Behavioral activation for children and adolescents: a systematic review of progress and promise

Abstract

Behavioral activation (BA) effectively treats depression in adults, and shows promise in treating anxiety. Research into its application to children and adolescents is emerging. This review aimed to explore the scope of studies, current evidence of effectiveness and how the intervention has been delivered and adapted, to inform future research. A systematic review was undertaken searching PsycInfo, PubMed including Medline, EMBASE, and Scopus for terms relating to BA and children and adolescents. Two researchers scored abstracts for inclusion. Data extraction was completed by one researcher and checked by another. 19 studies were identified, across 21 published articles. 12 were case studies, with three pre-post pilot designs and four randomized-controlled trials. Case studies found early support for the feasibility and potential effectiveness of BA to address both anxiety and depression. The RCTs reported largely positive outcomes. Meta-analysis of depression scores indicated that BA may be effective; however, high heterogeneity was observed. Sample sizes to date have been small. BA has been delivered by trained therapists, doctoral trainee psychologists, social workers, or psychology graduates. Studies are uniquely in high-income settings. Adaptations include flexibility in content delivery, youth friendly materials, and parental involvement. There is some limited evidence to support BA as effective for young people. Feasibility and acceptability are supported. Fully powered trials are now required, with expansion to delivery in low- and middle-income settings, and detailed consideration of implementation issues that consider culture and environment.

Do-it-Yourself Activities and Subjective Well-Being

“…Rumination also interferes with the ability to fully engage in optimal activities, thereby minimizing or reducing positive psychological benefits from work and leisure activities (e.g., Peifer et al 2015;Rusting and Nolen-Hoeksema 1998). For example, greater depression is associated with less engagement in daily activities that bring pleasure (e.g., McAndrew et al 2017) and behavioral activation, the encouragement of becoming more active and engaged in life, is a useful intervention strategy for people experiencing dysphoria and depression (e.g., Chartier and Provencher 2013;Martin and Oliver 2018;Soucy et al 2013). Previous studies have also shown that the quiet ego is negatively associated with measures of depression and anxiety (Collier and Wayment 2019b; Wayment and Brookshire 2018; Wayment and Silver 2018; Wayment and Walters 2017).…”

Randomized Clinical Trial of an Internet-Based Adolescent Depression Prevention Intervention in Primary Care: Internalizing Symptom Outcomes

“…It is also true that the CATCH-IT intervention includes an optional anxiety module (Module #15), which addresses symptoms of anxiety more directly and provides instructions for exercises such as progressive muscle relaxation. Because so few adolescents ( N = 18) in our sample completed the anxiety module, however, it is more likely that the observed improvement in anxiety symptoms is explained by participants’ use of other skills taught in CATCH-IT, such as cognitive restructuring and behavioral activation, both of which are commonly used to treat symptoms of anxiety in adolescents [ 66 , 67 , 68 ].…”

Gaps Between Knowledge, Services, and Needs

“…Decades-old techniques used in psychotherapy sessions are being adapted to the digital context, enabling the delivery of interventions that are automated or partially mediated by a mental health professional. An interesting example is the case of behavioral activation, an intervention designed to help depressed patients identify, schedule, and engage in positive and productive activities to address lack of positive reinforcement and behaviors of avoidance (Martin and Oliver 2018). While in one-on-one psychotherapy sessions behavioral activation is highly customized, taking into account numerous characteristics, such as symptomatology and life aspects, it can be simplified and adapted into apps due to its inherent simplicity.…”