J Korean Neuropsychiatr Assoc.  2017 May;56(2):89-97. 10.4306/jknpa.2017.56.2.89.

The Reliability and Validity of the Korean Version of Behavioral Activation for Depression Scale

• Oh JH
• Hwang NR
• Cha YJ
• Lee EB
• Choi KH
• Seo HJ

• KMID: 2379391
• DOI: http://doi.org/10.4306/jknpa.2017.56.2.89

Abstract

OBJECTIVES
The Behavioral Activation of Depression Scale (BADS) has been reported to be a valid tool for assessing the different behavioral aspects of depression, such as activation, rumination or avoidance, and functional impairment. The aim of this study was to assess the reliability and validity of the Korean version of BADS (K-BADS).
METHODS
A sample of 196 outpatients completed the K-BADS and the data were analyzed for internal consistency and factor structures. An additional 51 outpatients re-filled the K-BADS after two weeks for the test-retest reliability. To test for the validity, the Hospital Anxiety and Depression Scale (HADS), Working Alliance Inventory (WAI), Drug Attitude Inventory-10 (DAI-10), and Mindfulness Attention Awareness Scale (MAAS) were administered.
RESULTS
Internal consistency of K-BADS was good (Cronbach's alpha=0.843) and principal component factor analysis revealed the four-factor structure. The K-BADS showed a reasonable test-retest reliability (r=0.863, p<0.001). The total score of K-BADS correlated significantly with the total scores of the HADS depression (r=−0.694) and HADS anxiety (r=−0.681). No correlations were found between the K-BADS and the K-WAI (r=0.170) and between the K-BADS and the K-DAI-10 (r=0.311).
CONCLUSION
The K-BADS is a reliable and valid instrument for measuring the behavioral activation for depression in Korean patients with depressive symptoms.

Keyword

Korean version of Behavioral Activation for Depression Scale (K-BADS); Behavioral activation; Reliability; Validity

MeSH Terms

Anxiety
Depression*
Humans
Mindfulness
Outpatients
Reproducibility of Results*

Reference

1. Hopko DR, Lejuez CW, Ruggiero KJ, Eifert GH. Contemporary behavioral activation treatments for depression: procedures, principles, and progress. Clin Psychol Rev. 2003; 23:699–717.

2. Ferster CB. A functional anlysis of depression. Am Psychol. 1973; 28:857–870.

3. Lewinsohn PM. A behavioral approach to depression. In : Friedman RJ, Katz MM, editors. The psychology of depression: contemporary theory and research. New York: Wiley;1974.

4. Dimidjian S, Hollon SD, Dobson KS, Schmaling KB, Kohlenberg RJ, Addis ME, et al. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. J Consult Clin Psychol. 2006; 74:658–670.

5. Dobson KS, Hollon SD, Dimidjian S, Schmaling KB, Kohlenberg RJ, Gallop RJ, et al. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. J Consult Clin Psychol. 2008; 76:468–477.

6. O’Hara MW, Rehm LP. Self-monitoring, activity levels, and mood in the development and maintenance of depression. J Abnorm Psychol. 1979; 88:450–453.

7. Harmon TM, Nelson RO, Hayes SC. Self-monitoring of mood versus activity by depressed clients. J Consult Clin Psychol. 1980; 48:30–38.

8. Snarski M, Scogin F, DiNapoli E, Presnell A, McAlpine J, Marcinak J. The effects of behavioral activation therapy with inpatient geriatric psychiatry patients. Behav Ther. 2011; 42:100–108.

9. Takagaki K, Okamoto Y, Jinnin R, Mori A, Nishiyama Y, Yamamura T, et al. Behavioral activation for late adolescents with subthreshold depression: a randomized controlled trial. Eur Child Adolesc Psychiatry. 2016; 25:1171–1182.

10. Weinstock LM, Melvin C, Munroe MK, Miller IW. Adjunctive behavioral activation for the treatment of bipolar depression: a proof of concept trial. J Psychiatr Pract. 2016; 22:149–158.

11. Weinstock LM, Munroe MK, Miller IW. Behavioral activation for the treatment of atypical depression: a pilot open trial. Behav Modif. 2011; 35:403–424.

12. Parikh SV, Quilty LC, Ravitz P, Rosenbluth M, Pavlova B, Grigoriadis S, et al. Canadian network for mood and anxiety treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 2. Psychological Treatments. Can J Psychiatry. 2016; 61:524–539.

13. Porter JF, Spates CR, Smitham S. Behavioral activation group therapy in public mental health settings: a pilot investigation. Prof Psychol Res Pr. 2004; 35:297–301.

14. Jakupcak M, Roberts LJ, Martell C, Mulick P, Michael S, Reed R, et al. A pilot study of behavioral activation for veterans with posttraumatic stress disorder. J Trauma Stress. 2006; 19:387–391.

15. Jakupcak M, Wagner A, Paulson A, Varra A, McFall M. Behavioral activation as a primary care-based treatment for PTSD and depression among returning veterans. J Trauma Stress. 2010; 23:491–495.

16. Plagge JM, Lu MW, Lovejoy TI, Karl AI, Dobscha SK. Treatment of comorbid pain and PTSD in returning veterans: a collaborative approach utilizing behavioral activation. Pain Med. 2013; 14:1164–1172.

17. Ryba MM, Lejuez CW, Hopko DR. Behavioral activation for depressed breast cancer patients: the impact of therapeutic compliance and quantity of activities completed on symptom reduction. J Consult Clin Psychol. 2014; 82:325–335.

18. Samaan Z, Dennis BB, Kalbfleisch L, Bami H, Zielinski L, Bawor M, et al. Behavioral activation group therapy for reducing depressive symptoms and improving quality of life: a feasibility study. Pilot Feasibility Stud. 2016; 2:22.

19. Hopko DR, Armento ME, Robertson SM, Ryba MM, Carvalho JP, Colman LK, et al. Brief behavioral activation and problem-solving therapy for depressed breast cancer patients: randomized trial. J Consult Clin Psychol. 2011; 79:834–849.

20. Hopko DR, Sanchez L, Hopko SD, Dvir S, Lejuez CW. Behavioral activation and the prevention of suicidal behaviors in patients with borderline personality disorder. J Pers Disord. 2003; 17:460–478.

21. Ottenbreit ND, Dobson KS. Avoidance and depression: the construction of the cognitive-behavioral avoidance scale. Behav Res Ther. 2004; 42:293–313.

22. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4:561–571.

23. Hollon SD, Kendall PC. Cognitive self-statements in depression: development of an automatic thoughts questionnaire. Cognit Ther Res. 1980; 4:383–395.

24. MacPhillamy DJ, Lewinsohn PM. The pleasant events schedule: studies on reliability, validity, and scale intercorrelation. J Consult Clin Psychol. 1982; 50:363–380.

25. Kanter JW, Mulick PS, Busch AM, Berlin KS, Martell CR. The behavioral activation for depression scale (BADS): psychometric properties and factor structure. J Psychopathol Behav Assess. 2006; 29:191.

26. Raes F, Hoes D, Van Gucht D, Kanter JW, Hermans D. The Dutch version of the Behavioral Activation for Depression Scale (BADS): psychometric properties and factor structure. J Behav Ther Exp Psychiatry. 2010; 41:246–250.

27. Teismann T, Ertle A, Furka N, Willutzki U, Hoyer J. The German version of the Behavioral Activation for Depression Scale (BADS): a psychometric and clinical investigation. Clin Psychol Psychother. 2016; 23:217–225.

28. Barraca J, Pérez-Alvarez M, Lozano Bleda JH. Avoidance and activation as keys to depression: adaptation of the Behavioral Activation for Depression Scale in a Spanish sample. Span J Psychol. 2011; 14:998–1009.

29. Lee GY, Cha YJ, Seo HJ, Choi KH. Feasibility of behavioral activation therapy for depression in Korea: a case study. Cognitive Behav Ther Korea. 2016; 16:299–322.

30. Hogan TP, Awad AG, Eastwood R. A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychol Med. 1983; 13:177–183.

31. Yoon BH, Bahk WM, Lee KU, Hong CH, Ahn JK, Kim MK. Psychometric properties of Korean version of Drug Attitude Inventory (KDAI-10). Korean J Psychopharmacol. 2005; 16:480–487.

32. Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003; 84:822–848.

33. Jeon JH, Lee WK, Lee SJ, Lee WH. A pilot study of reliability and validity of the Korean version of Mindful Attention Awareness Scale. Korean J Clin Psychol. 2007; 26:201–212.

34. Kabat-Zinn J, Lipworth L, Burney R. The clinical use of mindfulness meditation for the self-regulation of chronic pain. J Behav Med. 1985; 8:163–190.

35. Miller JJ, Fletcher K, Kabat-Zinn J. Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. Gen Hosp Psychiatry. 1995; 17:192–200.

36. Shapiro SL, Schwartz GE, Bonner G. Effects of mindfulness-based stress reduction on medical and premedical students. J Behav Med. 1998; 21:581–599.

37. Horvath AO, Greenberg LS. Development and validation of the Working Alliance Inventory. J Couns Psychol. 1989; 36:223–233.

38. Munder T, Wilmers F, Leonhart R, Linster HW, Barth J. Working Alliance Inventory-Short Revised (WAI-SR): psychometric properties in outpatients and inpatients. Clin Psychol Psychother. 2010; 17:231–239.

39. Yoo SH, Ha HK, Lee HJ. Korean Cultural Adaptation of Working Alliance Inventory and its reliability. J Korean Soc Phys Ther. 2014; 26:90–96.

40. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983; 67:361–370.

41. Min KJ, O SM, Park DB. A comparison of normal, depressed and anxious groups=a study on the standardization of the Hospital Anxiety and Depressed Scale for Koreans. J Korean Neuropsychiatr Assoc. 1999; 38:289–296.

42. Kim W. Psychological testing. Seoul: Yulkok;1994.

43. Soleimani M, Mohammadkhani P, Dolatshahi B, Alizadeh H, Overmann KA, Coolidge FL. A comparative study of group behavioral activation and cognitive therapy in reducing subsyndromal anxiety and depressive symptoms. Iran J Psychiatry. 2015; 10:71–78.

44. Chu BC, Crocco ST, Esseling P, Areizaga MJ, Lindner AM, Skriner LC. Transdiagnostic group behavioral activation and exposure therapy for youth anxiety and depression: initial randomized controlled trial. Behav Res Ther. 2016; 76:65–75.

45. Buyck D. Depression in context: strategies for guided action. Prim Care Companion J Clin Psychiatry. 2002; 4:201.

46. Jang SH, Park YN, Jae YM, Jun TY, Lee MS, Kim JM, et al. The symptom frequency characteristics of the Hamilton Depression Rating Scale and possible symptom clusters of depressive disorders in Korea: the CRESCEND study. Psychiatry Investig. 2011; 8:312–319.

47. Choi KH, Jaekal E, Lee GY. Motivational and behavioral activation as an adjunct to psychiatric rehabilitation for mild to moderate negative symptoms in individuals with schizophrenia: a proof-of-concept pilot study. Front Psychol. 2016; 7:1759.