Behavioural activation for overweight and obese adolescents with low mood delivered in a community setting: feasibility study

Abstract

BackgroundMood and weight problems are common in young people, yet few treatments address both conditions concurrently. Behavioural activation (BA) has shown promise as a treatment for adults with comorbid obesity and depression. This study aimed to examine the feasibility and acceptability of a manualised BA treatment targeting weight and mood problems in young people.MethodsYoung people with low mood and weight difficulties were identified via a school-based screening process. Following a diagnostic interview, young people with clinically significant mood problems and concurrent overweight/obesity were invited to participate. A total of 8–12 sessions of BA were delivered by a graduate therapist to eight adolescents (four male) aged 12–15 years. Weight, mood and functioning were assessed before, during and after treatment, and a semistructured qualitative interview was conducted, along with selected outcome measures at 4 months’ follow-up.ResultsLow attrition and positive qualitative feedback suggested the intervention was acceptable. Trends towards a reduction in reported depression symptoms and improved functioning scores were observed at follow-up, with more mixed results for change in body mass index. Of those attending the 4-month follow-up, 57% (4/7) no longer met the screening threshold for major depressive disorder. However, low screening and baseline recruitment rates would pose challenges to executing a larger trial.ConclusionsBA delivered by a graduate therapist in a British community setting is an acceptable, feasible treatment for comorbid mood and weight problems in adolescence, and its effectiveness should be evaluated in an adequately powered randomised controlled trial.

Innovations in Practice: A randomised controlled feasibility trial of Behavioural Activation as a treatment for young people with depression

“…We recruited staff from Tier 2 and 3 but not LD due to the reading age required for the manual materials. The BA treatment was administered using a treatment manual adapted during a previous study (Arnott, Kitchen, Ekers, Gega, & Tiffin, 2020). Staff were required to pass a half-day competency assessment prior to treating patients in the study.…”

Barriers and enablers for young people, parents and therapists undertaking behavioural activation for depression: A qualitative evaluation within a randomised controlled trial

“…Therapists attended a four‐day training course to deliver an 8‐week manualised therapy (Ekers et al, 2011 ; McCauley, 2011 ) based on BA principles (Kanter et al, 2010 ) and methods refined during a previous study (Arnott et al, 2020 ). Our BA approach is aligned to the theoretical model by Martell et al ( 2001 ), which focuses on maximising behaviours that act as sources of positive reinforcement while minimising sources of negative reinforcement such as avoidance and procrastination.…”

“…The largest BA study with adolescents to date did not seek narrative feedback from its participants (McCauley et al, 2016 ). Smaller, UK‐based studies interviewed young people to explore their experiences of BA in clinical (Dubicka et al, 2022 ; Shenton et al, 2021 ; Watson et al, 2021 ) and educational settings (Arnott et al, 2020 ; Lewis‐Smith et al, 2021 ). In UK Child and Adolescent Mental Health Services (CAMHS), qualitative feedback has been limited to studies focusing on anhedonia as a symptom of depression (Watson et al, 2021 ), low mood without a formal diagnosis of depression (Shenton et al, 2021 ) or been focused on feedback on intervention materials rather than experiences during BA treatment (Dubicka et al, 2022 ).…”