“Engage” Therapy: Behavioral Activation and Improvement of Late-Life Major Depression

Abstract

Objective Engage is a treatment for late-life depression developed to match the skills of community clinicians. It is based on the theory that dysfunction in the RDoC positive valence systems (PVS) is a critical mechanism of late life depression. Accordingly, it uses “reward exposure” (engagement in meaningful, rewarding activities) as its principal intervention. This study tests the hypothesis that change in behavioral activation, an index of PVS function, during successive treatment periods with Engage and during follow-up predicts depression at the end of each period. Methods Forty-eight non-demented, older adults with unipolar major depression were treated openly with 9 weekly sessions of Engage and assessed 36 weeks after entry. Depression severity was assessed with the 24-item Hamilton Depression Rating Scale (HAM-D) and behavioral activation with the Behavioral Activation for Depression Scale (BAS) at baseline, 6 weeks (mid-treatment), 9 weeks (end of treatment), and 36 weeks. Results A mixed effects model examined whether change in BAS in successive periods occurring during Engage treatment and during follow-up predicts depression at the end of each period. Both BAS change (F1, 52=18.63, p<0.0001) and time (F2, 52=7.68, p=0.0012) predicted HAM-D scores at the end of each observation period. For every point of increase in BAS change, there was a reduction of HAM-D by 0.105 points. HAM-D at each point did not predict subsequent change in BAS (F1, 52=2.17, p = 0.146). Conclusion During Engage treatment and follow-up, change in behavioral activation is followed by improvement of depressive symptoms and signs.

Six Years of Research on the National Institute of Mental Health’s Research Domain Criteria (RDoC) Initiative: A Systematic Review

“…The Engage intervention demonstrated comparable efficacy to PST in reducing symptoms and functional impairment associated with MDD. In order to explore the mechanism underlying this change, Alexopoulos et al (2016) examined how MDD symptoms and a self-reported rating of behavioral activation influenced each other throughout Engage. In a sample of 48 older adults with MDD completing 9 weeks of Engage, greater increases in behavioral activation, taken as a broad index of Positive Valence Systems function, predicted change in depression severity during treatment and at a 36-week follow-up assessment.…”

“Engage” therapy: Prediction of change of late-life major depression

“…No participant met DSM-IV criteria for dementia and their MMSE scores were above the dementia range (≥24). Participant demographic and clinical characteristics and attrition rate have been reported elsewhere (Alexopoulos et al, 2016). Briefly, their depression and disability (WHODAS II mean: 29.1, SD: 8.1) were of mild to moderate severity and they had a wide range of medical burden (Charlson Comorbidity Index mean: 2.6, SD: 2.1).…”

“…An earlier analysis showed that the BADS total score mediates improvement of late-life depression during treatment with Engage and at follow-up (Alexopoulos et al, 2016). The current analysis examines the role of BADS subscales in predicting the reduction of depressive symptomatology during the 9 weeks of Engage therapy and 27 weeks after termination of treatment.…”

Psychosocial Treatment Options for Major Depressive Disorder in Older Adults

“…We have recently been funded to study the impact of a stepped behavioral intervention, called Engage, on LLD. This intervention was developed using patient-centered and clinician centered design, as well as recent information regarding reward seeking and processing in LLD (62, 63). Preliminary data suggests that not only is this intervention easy for clinicians and patient to use, but maybe more effective than PST(62).…”

“…This intervention was developed using patient-centered and clinician centered design, as well as recent information regarding reward seeking and processing in LLD (62, 63). Preliminary data suggests that not only is this intervention easy for clinicians and patient to use, but maybe more effective than PST(62). The role of cognitive processing variables, particularly executive function, has garnered increased attention as moderators of treatment effects.…”