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

Abstract

Objective Engage grew out of the need for streamlined psychotherapies that can be accurately used by community therapists in late-life depression. Engage was based on the view that dysfunction of reward networks is the principal mechanism mediating depressive symptoms. Accordingly, Engage uses “reward exposure” (exposure to meaningful activities) and assumes that repeated activation of reward networks will normalize these systems. This study examined whether change in a behavioral activation scale, an index of reward system function, predicts change in depressive symptomatology. Methods The participants (N=48) were older adults with major depression treated with 9 weekly sessions of Engage and assessed 27 weeks after treatment. Depression was assessed with the 24-item Hamilton Depression Rating Scale (HAM-D) and behavioral activation with the four subscales of Behavioral Activation for Depression Scale (activation, avoidance/rumination, work impairment, social impairment) at baseline, 6 weeks (mid-treatment), 9 weeks (end of treatment), and 36 weeks. Results Change only in the Activation subscale during successive periods of assessment predicted depression severity (HAM-D) at the end of each period (F1,47=21.05, p<0.0001). An increase of one standard deviation in the Activation score resulted in a 2.04 (95% CI: 1.17–2.92) point decrease in HAM-D. For every one point increase in the Activation score, HAM-D was decreased by 0.22 points (95% CI: 0.12–0.31). Limitations No comparison group. Partial overlap of Activation Subscale with HAM-D, lack of detailed neurocognitive assessment and social support. Conclusion Change in behavioral activation predicts improvement of depressive symptoms and signs in depressed older adults treated with Engage.

Reward learning impairment and avoidance and rumination responses at the end of Engage therapy of late‐life depression

“…Perseveration on a negative representation of the environment and increased focus on negative stimuli may be addressed with an intervention that targets negativity bias early and consistently during treatment. These strategies include training patients to recognize when they are disproportionately focused on negative expectations and redirect their attention to positive or rewarding outcomes …”

“…Engage is a psychotherapy for late‐life depression that grew out of the need for streamlined therapies that can be accurately used by community therapists. It was built on a theory that implicates a dysfunction of reward networks as the principal mechanism mediating depressive symptoms . Accordingly, Engage uses reward exposure as its principal therapeutic intervention.…”

Empirically supported interventions in psychology: contributions of Research Domain Criteria

“…Engage is a structured, stepped approach therapy for latelife depression with nine sessions of 40-45 min each (Alexopoulos et al, 2015(Alexopoulos et al, , 2017Alexopoulos & Arean, 2014). The Engage key RDoC constructs for intervention were defined after consider the input provided by professionals in the field.…”

“…In other words, it is not intended to isolate specific constructs to intervention, but rather consider multiple RDoC constructs of interest while defining a unique profile of intervention (Alexopoulos & Arean, 2014;Geraldo, Azeredo, Pasion, Dores, & Barbosa, 2018). Despite the focus on positive valence system-the core system to explain depression in later-life-the Engage program also includes additional constructs that may moderate the efficacy in intervention, namely loss, arousal, and cognitive control (Alexopoulos et al, 2015(Alexopoulos et al, , 2016(Alexopoulos et al, , 2017Alexopoulos & Arean, 2014).…”

“…The RDoC positive valence system is proposed by the authors (Alexopoulos et al, 2015(Alexopoulos et al, , 2016(Alexopoulos et al, , 2017Alexopoulos & Arean, 2014) as a central mechanism to late-life depression, since the alterations on approach motivation and reward learning constructs seem to hinder rewarding activities, strengthening depressive symptoms and beliefs of lack of meaning of life.…”