Pilot of the Brief Behavioral Activation Treatment for Depression in Latinos With Limited English Proficiency: Preliminary Evaluation of Efficacy and Acceptability

Abstract

Latinos with limited English proficiency (LEP) experience multiple barriers to accessing efficacious mental health treatments. Using a stage model of behavioral therapies research, this Stage 1b investigation evaluated the Brief Behavioral Activation Treatment for Depression (BATD), an intervention which may be well-equipped to address existing treatment barriers. A sample of 10 Latinos with LEP and depressive symptomatology participated in a 10-session,direct (i.e., literal) Spanish-language translation of BATD, with no other cultural modifications. Participants were assessed at each session for depressive symptomatology and for the proposed BATD mechanisms: activity engagement and environmental reward. One month after treatment, participants were reassessed and interviewed to elicit feedback about BATD. Hierarchical Linear Model analyses were used to measure BATD outcomes. Results showed depressive symptomatology decreased (p<.001), while both activation (p = .04) and environmental reward (p = .02) increased over the course of BATD. Increases in activation corresponded concurrently with decreases in depression (p = .01), while environmental reward preceded decreases in depressive symptomatology (all p’s≤ .04). Follow-up analyses revealed sustained clinical gains in depression and activation, and an increase in environmental reward at follow-up. Participant interviews conducted one month after treatment conclusion indicated that BATD is an acceptable treatment for our sample of interest. Despite the limitations inherent to a study restricted to sample of ten, preliminary outcomes of this Stage I research suggest that members of this otherwise underserved group showed improvements in depressive symptomatology and are willing to participate in and adhere to BATD. The study’s positive outcomes suggest that a Stage II randomized clinical trial is a logical next step.

Behavioral activation in acute inpatient psychiatry: A multiple baseline evaluation

“…Such consistent findings across different populations, treatment durations and settings provide support for continued research on the role of activation and avoidance in depression treatment. The somewhat different results obtained with different process measures in both our and other studies (Collado et al, 2014) underscore the need for using a variety of measures and for continued process measure Fig. 4.…”

“…In fact, previous research shows that different change patterns are discovered with different measures. Collado et al (2014) used weekly assessments of depressive symptoms along with an activation and an environmental reward measure. Improvement in depression was concurrent with increased activation and was preceded by increased environmental reward.…”

“…In a single subject study by Gaynor and Harris (2008), activation appeared to mediate outcomes in 50% of participants. Collado, Castillo, Maero, Lejuez, and MacPherson (2014) found, in a small pilot trial, that depression improved in tandem with activation and was preceded by environmental reward. In another case study by Manos, Kanter, and Luo (2011) activation preceded depression improvement in one client and was concurrent with improvement in the other.…”

The efficacy of behavioral activation treatment among depressed Spanish-speaking Latinos.

“…Initial eligibility was determined in a telephone screener, which included questions from the Structured Clinical Interview for DSM-IV-TR ( SCID-IV ; Collado et al, 2014) was the translation of the most recent BATD manual (see First, Spitzer, Gibbon & Williams, 2002). Eligible participants had to: 1) be a minimum of 18 years of age, 2) Latino/a, 3) report Spanish-language preference, 4) meet MDD criteria, 5) not meet criteria for substance abuse or dependence, bipolar or psychotic disorders, 6) not be receiving psychotherapy, and 7) if taking antidepressants, demonstrate three or more consecutive months of use.…”

“…Participants completed 88% of total sessions. An in-depth interview showed high treatment acceptability and no need for changes to BATD’s content, cultural or otherwise (Collado et al, 2014) 1 .…”