The Adolescent Behavioral Activation Program: Adapting Behavioral Activation as a Treatment for Depression in Adolescence

Abstract

Objective This study aimed to examine implementation feasibility and initial treatment outcomes of a behavioral activation based treatment for adolescent depression, the Adolescent Behavioral Activation Program (A-BAP). Method A randomized, controlled trial was conducted with 60 clinically referred adolescents with a depressive disorder who were randomized to receive either 14 sessions of A-BAP or uncontrolled evidenced-based practice for depression (EBP-D). The urban sample was 64% female, predominantly Non-Hispanic White (67%) and had an average age of 14.9 years. Measures of depression, global functioning, activation and avoidance were obtained through clinical interviews and/or through parent and adolescent self-report at pre-intervention and end of intervention. Results Intent-to-treat linear mixed effects modeling and logistic regression analysis revealed that both conditions produced statistically significant improvement from pre- to end of treatment in depression, global functioning and activation and avoidance. There were no significant differences across treatment conditions. Conclusions These findings provide the first step in establishing the efficacy of BA as a treatment for adolescent depression and support the need for ongoing research on BA as a way to enhance the strategies available for treatment of depression in this population.

Modular, scalable, and personalized: Priorities for behavioral interventions for adolescent depression.

“…Their study was distinguished by a number of methodological strengths, including the thoughtful adaptation of the standard BA adult intervention model in a developmentally sensitive manner, careful assessment of depression and comorbidities, attention to reliability and validity of measurement, inclusion of parent as well as adolescent reports, ongoing training and supervision for clinicians, and use of qualitative exit interviews to explore satisfaction with treatment among adolescents and parents. Although limited by the open trial design, their findings are convergent with our own work testing BA with depressed adolescents in a randomized controlled trial (McCauley et al., ).…”

Is behavioural activation effective in the treatment of depression in young people? A systematic review and meta‐analysis

“…Two of the included RCTs measured depression outcomes using two continuous measures of depression (Chu et al ., : CDRS‐R, Center for Epidemiologic Studies Depression Scale [CES‐D]; McCauley et al ., : CDRS‐R, Short Mood and Feelings Questionnaire [SMFQ]), whilst the third reported on three (Stark, : CDRS‐R, Children's Depression Inventory [CDI], Children's Depression Scale [CDS]). A forest plot was produced to provide a graphical display of these study outcomes (Figure ).…”

Dysfunctional Connectivity in the Depressed Adolescent Brain

“…On a molecular level, anhedonia-related abnormalities in the activity of midline cortical regions have been linked to disrupted glutamatergic function (8), while on a systems level, anhedonia has been associated with amplified connectivity between default network and striatal regions (9). Accordingly, depressed adolescents that experience more severe anhedonia may particularly benefit from pharmacotherapy that targets glutamatergic systems, or from interventions that increase contact with positive reinforcement for healthy behaviors such as behavioral activation (10). By including neurobiological methods that probe multiple facets of functional connectivity and molecular mechanisms, along with behavioral methods that precisely define depressive phenotypes, the field is poised to gain a better grasp of the diverse manifestations of this disorder.…”