, feelings and memories related to the oncological process may play an important role in the emotional problems of cancer survivors. METHODS: Emotional state was evaluated, as was quality of life and psychological flexibility in a sample of 122 breast cancer survivors (Mage = 52.40; SDage = 7.26). The analysis was carried out using a cross-sectional predictive study. RESULTS: Approximately half of those in the sample suffered from clinically significant emotional distress. The predictor variables selected explained a high percentage of the variability in emotional problems and quality of life (51.10-77.10%). CONCLUSION: Avoidance explained a high percentage of the variance in anxiety, depression and general distress. A lower degree of participation in valuable activities contributed, more specifically, to explaining variability in depression. The quantity and availability of environmental reinforcement was closely related to quality of life. A decisive contribution towards promoting emotional well-being and quality of life can be made by nursing action aimed at diminishing those avoidance strategies related to the oncological experience which may distance patients from daily activities which are gratifying and congruent with their values.

Esophagogastric pathology in morbid obese patient: Preoperative diagnosis, influence in the selection of surgical technique.

INTRODUCTION: Given the difficulty in accessing to the excluded stomach after gastric bypass and the increase in gastroesophageal reflux after sleeve gastrectomy, it is justified to perform a preoperative fibrogastroscopy.The influence of the fibrogastroscopy (FGS) findings in the therapeutic approach is analyzed. PATIENTS AND METHODS: A retrospective study of preoperative FGS findings is performed, from 04/06 to 12/12. The influence of the FGS results on the surgical technique selection, in the endoscopic or medical treatment and its relation to gastric fistula is analyzed by means of multivariate regression (confounding factors: Age, body mass index, arterial hypertension, diabetes mellitus, antiplatelet therapy, surgical technique (bariatric surgery, sleeve gastrectomy). RESULTS: Three hundred thirty one patients are included: 32.6% biopsy of gastric lesion; 27% gastritis; 18.1% hiatal hernia; 3% metaplasia; 0.6% Barrett esophagus; 2.1% esophagitis; 0.3% dysplasia; 0.3 Schatzky´s ring; 1.5% incompetent cardia; 2.4% duodenitis; 0.3% gastric erosions; 0.6% gastric xanthoma; 1.8%, gastric polyp; 1.6% duodenal ulcer; 0.6% papulo-erosive gastritis; 0.6% esophageal papilloma; 0.3% submucosal tumor. Helicobacter pylori+ 30.2% (triple therapy eradication in all patients). The FGS findings led to a variation in the surgical technique or to the completion of endoscopic treatment in 22.2% of cases.The gastric lesions did not influence the development of gastric fistula. Independent prognostic factors of fistula: Sleeve gastrectomy (7.9% vs. 2.7%; p = 0.02; OR: 1.38 IC95: 1.01-1.87) and the body mass index > 50 kg/m2) (6.7% vs. 2.2%; p = 0.04; OR: 3.7 IC95: 1.12-12.4). CONCLUSIONS: The diagnosis of gastroesophageal disease through preoperative FGS motivated variations in the therapeutic approach in 52% of patients, so we consider essential to include the preoperative FGS in bariatric surgery.

Patología esofagogástrica en el obeso mórbido: diagnóstico preoperatorio e influencia en la selección de la técnica quirúrgica / Esophagogastric pathology in morbid obese patient: Preoperative diagnosis and influence in the selection of surgical technique

INTRODUCCIÓN: la dificultad de acceso al estómago excluido tras el bypass gástrico (BG) y el empeoramiento del reflujo gastroesofágico tras la gastrectomía vertical (GV) justifican la fibrogastroscopia (FGS) preoperatoria. Se analiza la influencia de los hallazgos de FGS en la actitud terapéutica. PACIENTES Y MÉTODOS: estudio retrospectivo de hallazgos de FGS previa a cirugía bariátrica desde 04/06 a 12/12. Influencia del resultado FGS en la selección de la técnica quirúrgica y en el tratamiento médico o endoscópico; y su relación con la fístula gástrica mediante regresión multivariada (factores de confusión: edad, índice de masa corporal, hipertensión arterial, diabetes mellitus, tratamiento antiagregante, técnica quirúrgica (bypass gástrico o gastrectomía vertical). RESULTADOS: se incluyen 331 pacientes: 32,6% biopsia de lesión gástrica; 27% gastritis. 18,1% de hernia de hiato; 3% metaplasia, 0,6% Barret, 2,1% esofagitis, 0,3% displasia, 0,3 anillo de Schalzsky, 1,5% de cardias incompetente, 2,4% de duodenitis, 0,3% erosiones gástricas, 0,6% xantoma gástrico, 1,8%, pólipos gástricos, 1,6%, úlcera duodenal, 0,6% gastritis papuloerosiva, 0,6% papiloma esofágico, 0,3% tumor submucoso. Helicobacter pylori+ 30,2% (triple terapia añadida en todos). Variación de técnica quirúrgica o tratamiento endoscópico debido a FGS 22,2%. Las lesiones gástricas no influyeron en el desarrollo de fístula gástrica. Factores pronósticos independientes de fístula: GV (7,9% vs. 2,7%; p = 0,02; OR: 1,38 IC95: 1,01-1,87) y el índice de masa corporal (IMC) > 50 kg/m2 (6,7% vs. 2,2%; p = 0,04; OR: 3,7 IC95: 1,12-12,4). CONCLUSIONES: el diagnóstico de patología esofagogástrica mediante FGS preoperatoria motivó variaciones en la actitud terapéutica del 52% de los procedimientos, por lo que consideramos imprescindible incluir la FGS en el preoperatorio de la cirugía bariátrica

INTRODUCTION: Given the difficulty in accessing to the excluded stomach after gastric bypass and the increase in gastroesophageal reflux after sleeve gastrectomy, it is justified to perform a preoperative fibrogastroscopy. The influence of the fibrogastroscopy (FGS) findings in the therapeutic approach is analyzed. PATIENTS AND METHODS: A retrospective study of preoperative FGS findings is performed, from 04/06 to 12/12. The influence of the FGS results on the surgical technique selection, in the endoscopic or medical treatment and its relation to gastric fistula is analyzed by means of multivariate regression (confounding factors: Age, body mass index, arterial hypertension, diabetes mellitus, antiplatelet therapy, surgical technique (bariatric surgery, sleeve gastrectomy). RESULTS: Three hundred thirty one patients are included: 32.6% biopsy of gastric lesion; 27% gastritis; 18.1% hiatal hernia; 3% metaplasia; 0.6% Barrett esophagus; 2.1% esophagitis; 0.3% dysplasia; 0.3 Schatzky's ring; 1.5% incompetent cardia; 2.4% duodenitis; 0.3% gastric erosions; 0.6% gastric xanthoma; 1.8%, gastric polyp; 1.6% duodenal ulcer; 0.6% papulo-erosive gastritis; 0.6% esophageal papilloma; 0.3% submucosal tumor. Helicobacter pylori+ 30.2% (triple therapy eradication in all patients). The FGS findings led to a variation in the surgical technique or to the completion of endoscopic treatment in 22.2% of cases. The gastric lesions did not influence the development of gastric fistula. Independent prognostic factors of fistula: Sleeve gastrectomy (7.9% vs. 2.7%; p = 0.02; OR: 1.38 IC95: 1.01-1.87) and the body mass index > 50 kg/m2) (6.7% vs. 2.2%; p = 0.04; OR: 3.7 IC95: 1.12-12.4). CONCLUSIONS: The diagnosis of gastroesophageal disease through preoperative FGS motivated variations in the therapeutic approach in 52% of patients, so we consider essential to include the preoperative FGS in bariatric surgery

Efectos de la activación conductual en la calidad de vida y estado emocional / Effects of the behavioral activation in the life quality and emotional state for lung cancer patients

Objetivo: Desde un análisis contextual-funcional de los problemas/limitaciones del paciente oncológico, se valora el efecto en la calidad de vida y estado emocional de una intervención centrada en la Activación Conductual con enfermos de cáncer de pulmón durante el tratamiento oncológico. Método: 90 pacientes de reciente diagnóstico fueron asignados aleatoriamente a una condición experimental (G.E.: N=50) de 4 sesiones individuales orientadas a restablecer actividades relevantes, eliminar conductas de enfermedad y modificar el patrón de evitación experiencial; y a una condición control (G.C.: N=40) que ocupó el mismo número de sesiones en la evaluación de la calidad de vida sin ofrecer asesoramiento o tratamiento psicológico. Todos los participantes completaron, en cada sesión y en seguimiento trimestral, las escalas QLQ-C30, HAD, IK, EG y SP. Se empleó un diseño de medidas parcialmente repetidas. La evolución y tendencia de las variables se realizó mediante MLG y MLM. Resultados: Los participantes resultaron representativos de la población estudiada y no difirieron entre ellos en el pre-tratamiento. En ambos grupos se produjo una pérdida elevada de sujetos por hospitalización/fallecimiento. El G.E. mostró, a lo largo del tiempo, mejoría estadísticamente significativa (p<0,05) en todas las subescalas del QLQ-C30. En las subescalas HAD, se alcanzaron diferencias significativasentre grupos a favor del G.E (p<0,05). Los beneficios del G.E. se debilitaron en el seguimiento. El GC no experimentó cambios. Conclusiones: Se aportan evidencias del interés de los objetivos y procedimientos de Activación Conductual para mejorar, durante el tratamiento oncológico, la calidad de vida y estado emocional. Se señala la necesidad de indagar las características de los pacientes y/o de la intervención de las que depende su eficacia y eficiencia

Objective: Based on a functional-contextual analysis of the problems cancer patients have, the efficacy of Behavioral Activation Therapy for the prevention of emotional disorders and the promotion of life quality on lung cancer patients will be analyzed. Method: A total of 90 lung cancer patients were selected consecutively. Patients were randomly assigned to un experimental group (G.E.: N=50) where a specific protocol was designed to increase relevant activities and healthy behaviors, erasing disease behaviors previously learned and modifying the pattern of experiential avoidance; and a control group (G.C.: N=40) where life quality and psychosocial effects of both illness and treatment were assessed, without ever offering counseling or psychological treatment. Both conditions received a total of four individual one hour long treatment sessions in the hospital. Results were collected through standardized scales (IK, HADS, QLQ-C30, EG y SP) in each of the treatment sessions and during the three months follow-ups. The evolution and tendency of the variables was analyzed using MLG y MLM. Results: Participants, doe to their clinical and sociodemographic characteristics resulted a representative group of the population studied and did not differ between themselves in the pre-treatment. In both groups there was a loss of subjects produced by hospitalization / death. The comparison analysis inter and intra groups indicate that among participants, the G. E. showed, over time, statistically significant differences (p< 0.05) in all subscales of QLQ- C30 functioning. In the HAD subscales, significant differences between groups in favor of GE (p<0.05) were achieved. Improvements shown by the G.E. weakened during the follow-up. Conclusions: Behavioral Activation Therapy, during cancer treatment, improved life qualityand emotional adjustment. The study indicates the need to investigate the characteristics of patients and/or intervention, as its effectiveness and efficiency depends on them