Adapting Behavioral Activation to Technology Platform
Condition: Depression
MeSH terms: Depression
Study type: Interventional

Summary: 
      This project aims to use an asynchronous remote communities (ARC) approach both to discover
      the design requirements for adapting Behavioral Activation (BA) to ARC as well as
      design/build an ARC platform for administering BA. The investigators will test the
      feasibility of our approach in a small feasibility observational study with clinicians and
      adolescents.
    

Detailed description: 
      An estimated 3.1 million adolescents are diagnosed with depression (MDD) each year (SAMHSA,
      2016), and adolescent onset MDD is associated with chronic physical, mental and psychosocial
      disability (Birmaher et al., 1996). However, over 60% of adolescents with MDD do not receive
      mental health care, and, among those who do, treatment engagement is low (SAMHSA, 2016;
      Olfson et al., 2003). Behavioral Activation (BA) is an evidence-based psychosocial
      intervention (EBPI) for individuals with MDD (Dimidjian et al., 2006). While BA holds promise
      as an effective treatment with adolescents (McCauley et al., 2015, 2016), previous research
      approaches have found that adolescents may be better reached and engaged through social
      media, mobile technologies, and other technology platforms (Boyd, 2007; Park & Calamaro,
      2013). In addition, BA requires frequent interaction from patients over time, which can be
      difficult and costly for clinicians to administer directly. Thus, there is an opportunity to
      improve usability and engagement of EBPIs via new technology-based tools. Asynchronous Remote
      Communities (ARC) is a promising technology-based approach for engaging adolescents that
      capitalizes on the reach of technology while also providing support, social interactions, and
      motivation to engage. ARCs are technology-mediated groups that use private online platforms
      to deliver weekly tasks to participants and gather information about perceptions in a format
      that is lightweight, accessible, usable, and low burden. The investigators aim to use ARC
      both to discover the design requirements for adapting BA to ARC as well as design/build an
      ARC platform for administering BA. The investigators will test the feasibility of our
      approach in a small feasibility study with clinicians and adolescents. The investigators
      propose the following specific aims:

      Aim 1: Use the ARC approach with adolescents, primary care physicians, and mental health
      specialists to discover target user needs, design constraints and to observe their experience
      with ARC: The investigators will first use ARC to collect target user (i.e., primary care
      providers (PCP) and mental health specialists, adolescents at risk for depression) data to
      understand their needs and the facilitators and barriers to adapting BA to ARC.

      Aim 2: Design & build an ARC platform for BA delivery with adolescents: Once the
      investigators have a strong understanding of the facilitators and barriers, the investigators
      will design a platform to use the ARC approach for BA delivery via Slack. The investigators
      will use an iterative design approach to understand the technical feasibility of the
      approach, whether and how to automate parts of the BA intervention using chatbots and other
      custom applications within Slack. The investigators will conduct small, informal usability
      testing with target users during this stage.

      Aim 3: Test feasibility and usability with small pilot groups of adolescent and clinician
      target users: Once the investigators have a robust enough prototype of the ARC delivery
      platform for BA, the investigators will conduct a small pilot study with adolescents at-risk
      for depression and clinicians to assess the feasibility and usability of the approach. The
      investigators will collect data on the feasibility, usability, user burden, acceptability,
      and symptom outcomes.
    

Intervention name(s): Behavioral Activation
Intervention type(s): Behavioral
Intervention description(s): Intervention: Behavioral Activation (BA) therapy is based on a functional analytic model of depression that highlights the need for increased positive reinforcement (rewards) and decreased anhedonia, or diminished motivation to seek rewards, to maintain normal mood. BA is significantly more effective than Cognitive Behavioral Therapy and comparable to antidepressant medication in reducing depressive symptoms among depressed adults (Dimidjian et al., 2006). McCauley (senior mentor) et al. (2016) adapted BA for adolescents to target anhedonia, effective problem solving and avoidant behaviors with peers, family, and school. McCauley's findings and others show BA is a promising intervention for adolescent MDD (Chu et al., 2009; Cuijpers et al.,, 2007; McCauley et al., 2015; Ritschel et al., 2011). BA focuses on targeting ideographically identified avoidant behaviors and rewarding experiences that affect mood.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment