Furthermore, our data suggest that participants experienced the active and goal-directed approach as credible and working alliance was maintained. This may be of particular click here interest for inpatient nurses who may feel uncomfortable in persevering at the importance of some activity in the face of noncompliance. BA may thus provide staff with a useful model for how to be assertive without compromising the working alliance. This study was the first to use the BA model outlined by Kanter et al., 2009 and Kanter et al., 2011 in a clinical sample. A main characteristic of this model is to tailor the interventions according to the function of nonadherence (i.e., the reasons for not completing activation

assignments). The study provided preliminary validity

to that model as all the reasons for nonadherence proposed by the model were indicated at some point. Private consequences were the most common of reasons for noncompliance. Our decision to add explicit focus on exposure to counter avoidance thus seems to be warranted in this context. Given the uncontrolled nature of our study design, reporting effectiveness was only a secondary aim of the pilot study. However, a quick benchmark with previous inpatient depression studies of behavioral (Hopko et al., 2003) and cognitive therapy (Miller et al., 1989 and Whisman et al., 1991) roughly suggests a 50% average reduction in depressive symptoms. This appeared consistent with the improvement magnitude in our current pilot trial. This study had several methodological limitations. PD0325901 cost First, our pilot sample was limited in size and some patient groups were excluded (e.g., acute psychosis and mania) and thus our findings regarding feasibility cannot be generalized across the inpatient population at large. Second, our pilot study design lacked a control group, did not Interleukin-2 receptor apply long-term follow-up, and assessments were not blind. We are thus unable to draw any conclusions about the effectiveness of BA and what it adds to standard care in terms

of outcome. Overall, the present study provides a detailed description of and preliminary support for the feasibility of BA in the transition between acute inpatient and outpatient services. Our study indicates that inpatients with acute and heterogeneous psychiatric problems may experience BA as a credible and helpful treatment to bridge the gap after inpatient treatment. Furthermore, adherence to the principles of BA appears to be the rule and may have a positive effect on outcome. Future research using rigorous methods (e.g., multiple baseline and randomized controlled study designs) will be necessary to study the efficacy of adding BA to standard care. Such research will present a significant challenge for researchers given the difficulty to control the context of acute care and the organizational boundaries between inpatient and outpatient services.