Expanding Behavioral Activation to Depressed Adolescents: Lessons Learned in Treatment Development
Section snippets
History and Overview of BA
An initial dismantling study, comparing the cognitive and behavioral components of cognitive therapy (CT; Beck, Rush, Shaw, & Emery, 1979), found that the BA component was comparable to CT in treating depressed adults, both acutely and over a 2-year follow-up period (Gortner et al., 1998, Jacobson et al., 1996). Dimidjian and colleagues (2005) replicated and extended these results, finding that BA was comparable in efficacy to antidepressant medication in reducing depressive symptoms and
The Rationale for Extending BA to Depressed Adolescents
Two bodies of literature provide a strong foundation supporting the extension of BA to the treatment of depressed adolescents. First, clinical trial results reveal important limitations to current treatments for depressed adolescents. Second, studies investigating the developmental psychopathology of adolescents suggest that BA may better address the developmental characteristics of adolescence that may pose challenges to other therapeutic approaches.
Of the well-controlled studies of
Case Illustration
Tim1 was a bright, 17 year-old, European-American male. He was an only child and lived in a large metropolitan area with his biological parents. Tim was referred to the ATA project by his primary care physician after experiencing depressive symptoms over several months that had significantly
Reflections and Lessons Learned
The initial pilot trial with a small number of adolescents taught us a great deal about modifications that could potentially improve BA treatment with adolescents. The work with Tim, even though unsuccessful, helped us to identify changes needed in both the structure and content of the ATA approach. The lessons we learned from this initial pilot phase, as illustrated by the case of Tim, had implications for restructuring the treatment, and informed a significant revision of our approach and
Summary
The work outlined above was conducted within the framework of the deployment focused model of treatment development (Weisz, Jensen, & McLeod, 2005). This model attempts to break down the distinction between mental health services research and clinical trials research in an effort to bring new treatments into service settings in a timely fashion. Weisz and colleagues (2005) argue that treatments should be developed and tested through a sequence of studies designed to assure that developing
Acknowledgement
This research was funded by a grant from the National Institutes of Mental Health R34MH076956. Dr. Schloredt was also supported a Clinical Faculty Scholar Award from the Seattle Children’s Hospital Research Center. We wish to thank our research staff and the adolescents and parents who participated in the Adolescents Taking Action Project.
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