Behavioral Activation, Affect, and Self-Efficacy in the Context of Alcohol Treatment for Women With Elevated Depressive Symptoms

Women with Alcohol use disorder (AUD) are more likely than men to have co-occurring depression, drink to cope with negative affect (NA), and cite negative affect as a contributor to relapse. Among AUD treatment seekers, low behavioral activation, NA, and reduced self-efficacy in abstaining from alcohol (e.g., in tempting situations) are relapse risk factors. This study investigated the association between behavioral activation, affective states, and self-efficacy among treatment-seeking women. Participants were 70 women (M = 40.50, SD = 11.59 years of age) with elevated depressive symptoms seeking AUD treatment. The Behavioral Activation for Depression Scale (BADS) was used to assess environmental engagement. The Alcohol Abstinence Self-Efficacy (AASE) scale was used to assess temptation to drink in contexts of positive and negative affect, and general positive and negative affect were assessed with the Positive and Negative Affect Schedule. Results indicated that behavioral activation was directly correlated with positive affect (PA; r =.62, p <.001) and inversely correlated with depression (r = −.35, p =.004), negative affect (r = −.39, p =.001), and temptation to drink in the context of negative affect (r = −.33, p =.006). After controlling for depressive symptoms, behavioral activation continued to be associated with greater general positive affect (β =.595, p <.001) and lower temptation to drink in the context of negative affect (β = −.348 p =.008). Our results suggest a nuanced association between behavioral activation, negative affect, and temptations to drink that is not accounted by depressive symptoms. Self-efficacy to abstain from drinking in a negative affect context should be considered when designing AUD interventions for women.