Shaping Actions and Responses to Emotions
Condition: Depression in Adolescence; Adverse Childhood Experiences
MeSH terms: Depression; Depressive Disorder
Study type: Interventional

Summary: 
      The primary objective of this research is to examine two brief interventions for depression,
      Behavioral Activation (BA), and Problem Solving Therapy (PST), to investigate whether
      exposure to adverse childhood experiences influences change in the hypothesized target
      treatment mechanisms linked to each intervention. Research suggests that the treatment
      targets of BA (reward processing) may be well-matched for youths exposed to childhood
      adversity, due to disruptions in reward that are linked with adversity exposure. The
      investigators will examine the effects of youths' adverse life experiences on change in
      reward-related treatment targets in BA, and compare this to change in the treatment targets
      of PST, executive functioning processes. The first aim is to investigate the effects of
      childhood adversity on change in target treatment mechanisms in BA and PST. The second aim is
      to test whether changes in reward processes is specific to BA, and not PST, among youths
      exposed to adversity. The third aim is to test the match of BA for depression among youths
      exposed to adversity, by examining whether BA results in greater reductions in depression
      symptoms among youths with greater adversity exposure. The investigators will also test
      whether greater change in reward in associated with greater depression symptom reductions in
      BA, and not PST.
    

Detailed description: 
      ASSESSMENT: Adolescents and a parent that is able to provide consent for participation will
      be contacted by research staff to discuss the research project and determine interest in
      study participation. With verbal permission from the parent, both the parent and adolescent
      will complete an eligibility screener over the phone. The eligibility screener includes
      demographic information, psychiatric history, and current depression symptoms
      (adolescent-report Patient Health Questionnaire-9 and the parent-report Children's Depression
      Inventory-2) to confirm that interested families meet initial inclusion criteria.

      Baseline Assessment. A baseline assessment will be scheduled with all families. Informed
      consent and assent will be obtained prior to the start of any baseline assessment activities.

      A diagnostic interview (Kiddie Schedule for Affective Disorders and Schizophrenia:
      K-SADS-P/L) will be completed by a trained study staff member with each adolescent and their
      consenting parent. Diagnoses will be based on consensus ratings between adolescents and
      parents. Study staff will also administer the pediatric Columbia Suicide Severity Rating
      Scale, the Depression Rating Scale (embedded in K-SADS-P/L), and the Stress and Adversity
      Inventory (STRAIN).

      Participants and parent will complete self-report questionnaires assessing depression symptom
      severity, sleep behavior, family and participant demographics, pubertal development,
      behavioral activation, and problem solving strategies and efficacy.

      The Wechsler Abbreviated Scale for Intelligence-II (WASI-II), the Cambridge
      Neuropsychological Test Automated Battery (CANTAB), and reward processing outcome tasks will
      be administered to the adolescent by study staff in the lab setting.

      Final study eligibility will be confirmed based on interviews and the WASI-II.

      RANDOMIZATION: The investigators will use a simple randomization procedure whereby 50% of
      participants will be randomly assigned to Behavioral Activation (BA) and 50% to Problem
      Solving Therapy (PST).

      INTERVENTIONS:

      Behavioral Activation (BA) Therapy. Brief BA is a manualized individual psychotherapy adapted
      to a four-session structure for this pilot study. The first session provides psychoeducation
      about the value and reinforcement of various behaviors and treatment rationale. Three
      additional sessions include reviewing the youth's log of the activities they planned each
      week, assessing youths' values and planning further valued activities, and reviewing
      progress.

      Problem Solving Therapy (PST). Brief PST is a manualized individual psychotherapy adapted to
      a four-session structure for this study. The first session provides psychoeducation on links
      between mood and managing social problems, as well as defining and identifying individual
      problems. Three additional sessions focus on generating solutions, decision making,
      implementing solutions, and evaluation and assessment of the outcomes of these solutions.

      Adherence. A randomly selected 10% of the audio recorded sessions from each intervention will
      be reviewed and coded for therapist adherence to each protocol. Graduate and undergraduate
      student raters will be trained code sessions reliably, and the PI will conduct quarterly data
      checks to ensure coders remain reliable.

      ENGAGEMENT OF TARGET TREATMENT MECHANISMS. Following the last therapy session, participants
      will repeat the four computerized behavioral tasks that were administered at baseline. Change
      in scores from pre- to post-intervention reflects change in the target treatment mechanisms.
      Youths will complete depression rating scales online at post-treatment, and again at
      one-month follow-up to assess the effects of the intervention on depression symptom levels.
    

Intervention name(s): Behavioral Activation (BA) Therapy; Problem Solving Therapy (PST)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Brief BA is a manualized individual psychotherapy adapted to a four-session structure for this pilot study. The first session provides psychoeducation about the value and reinforcement of various behaviors and treatment rationale. Three additional sessions include reviewing the youth's log of the activities they planned each week, assessing youths' values and planning further valued activities, and reviewing progress.; Brief PST is a manualized individual psychotherapy adapted to a four-session structure for this study. The first session provides psychoeducation on links between mood and managing social problems, as well as defining and identifying individual problems. Three additional sessions focus on generating solutions, decision making, implementing solutions, and evaluation and assessment of the outcomes of these solutions.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: Depression; Adolescents; Behavioral Activation Therapy; Problem Solving Therapy; Childhood Adversity; Executive Function; Reward Processing