The efficacy of a behavioral activation intervention among depressed US Latinos with limited English language proficiency: study protocol for a randomized controlled trial

Abstract

BackgroundMajor depressive disorder is highly prevalent among Latinos with limited English language proficiency in the United States. Although major depressive disorder is highly treatable, barriers to depression treatment have historically prevented Latinos with limited English language proficiency from accessing effective interventions. The project seeks to evaluate the efficacy of behavioral activation treatment for depression, an empirically supported treatment for depression, as an intervention that may address some of the disparities surrounding the receipt of efficacious mental health care for this population.Methods/designFollowing a pilot study of behavioral activation treatment for depression with 10 participants which yielded very promising results, the current study is a randomized control trial testing behavioral activation treatment for depression versus a supportive counseling treatment for depression. We are in the process of recruiting 60 Latinos with limited English language proficiency meeting criteria for major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders 4th and 5th Edition for participation in a single-center efficacy trial. Participants are randomized to receive 10 sessions of behavioral activation treatment for depression (n = 30) or 10 sessions of supportive counseling (n = 30). Assessments occur prior to each session and at 1 month after completing treatment. Intervention targets include depressive symptomatology and the proposed mechanisms of behavioral activation treatment for depression: activity level and environmental reward. We will also examine other factors related to treatment outcome such as treatment adherence, treatment satisfaction, and therapeutic alliance.DiscussionThis randomized controlled trial will allow us to determine the efficacy of behavioral activation treatment for depression in a fast-growing, yet highly underserved population in US mental health services. The study is also among the first to examine the effect of the proposed mechanisms of change of behavioral activation treatment for depression (that is, activity level and environmental reward) on depression over time. To our knowledge, this is the first randomized controlled trial to compare an empirical-supported treatment to a control supportive counseling condition in a sample of depressed, Spanish-speaking Latinos in the United States.Trial registrationClinical Trials Register: NCT01958840; registered 8 October 2013.

Pilot randomized controlled trial of a Spanish-language Behavioral Activation mobile app (¡Aptívate!) for the treatment of depressive symptoms among united states Latinx adults with limited English proficiency

“…Briefly, ¡Aptívate! is a self-help Spanish language adaptation of Brief BA (Collado et al, 2014b;Lejuez et al, 2011). Within ¡Aptívate!, the user identifies individualized values and associated activities across five life areas, including relationships, daily responsibilities, recreation, career and education, and health.…”

“…Because U.S. Latinx are a highly heterogeneous group with varied sociocultural and historical origins (González Burchard et al, 2005), an appropriate depression psychotherapy to adapt for mobile app delivery must be idiographic to accommodate personal beliefs/ values on a case-by-case basis. Brief Behavioral Activation Treatment for Depression (Brief BA;Collado et al, 2014b;Lejuez et al, 2011) is an idiographic, straightforward, concise, yet evidence-based psychotherapy for depression. Collado et al (2014a;2014b) developed a direct Spanish language translation of Brief BA, delivered in person using paper forms, for Latinx adults with LEP.…”

“…Brief Behavioral Activation Treatment for Depression (Brief BA;Collado et al, 2014b;Lejuez et al, 2011) is an idiographic, straightforward, concise, yet evidence-based psychotherapy for depression. Collado et al (2014a;2014b) developed a direct Spanish language translation of Brief BA, delivered in person using paper forms, for Latinx adults with LEP. Treatment efficacy was evaluated as compared to a supportive counseling control condition, also delivered in Spanish.…”

The efficacy of adding group behavioral activation to usual care in patients with fibromyalgia and major depression: design and protocol for a randomized clinical trial

“…Its Spanish version showed adequate psychometric properties [ 34 ]. In a recent study conducted with Latino participants with depression, a BA intervention was found to produce not only a greater decrease in depressive symptoms than supporting counseling, but also increased activation and environmental reward [ 35 ]. The Cronbach alpha for the Activation subscale is .81.…”

Development and Preliminary Feasibility Study of a Brief Behavioral Activation Mobile Application (Behavioral Apptivation) to Be Used in Conjunction With Ongoing Therapy

“…Moreover, BATD has been used efficaciously with depressed individuals with a range of other comorbidities including substance use (Daughters et al, 2008; MacPherson et al, 2010; Magidson et al, 2011), anxiety/trauma (Gros et al, 2012; Strachan, Gros, Ruggiero, Lejuez, & Acierno, 2012), and physical health conditions such as cancer (Hopko et al, 2011). BATD has been tested in a variety of patient populations including college students (Gawrysiak et al, 2009; Reynolds et al, 2011), veterans (Egede et al, 2015), Spanish-speaking Latinos (Collado, Calderon, MacPherson, & Lejuez, 2016; Collado, Castillo, Maero, Lejuez, & MacPherson, 2014; Collado, Long, MacPherson, & Lejuez, 2014), and survivors of systematic violence in Kurdistan, Iraq (Bolton et al, 2014). A key strength of BATD, which contributes to its popularity, is that it is simple, straightforward, and as such is easy for clinicians to be trained in and to use with their patients (e.g., Bolton et al, 2014).…”