4 - (IOP 36) Active versus Passive Activity Engagement: Testing a Core Premise of Behavioral Activation

Behavioral Activation (BA) treats Major Depressive Disorder (MDD) by monitoring and scheduling client engagement in activities associated with pleasure and/or a sense of accomplishment (“mastery”; Martell et al., 2021). Much research has shown BA to be an efficacious treatment for MDD (see meta-analysis; Ekers et al., 2014). BA’s rationale theorizes that active activities with participatory engagement lead to more pleasure and mastery than passive, non-participatory activities (Martell et al., 2021). Thus, more active activities are thought to result in greater positive reinforcement and motivational enhancement to counter depression (Kanter et al., 2011). However, these assumed differences between active and passive activities have never been directly tested under controlled conditions. Studies tangentially related to this question have also neglected to rule out the confound of exercise. Exercise is itself an efficacious treatment for MDD (e.g., Shuch et al., 2016). Accordingly, we aimed to study the differential benefits of active versus passive activities with an experiment that does not include physical exercise.

115 participants were randomly assigned to either an active art creating condition or a passive art viewing condition for 15 minutes each. Art activities allow for sufficient comparison because they 1) can be either active or passive and 2) do not include the confound of exercise. Pre-task Beck Depression Inventory II scores were used to determine MDD analogue status via clinical cut-off score. Participants took a series of validated self-report measures on BA outcome constructs (intrinsic motivation, vitality, self-confidence, flow, fatigue, effort) both before and after their condition. Participants also rated post-activity pleasure and mastery in classic BA fashion, as well as personally-perceived meaningfulness. In the active condition, participants were directed to paint with watercolor paint. In the passive condition, they were directed to view watercolor paintings selected from the Splash “best watercolor of 2020” publication (paintings with human faces were excluded to rule out emotional reciprocity and sociality). Analyses used longitudinal linear mixed models to compare pre- to post-task changes between conditions, as well as independent samples t-tests for post-only measures.

Aligning with BA theory, the active condition led to greater reported pleasure (t(113) = -3.71, p < .001, d = -0.69), mastery/accomplishment (t(113) = -2.89, p = .005, d = -0.54), meaning (t(113) = -2.89, p = .005, d = -0.54), intrinsic motivation (t(113) = -3.91, p < .001, d = -0.73), and flow (t(113) = -2.52, p = .013, d = -0.47) than the passive condition. The active condition (versus passive) also led to greater increases in vitality (t(111.46) = 3.80, p < .001, d = 0.72) and self-confidence (t(113) = 2.41, p = .018, d = 0.46), as well as greater decreases in fatigue (t(113) = -2.63, p = .010, d = -0.50). These results all held true within a sub-sample of MDD analogues with clinically-elevated depression symptoms (e.g., pleasure, t(31) = -3.27, p = .003, d = -1.17). Reported effort did not differ between conditions (t(31) = 1.88, p = .070, d = 0.67). These results support the benefits of emphasizing participatory activities during BA.