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| Patterns and Processes of Change in Behavior Therapy for Youth Depression |
| Tuesday, June 1, 2010 |
| 10:00 AM–11:20 AM |
| Crockett A/B (Grand Hyatt) |
| Area: CBM; Domain: Applied Behavior Analysis |
| Chair: Daniel William Maitland (Western Michigan University) |
| CE Instructor: Susan Friedman, Ph.D.U.S. Fish and Wildlife Service |
| Abstract: Clinical behavior analysis involves the application of strategies derived from behavioral concepts and principles to traditional (outpatient) psychotherapy settings and populations. When a particular behavioral technique alters a well-specified target behavior whose function has been experimentally demonstrated, the cause of the change is relatively apparent. However, in settings where functional analyses are interpretive, intervention based on verbal exchanges between therapist and client, and outcome measured according to multi-dimensional, client-reported indices of functioning, understanding the change process is complicated. In this symposium we focus on our attempts to understand the course of change and the variables responsible for it during behavioral interventions for youth who present with the array of features commonly identified by the summary label depression. |
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| The Time-Course of Change in Youth Depression Treatment: Evidence and Implications |
| SCOTT T. GAYNOR (Western Michigan University), Sarah N. VerLee (Western Michigan University) |
| Abstract: A better understanding of the pattern of change during effective treatment may help in determining the (therapeutic and behavioral) processes responsible for producing that change. The present paper reviews the existing single-case and group design literature to examine the time-course of change during treatment for youth depression. Replicating results from a seminal review in the adult depression literature (Ilardi & Craighead, 1994), group-level results from multiple large scale efficacy trials suggest a substantial amount of the overall change occurs in the early stages of the treatment process. Individual-level analyses further suggest this pattern applies to a substantial percentage of participants. These data have implications for how the field goes about trying to determine the mechanisms of action by which therapy works and determine how best to structure interventions, topics which are addressed in detail in the subsequent papers. |
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| Single-Participant Assessment of Treatment Mediators During Behavioral Activation for Depressed Youth |
| ANDREW R. RILEY (Western Michigan University), Amanda M. Harris (Oglethorpe), Scott T. Gaynor (Western Michigan University) |
| Abstract: It is desirable to understand the mechanisms by which effective psychotherapy works. Assessment of treatment mediators in single-participant design research provides valuable information about the potential causal variables in behavior change. Such analysis requires documenting, for each participant, the receipt of treatment, change on the mediator and relevant clinical outcome measures, and that the change on the mediator happened at the expected time and preceded significant change on the dependent variable. Procedures used in single-participant assessment of mediators will be described, and example data from a behavioral activation intervention with four depressed youths who demonstrated remission following treatment will be presented. For two participants, increased activation appeared to be a mediator, whereas decreased dysfunctional thinking never emerged as a plausible mediator. It is concluded that single-participant assessment of mediators of treatment outcome offers a useful additional tool for determining possible mechanisms of action in effective psychotherapy. |
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| A Stepped Behavioral Care Approach for Youth Depression: Assessment, Rationale, and Clinical Illustrations |
| LUCAS A. BROTEN (Western Michigan University), Scott T. Gaynor (Western Michigan University) |
| Abstract: This presentation will focus on clinical implementation of the stepped behavior therapy approach for depressed adolescents. The rationale will be explicated for a sequence consisting of 1) Watchful Waiting (WW), 2) Behavioral Activation (BA), and 3) Acceptance and Commitment Therapy (ACT). In short, because a substantial number of youth appear to respond to therapeutic support we implemented WW as the first step. A lack of response led to treatment with BA , which was selected for the second step based on the existing efficacy data with adults and its more straightforward implementation. The final step was ACT, which was reserved for cases that failed to respond to steps 1 and 2 (see Kanter, Baruch, and Gaynor, 2006). The presentation will also outline the decision-rule used to determine step progression and will provide clinical material from sessions with youth receiving each of the steps to illustrate what these treatments looked like when being implemented with depressed adolescents. |
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| A Stepped Behavioral Care Approach for Youth Depression: Times-Series Data |
| LUCAS A. BROTEN (Western Michigan University), Scott T. Gaynor (Western Michigan University) |
| Abstract: The purpose of this presentation is to examine data collected using a stepped -treatment sequence involving WW, BA, and ACT for depressed adolescents. The experiment used a single participant A/B/C design where exposure to the next level of the independent variable in the sequence was based on treatment response at the prior level. That is, a clinically significant response to A precluded exposure to B, and a clinically significant response to B precluded exposure to C. The goal was to begin to develop a behavioral treatment algorithm wherein more intensive and specialized treatment was implemented for those who demonstrated need. Time series data from six depressed youth will be presented. The clinical outcome across steps as well as potential mediators of treatment response (as outlined in Riley et al. above) will be emphasized. |
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