Do all roads lead to Rome? A qualitative process evaluation of two types of group-based Behavioural Activation following acquired brain injury from the MAPLES feasibility trial
Randomized trial process evaluation reveals distinct therapeutic mechanisms in group behavioral activation after brain injury, indicating multiple pathways relieve depression.
Key Points
To examine and compare the perceived therapeutic mechanisms and processes influencing mood and activity changes across two group-based Behavioural Activation interventions for adults with acquired brain injury.
Qualitative process evaluation nested within a randomized feasibility trial (NCT03874650) evaluating 8-week, once-weekly group interventions.
Adult participants (≥18 years) recruited from brain injury services, charities, and self-referrals were randomized to Traditional Behavioural Activation or Experiential Behavioural Activation.
Post-intervention semi-structured qualitative interviews were conducted with N = 49 participants (Traditional BA n = 25; Experiential BA n = 24).
Shared mechanisms across both formats included group cohesion, a supportive therapeutic milieu, and shared lived experiences, which enhanced psychological safety, decreased social isolation, and elevated mood.
Traditional Behavioural Activation drove change through skill-building, managing low mood, addressing avoidance and cognitive barriers, values-congruent activity scheduling, and cognitive reframing.
Experiential Behavioural Activation improved mood through direct in-session enjoyment, heightened present-moment awareness, and personal autonomy in selecting group activities.