{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T05:11:51Z","timestamp":1783660311868,"version":"3.55.0"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2022,2,3]],"date-time":"2022-02-03T00:00:00Z","timestamp":1643846400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000050","name":"national heart, lung, and blood institute","doi-asserted-by":"publisher","award":["1R03HL136540"],"award-info":[{"award-number":["1R03HL136540"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"national institute on aging","doi-asserted-by":"publisher","award":["K23AG061214"],"award-info":[{"award-number":["K23AG061214"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"national institute of diabetes and digestive and kidney diseases","doi-asserted-by":"publisher","award":["K23DK118117"],"award-info":[{"award-number":["K23DK118117"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Patients with acute coronary syndrome (ACS) with depressed mood demonstrate poor cardiovascular behavioral risk profiles and elevated risk for recurrent ACS and mortality. Behavioral Activation (BA) offers an intervention framework for an integrated treatment targeting both depression and critical health behaviors post-ACS. Behavioral Activation for Health and Depression (BA-HD) was developed and pilot tested in a multiphase iterative process.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>First, an initial treatment manual was conceptualized based on the team\u2019s prior work, as well as the extant literature. Second, qualitative interviews were conducted with target patients and target providers on the proposed BA-HD treatment rationale, content, and structure. Framework matrix analyses were used to summarize and aggregate responses. Third, an expert panel was convened to elicit additional manual refinements. Finally, patients with post-ACS depression and health behavior non-adherence were recruited to complete an open pilot trial to evaluate acceptability (Client Satisfaction Questionnaire [CSQ], exit interview) and treatment engagement (number of sessions attended; treatment completion was considered completion of 8 out of 10 possible sessions).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The initial BA-HD treatment manual expanded an existing treatment manual for post-ACS BA-based mood management and smoking cessation to target four health behaviors relevant to post-ACS patients (e.g., smoking cessation, medication adherence, physical activity, and diet). After the initial conceptualization, ten post-ACS patients and eight cardiac rehabilitation professionals completed qualitative interviews. Patients endorsed bi-directional interactions between mood and health behaviors post-ACS. Both patients and providers expressed general support of the proposed treatment rationale and values-guided, collaborative goal-setting approach. Patients, providers, and experts provided feedback that shaped the iterative manual development. After the BA-HD manual was finalized, eight participants were enrolled in a single-arm pilot trial. The mean CSQ score was 30.57 \u00b1 2.23, indicating high satisfaction. Seven out of eight (88%) completed treatment. Pre- to post treatment improvements in depressed mood and health behaviors were promising.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>BA-HD treatment is an acceptable approach to target both mood and health behaviors in post-ACS patients with depression. A future larger, controlled trial is needed to evaluate the efficacy of the BA-HD treatment.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Trial registration<\/jats:title>\n<jats:p>ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04158219\" xlink:type=\"simple\">NCT04158219<\/jats:ext-link><\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0261490","type":"journal-article","created":{"date-parts":[[2022,2,3]],"date-time":"2022-02-03T18:50:09Z","timestamp":1643914209000},"page":"e0261490","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["The development and pilot testing of a behavioral activation-based treatment for depressed mood and multiple health behavior change in patients with recent acute coronary 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C.","family":"Whited","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9157-4469","authenticated-orcid":true,"given":"Melissa","family":"Adkins-Hempel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Chrastek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill K.","family":"Carter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1598-667X","authenticated-orcid":true,"given":"Rochelle 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death in individuals with coronary heart disease: the REGARDS (Reason for Geographic and Racial Differences in Stroke) study.","volume":"61","author":"S Ye","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"pone.0261490.ref019","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4061\/2011\/429487","article-title":"Mediterranean diet mediates the adverse effect of depressive symptomatology on short-term outcome in elderly survivors from an acute coronary event.","volume":"2011","author":"C Chrysohoou","year":"2011","journal-title":"Cardiol Res Pract"},{"issue":"5","key":"pone.0261490.ref020","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/S0002-9149(03)00719-7","article-title":"Effect of smoking and sedentary behavior on the association between depressive symptoms and mortality from coronary heart disease","volume":"92","author":"BH Brummett","year":"2003","journal-title":"Am J 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research.","volume":"13","author":"NK Gale","year":"2013","journal-title":"BMC Med Res Methodol."},{"issue":"2","key":"pone.0261490.ref024","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1111\/j.1365-2850.2012.01906.x","article-title":"Dissemination of behavioural activation for depression to mental health nurses: training evaluation and benchmarked clinical outcomes: BA training for mental health nurses.","volume":"20","author":"DM Ekers","year":"2013","journal-title":"J Psychiatr Ment Health Nurs."},{"issue":"10065","key":"pone.0261490.ref025","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/S0140-6736(16)31589-6","article-title":"The Healthy Activity Program (HAP), a lay counsellor-delivered brief psychological treatment for severe depression, in primary care in India: a randomised controlled trial.","volume":"389","author":"V Patel","year":"2017","journal-title":"The 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Andresen","year":"1994","journal-title":"Am J Prev Med."},{"issue":"4","key":"pone.0261490.ref029","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1007\/BF01858007","article-title":"The impact of patient adherence on health outcomes for patients with chronic disease in the medical outcomes study.","volume":"17","author":"RD Hays","year":"1994","journal-title":"J Behav Med."},{"issue":"12","key":"pone.0261490.ref030","doi-asserted-by":"crossref","first-page":"1818","DOI":"10.1001\/archinte.160.12.1818","article-title":"Patients with depression are less likely to follow recommendations to reduce cardiac risk during recovery from a myocardial infarction","volume":"160","author":"RC Ziegelstein","year":"2000","journal-title":"Arch Intern Med"},{"key":"pone.0261490.ref031","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1046\/j.1532-5415.2002.50205.x","article-title":"The significance of depression in older patients after myocardial infarction.","volume":"50","author":"J Romanelli","year":"2002","journal-title":"J Am Geriatr Soc."},{"issue":"1 Suppl","key":"pone.0261490.ref032","doi-asserted-by":"crossref","first-page":"1S","DOI":"10.1016\/0197-2456(91)90002-4","article-title":"Cardiovascular risk factors in young adults. The CARDIA baseline monograph.","volume":"12","author":"GR Cutter","year":"1991","journal-title":"Control Clin Trials."},{"issue":"21","key":"pone.0261490.ref033","doi-asserted-by":"crossref","first-page":"2508","DOI":"10.1001\/archinte.165.21.2508","article-title":"Depression and medication adherence in outpatients with coronary heart disease: findings from the Heart and Soul Study","volume":"165","author":"A Gehi","year":"2005","journal-title":"Arch Intern Med"},{"issue":"6","key":"pone.0261490.ref034","doi-asserted-by":"crossref","first-page":"e0234420","DOI":"10.1371\/journal.pone.0234420","article-title":"Responsiveness of the single item measure to detect change in physical activity.","volume":"15","author":"P O\u2019Halloran","year":"2020","journal-title":"PLOS ONE."},{"issue":"7","key":"pone.0261490.ref035","doi-asserted-by":"crossref","first-page":"943","DOI":"10.2337\/diacare.23.7.943","article-title":"The summary of diabetes self-care activities measure: results from 7 studies and a revised scale","volume":"23","author":"DJ Toobert","year":"2000","journal-title":"Diabetes Care"},{"issue":"6","key":"pone.0261490.ref036","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1037\/0022-3514.54.6.1063","article-title":"Development and validation of brief measures of positive and negative affect: The PANAS scales","volume":"54","author":"D Watson","year":"1988","journal-title":"J Pers Soc Psychol"},{"issue":"2","key":"pone.0261490.ref037","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.beth.2015.10.005","article-title":"Feasibility of pairing behavioral activation with exercise for women with type 2 diabetes and depression: The Get It Study pilot randomized controlled trial","volume":"47","author":"KL Schneider","year":"2016","journal-title":"Behav Ther"},{"issue":"18","key":"pone.0261490.ref038","doi-asserted-by":"crossref","first-page":"1852","DOI":"10.1001\/jama.2021.4348","article-title":"Effect of a digital intervention on depressive symptoms in patients with comorbid hypertension or diabetes in Brazil and Peru: Two randomized clinical trials","volume":"325","author":"R Araya","year":"2021","journal-title":"JAMA"},{"issue":"3","key":"pone.0261490.ref039","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1161\/01.CIR.0000151788.08740.5C","article-title":"Cardiac rehabilitation and secondary prevention of coronary heart disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American association of Cardiovascular and Pulmonary Rehabilitation.","volume":"111","author":"AS Leon","year":"2005","journal-title":"Circulation"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0261490","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,3]],"date-time":"2022-02-03T18:50:45Z","timestamp":1643914245000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0261490"}},"subtitle":[],"editor":[{"given":"Walid Kamal","family":"Abdelbasset","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,2,3]]},"references-count":39,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2,3]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0261490","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,3]]}}}