Mood, Activity Participation, and Leisure Engagement Satisfaction (MAPLES): Results From a Randomised Controlled Pilot Feasibility Trial for Low Mood in Acquired Brain Injury

Background: Acquired brain injury (ABI) is linked to increased depression risk. Existing therapies for depression in ABI (e.g., Cognitive Behavioural Therapy) have mixed efficacy. Behavioural Activation (BA), an intervention that encourages engaging in positively reinforcing activities, shows promise. We assess feasibility, acceptability, and potential efficacy of two 8-week BA groups. Whereas the Activity Planning group (AP; “traditional” BA) trained participants to plan reinforcing activities over 8 weeks, the Activity Engagement group (AE; “experiential” BA) encouraged engagement in positive activities within session only. Both were compared to an 8-week Waitlist group (WL). Methods: Adults (≥ 18 years) recruited from local ABI services, charities, and self-referral via social media were randomised to condition. Feasibility and acceptability were assessed via recruitment, retention, and attendance. Participants provided qualitative feedback. Blinded assessments of self-reported activity levels, depression, and anxiety (at pre- and post-intervention and 1 month follow up) were compared across trial arms. Data were collected in-person and remotely due to COVID-19. Results: N = 60 participants were randomised to AP (randomised n = 22; total n = 29), AE (randomised n = 22; total n = 28), or re-randomised following WL (total n = 16). Whether in-person or remote, AP and AE were rated as similarly enjoyable (t = 0.27, p = 0.79) and helpful (t = 1.99, p = 0.05). In exploring efficacy, 58.33% of AP members had clinically meaningful activity level improvements, relative to 50% AE and 38.5% WL. Both AP (t = -4.30, p < 0.001) and AE (t = -4.60, p < 0.001) groups had depression reductions relative to WL, but only AP participants demonstrated anxiety reductions relative to AE (t = -3.98, p < 0.001) and WL (t = -4.13, p < 0.001). AP participants noted benefits of learning strategies to increase activities and learning from other group members. AE participants valued social discussion and choice in selecting in-session activities. Conclusions: Both in-person and remote group BA were feasible and acceptable in ABI. Though both traditional and experiential BA may be effective, these may have different mechanisms. Trial Registration: Clinicaltrials.gov, NCT03874650. Protocol version 2.3, May 26th 2020.