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Updated: Oct 27, 2026
Intra-Operative Behavioral Tasks in Awake Humans Undergoing Deep Brain Stimulation Surgery
Published on: January 6, 2011
Timing, dose, and Behavioral engagement in perioperative Behavioral activation: a secondary analysis of predictors of
Emily M Lenard1, Reya Mehta2, Joanna Abraham3
1Department of Psychiatry, Washington University School of Medicine (WashU Medicine), St. Louis, MO, USA.
Background:
Depression and anxiety are associated with poor outcomes in older adults undergoing surgery. Perioperative psychological interventions may improve symptoms, but the optimal dose, timing, and therapeutic processes remain unclear.
Methods:
This secondary analysis examined the intervention arm of a randomized clinical trial. Participants were aged ≥60, scheduled for cardiac, oncologic, or orthopedic surgeries, and had clinically meaningful depression and/or anxiety symptoms on the Patient Health Questionnaire-Anxiety Depression Scale (PHQ-ADS). Analyses included participants who completed baseline and 3-month assessments. Associations between intervention components and changes in PHQ-ADS, PHQ-9 depression and GAD-7 anxiety scores were evaluated across four a priori domains: intervention dose and perioperative timing, behavioral engagement through activity plan enactment, implementation quality and target engagement through measures of activation, compassion, and surgical preparedness scores.
Results:
Among 138 intervention participants, greater intervention dose was associated with larger reductions in anxiety at 3 months. Pre-operative initiation was consistently associated with symptom improvement. Participants completing ≥3 pre-operative sessions had a 6.05-point greater reduction in PHQ-ADS than those completing none (p = .003). Greater mean activity-plan completion was associated with larger reductions in PHQ-ADS (b = -2.42, SE = 1.00, p = .02), PHQ-9 (b = -1.35, SE = 0.65, p = .04), and GAD-7 scores (b = -1.07, SE = 0.53, p = .05).
Conclusions:
More sessions, earlier initiation, and greater behavioral engagement of patients were associated with greater reductions in depression and anxiety. Initiating behavioral activation before surgery and supporting activity-plan enactment may improve postoperative depression and anxiety symptoms for older surgical patients. Limitations include lack of random assignment to the variables studied and single-site population.
