Transdiagnostic Behavioral Activation Therapy for Youth Anxiety and Depression
Condition: Depressive Disorder; Anxiety Disorders
MeSH terms: Anxiety Disorders; Depressive Disorder; Depression
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): Group Behavioral Activation Therapy (GBAT)
Intervention type(s): Behavioral
Intervention description(s): GBAT consists of 15 weekly, hour-long sessions. The first five group sessions teach four core BA principles: (a) psychoeducation of anxiety and depression, (b) functional analysis and identifying the maintaining role of avoidance, (c) problem solving and approach-oriented decision-making, and (d) graded exposures and behavioral activation. The second five group sessions consist of graded exposures or engagement exercises, where group members take turns practicing skills in role plays and in vivo exposures. Each youth receives two individual meetings (30-45 minutes) after the second and fourth group sessions. The first individual meeting promotes engagement and motivation for the group; the second helps develop the youth's individual avoidance/challenge hierarchy.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Adolescent; Transdiagnostic therapy; Behavioral activation; Exposure therapy; Depressive Disorder; Anxiety Disorders