Transdiagnostic Behavioral Activation Therapy for Youth Anxiety and Depression
| Status: | Completed |
|---|---|
| Conditions: | Anxiety, Depression, Depression |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 11 - 15 |
| Updated: | 10/19/2017 |
| Start Date: | September 2009 |
| End Date: | June 2012 |
The Function of Avoidance in Depressed Behavior and a Pilot of Transdiagnostic Behavioral Activation Therapy
Psychological therapies for depression have demonstrated efficacy, but outcomes are still
unsatisfactory, especially in cases with high comorbidity. Depression and anxiety co-occur in
up to 69-75% of teens and intensify functional impairment and service use. This study will
develop treatment materials for a transdiagnostic Group Behavioral Activation Therapy (GBAT)
and conduct a pilot waitlist-controlled school-based study with 35 7th and 8th grade boys and
girls with co-occurring depression and anxiety. Multi-reporter, multi-domain assessments will
be conducted at initial screening, pre- and post-treatment, and 4-month follow-up. BA is a
straightforward, but flexible and robust, therapy that has demonstrated strong results in
adults. Current formulations of BA highlight the specific role of avoidance in depressotypic
behavior. It presumes that anhedonia, isolation, and negative behaviors associated with
depression function to avoid imminent distress even as it blocks access to otherwise
available positive reinforcement. This study will therefore employ novel electronic diary
technology to obtain Ecological Momentary Assessment and evaluate: (a) the function of
avoidance in distinguishing youth with depression (n=35) from a non-clinical comparison group
(n=18), and (b) the role of avoidance in mediating treatment gains in participants in the
GBAT intervention.
unsatisfactory, especially in cases with high comorbidity. Depression and anxiety co-occur in
up to 69-75% of teens and intensify functional impairment and service use. This study will
develop treatment materials for a transdiagnostic Group Behavioral Activation Therapy (GBAT)
and conduct a pilot waitlist-controlled school-based study with 35 7th and 8th grade boys and
girls with co-occurring depression and anxiety. Multi-reporter, multi-domain assessments will
be conducted at initial screening, pre- and post-treatment, and 4-month follow-up. BA is a
straightforward, but flexible and robust, therapy that has demonstrated strong results in
adults. Current formulations of BA highlight the specific role of avoidance in depressotypic
behavior. It presumes that anhedonia, isolation, and negative behaviors associated with
depression function to avoid imminent distress even as it blocks access to otherwise
available positive reinforcement. This study will therefore employ novel electronic diary
technology to obtain Ecological Momentary Assessment and evaluate: (a) the function of
avoidance in distinguishing youth with depression (n=35) from a non-clinical comparison group
(n=18), and (b) the role of avoidance in mediating treatment gains in participants in the
GBAT intervention.
Specific Aims and Hypotheses:
This study will develop treatment materials for a transdiagnostic Group Behavioral Activation
Therapy (GBAT). It will then conduct a double-gated screening of middle-school students
(N=895) to identify youth with subclinical or clinical DSM-IV-TR anxiety or mood disorders.
Eligible youth (N=35) will then participate in a randomized clinical trial of GBAT where 21
will be randomly assigned to GBAT and 14 to a 15-week waitlist period. This addresses
critical needs to develop first-line early interventions that are evidence-based and can
efficiently address commonly co-occurring problems in settings where treatment is needed
most.
Aim 1. To develop treatment materials and test GBAT's feasibility (e.g., recruitment and
retention rates, therapist adherence) and acceptability to youth participants (client
satisfaction, group cohesion, homework completion).
Aim 2. To estimate initial efficacy of GBAT compared to a waitlist (WL) control in a
randomized pilot study with 35 youth (21 assigned to two GBAT groups; 14 assigned to WL). It
is hypothesized that GBAT will show greater pre- to post-treatment outcomes on primary
(clinical diagnosis, symptom severity) and secondary measures (achievement of target goals,
reduced avoidance, social and academic adjustment). Youth who receive GBAT will also show
linear improvement on outcome measures from pretreatment through four-month follow-up.
A second major goal of the project is to understand the functional role of avoidance in
depression. Participating youth will carry Electronic Diaries (EDs; i.e., ipod touch)
throughout the active treatment and follow-up phases and complete twice-daily reports of
negative events, emotional and behavioral responses, and perceived function of one's
responses. A non-clinical comparison group (n=18) will also carry EDs during a two-week
period. Such Ecological Momentary Assessment (EMA) data has been used effectively with youth
populations to determine the impact of positive and negative coping responses on depressive
symptoms.
Aim 3. The research suggests that depressed youth seek out depressogenic activities and
respond less to positive events. Based on EMA data, the study hypothesizes that, compared to
non-clinical comparisons: (a) depressed youth will identify more events as negative during
the day, (b) depressed youth will respond with greater negativity than non-depressed youth,
(c) the coping strategies used will be more avoidant or aimed at disengagement, and (d) the
function of these strategies will be to minimize distress and conflict. Furthermore, youth
who receive GBAT, compared to WL participants, will demonstrate increased ratio of
engagement-based to avoidance-based coping strategies from pre- to post-treatment and 4-mo
FU.
This study will develop treatment materials for a transdiagnostic Group Behavioral Activation
Therapy (GBAT). It will then conduct a double-gated screening of middle-school students
(N=895) to identify youth with subclinical or clinical DSM-IV-TR anxiety or mood disorders.
Eligible youth (N=35) will then participate in a randomized clinical trial of GBAT where 21
will be randomly assigned to GBAT and 14 to a 15-week waitlist period. This addresses
critical needs to develop first-line early interventions that are evidence-based and can
efficiently address commonly co-occurring problems in settings where treatment is needed
most.
Aim 1. To develop treatment materials and test GBAT's feasibility (e.g., recruitment and
retention rates, therapist adherence) and acceptability to youth participants (client
satisfaction, group cohesion, homework completion).
Aim 2. To estimate initial efficacy of GBAT compared to a waitlist (WL) control in a
randomized pilot study with 35 youth (21 assigned to two GBAT groups; 14 assigned to WL). It
is hypothesized that GBAT will show greater pre- to post-treatment outcomes on primary
(clinical diagnosis, symptom severity) and secondary measures (achievement of target goals,
reduced avoidance, social and academic adjustment). Youth who receive GBAT will also show
linear improvement on outcome measures from pretreatment through four-month follow-up.
A second major goal of the project is to understand the functional role of avoidance in
depression. Participating youth will carry Electronic Diaries (EDs; i.e., ipod touch)
throughout the active treatment and follow-up phases and complete twice-daily reports of
negative events, emotional and behavioral responses, and perceived function of one's
responses. A non-clinical comparison group (n=18) will also carry EDs during a two-week
period. Such Ecological Momentary Assessment (EMA) data has been used effectively with youth
populations to determine the impact of positive and negative coping responses on depressive
symptoms.
Aim 3. The research suggests that depressed youth seek out depressogenic activities and
respond less to positive events. Based on EMA data, the study hypothesizes that, compared to
non-clinical comparisons: (a) depressed youth will identify more events as negative during
the day, (b) depressed youth will respond with greater negativity than non-depressed youth,
(c) the coping strategies used will be more avoidant or aimed at disengagement, and (d) the
function of these strategies will be to minimize distress and conflict. Furthermore, youth
who receive GBAT, compared to WL participants, will demonstrate increased ratio of
engagement-based to avoidance-based coping strategies from pre- to post-treatment and 4-mo
FU.
Inclusion Criteria:
- clinical (ADIS CSR ≥ 4) or subclinical (ADIS CSR = 2-3) principal diagnosis of either
a DSM-IV-TR unipolar depression disorder (Major Depressive Disorder ([MDD], Minor
Depression [MinD], or Dysthymia [Dys]) or
- an anxiety disorder (Generalized Anxiety Disorder [GAD], Social Phobia [SOP],
Separation Anxiety [SAD]).
Exclusion Criteria:
- any principal diagnosis other than anxiety or depression or parent report of mental
retardation,
- pervasive developmental disorder,
- schizophrenia, or
- bipolar disorder, or
- report of past-year hospitalization for a suicide attempt. Concurrent use of
antidepressant or anxiolytic medications was permitted as long as dosage was stable
for at least four weeks and the family intended to maintain the dose.
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