Dynamic processes in behavioral activation therapy for anhedonic adolescents: Modeling common and patient-specific relations.

Abstract

Objective: Behavioral activation (BA) is a brief intervention for depression encouraging gradual and systematic re-engagement with rewarding activities and behaviors. Given this treatment focus, BA may be particularly beneficial for adolescents with prominent anhedonia, a predictor of poor treatment response and common residual symptom. We applied group iterative multiple model estimation (GIMME) to ecological momentary assessment (EMA) treatment data to investigate common and person-specific processes during BA for anhedonic adolescents. Method: Thirty-nine adolescents (M age = 15.7 years old, 67% female, 81% White) with elevated anhedonia (Snaith-Hamilton Pleasure Scale) were enrolled in a 12-week BA trial, with weekly anhedonia assessments. EMA surveys were triggered every other week (2-3 surveys per day) throughout treatment assessing current positive affect (PA) and negative affect (NA), engagement in pleasurable activities and social interactions, anticipatory pleasure, rumination, and recent pleasurable and stressful experiences. Results: A multilevel model revealed significant decreases in anhedonia, t(25.5) = −4.76, p < .001, over the 12-week trial. GIMME results indicated substantial heterogeneity in variable networks across patients. PA was the variable with the greatest number (22% of all paths vs. 11% for NA) of predictive paths to other symptoms (i.e., highest out-degree). Higher PA (but not NA) out-degree was associated with greater anhedonia improvement, t(25.8) = −2.22, p = .035. Conclusions: Results revealed substantial heterogeneity in variable relations across patients, which may obscure the search for common processes of change in BA. PA may be a particularly important treatment target for anhedonic adolescents in BA. What is the public health significance of this article?This study demonstrates that behavioral activation (BA) therapy may be therapeutically beneficial for adolescents suffering from anhedonia (loss of pleasure or interest), a predictor of poor treatment response and common residual symptom following psychotherapy and antidepressant medication treatment. In addition, this study provides initial evidence that anhedonic adolescents may benefit from therapists focusing on boosting positive emotional states in their patients, which may have a downstream beneficial impact on other symptoms.

Behavioral Activation and Brain Network Changes in Depression

“… 46 The efficacy of BA treatment for anhedonia has also been validated in adolescent populations. 47 48 …”

Are ecological momentary assessment measures of intervention change worth the trouble? Examining rumination as a case-in-point

“…An increasing number of treatment studies are incorporating smartphone-delivered ecological momentary assessment (EMA) to measure symptom improvement Mofsen et al, 2019;Moore et al, 2016;Peterson et al, 2020;Targum et al, 2021;Webb, Swords, et al, 2021;Webb et al, 2022Webb et al, , 2023Wichers et al, 2009). Proponents of EMA argue that the reliance on commonly used retrospective self-report questionnaires may be convenient and cost-effective, but these measures often lack ecological validity and are contaminated by recall bias (Mofsen et al, 2019;Stone & Shiffman, 2010;Van den Bergh & Walentynowicz, 2016).…”