Background & Aims

Behavioral activation (BA) is a therapy for depression with considerable empirical support3. It could be particularly suitable for treating depression in patients with chronic pain, as it targets factors playing a role in the etiology of both disorders3. BA has been shown to reduce depressive symptoms as well as the severity of fibromyalgia symptoms among patients with fibromyalgia2. The Behavioral Activation for Depression Scale (BADS) was developed to measure changes in avoidance and activation throughout BA4. It has been translated into numerous languages and showed good psychometric properties. Nonetheless, its psychometric properties have never been examined in patients with chronic pain. Furthermore, it has not been adapted to be used in Chile yet. The purpose of the present study is to culturally adapt the Spanish version of the BADS to the Chilean population with chronic pain and provide evidence of its psychometric properties in this population.

Methods

We asked 11 Chilean patients with non-cancer chronic pain to read the Spanish version of the BADS and to report any expression considered unclear or inappropriate in the Chilean context. We made some modifications to the wording of the item according to the participants comments. After this, 401 patients with chronic pain completed a battery of questionnaires – including the resulting culturally validated version of the BADS as well as depressive symptoms and anxiety scales – on two separate occasions, with a three-month interval between assessments. We conducted a confirmatory factor analysis to test the four-factor structure found in previous studies. We assessed the internal consistency, the test-retest reliability, and the convergent validity of the BADS.

Results

The four-factor structure similar to the one found in the original4 and in the Spanish version of the scale1 presented good fix indexes (?2(269) = 566.803, p <0.001; RMSEA = 0.053; CFI = 0.98 and TLI = 0.98). Cronbach alphas were .81 for the activation, .85 for the avoidance/rumination, .81 for the work/school impairment, and .87 for the social impairment scales, respectively; and .91 for the total BASD score. The ICC was .64 (CI 95% = .57, .69). The total BADS score presented moderated significant correlation with depressive symptoms (r = .535) and anxiety (r = .569) supporting its convergence validity. Furthermore, the total BADS scores correlated with pain-related variables such as catastrophizing (r = .474), pain interference (r = .421), kinesiophobia (r = .297), pain intensity (r =.267), and quality of life associated with health (r = -.566).

Conclusions

The Chilean cultural adaptation of the BADS is a valid and reliable instrument to assess changes in activation, avoidance, work/school, and social impairment among Chilean patients with chronic pain. BA not only correlated with anxiety and depression but with several pain-related variables (such as catastrophizing, pain interference, pain intensity, and kinesiophobia), which suggest that, in line with other preliminary results2, this variable may also intervene in the improvement of chronic pain symptoms other than depressive symptoms.

References

1.Barraca, J., Pérez-Álvarez, M., & Bleda, J. H. L. (2011). Avoidance and activation as keys to depression: Adaptation of the Behavioral Activation for Depression Scale in a Spanish sample. The Spanish Journal of Psychology, 14(2), 998-1009.
2.Duran, J., Verges, A., Vázquez-Taboada, A., Gonzalez, M., Gómez-Pérez, L. (2021). The Efficacy of Group Behavioral Activation versus Usual Treatment in Patients with Fibromyalgia and Major Depression. Arthritis Rheumatology, 73 (suppl 10).
3.Gómez-Pérez, L., Vergés, A., Vázquez-Taboada, A. R., Durán, J., & González Tugas, M. (2018). The efficacy of adding group behavioral activation to usual care in patients with fibromyalgia and major depression: design and protocol for a randomized clinical trial. Trials, 19(1), 1-10.
4.Kanter, J. W., Mulick, P. S., Busch, A. M., Berlin, K. S., & Martell, C. R. (2007). The Behavioral Activation for Depression Scale (BADS): psychometric properties and factor structure. Journal of Psychopathology and Behavioral Assessment, 29, 191-202.

Presenting Author

María Labbé

Poster Authors

Teresa de Pablo Arellano

Psychology

Universidad de Málaga

Lead Author

E-mail

Camila Román MSc

Pontificia Universidad Católica de Chile

Lead Author

E-mail

Alvaro Vergés PhD

Universidad de los Andes, Chile

Lead Author

E-mail

Ivelisse Huerta MD

Pontificia Universidad Católica de Chile

Lead Author

E-mail

Jorge Flores PhD

Pontificia Universidad Católica de Chile

Lead Author

E-mail

Patricio Cespedes MD

Family medicine

Pontificia Universidad Católica de Chile

Lead Author

E-mail

Lydia Gómez-Pérez PhD

Universidad de Málaga

Lead Author

E-mail

Topics

  • Assessment and Diagnosis