Psychology

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    The efficacy of a behavioral activation intervention among depressed US Latinos with limited English language proficiency: study protocol for a randomized controlled trial
    (Springer Nature, 2014-06-18) Collado, Anahi; Long, Katherine E; MacPherson, Laura; Lejuez, Carl W
    Major 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. Following 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. This 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.
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    Evaluating the Efficacy of Behavioral Activation Among Spanish-Speaking Latinos
    (2014) Collado, Anahi; Lejuez, Carl W; MacPherson, Laura; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Major depressive disorder (MDD) is highly prevalent among U.S. Spanish-speaking Latinos. Although MDD is very treatable, the lack of empirically-supported treatments precludes this population's access to quality mental health care. Following the promising results of a small open-label pilot study in which we tested the efficacy of Behavioral Activation Treatment for Depression (BATD) in a sample Latinos with Spanish-speaking preference, we conducted a randomized control trial (RCT; N = 46) that compared BATD (N = 23) to supportive counseling (N = 23) across various domains, including depression, BATD proposed mechanisms (activity level and environmental reward), and non-specific psychotherapy factors. Results indicated that relative to SC, BATD led to greater decreases in depressive symptoms over time (p = 0.04) and greater MDD remission at the end of treatment and at the one-month follow-up (p = 0.01). Activity level (p = 0.01) and environmental reward (p = 0.05) showed greater increases over time among participants who received BATD compared to SC. Further, proposed BATD mechanisms of change did not correspond over time with depressive symptomatology. Treatment adherence, therapeutic alliance, and treatment satisfaction did not differ between the groups (ps > 0.17). The one-month follow-up suggested sustained clinical gains across therapies. The current study adds to a limited treatment research literature and suggests that BATD, a time-limited and straightforward intervention, is efficacious in reducing depression and increasing activity level and environmental reward in this important, yet underserved population of the U.S. The current study sets the stage for a larger RCT to examine BATD against an empirically-supported treatment, with additional moderators of treatment and mechanisms of change.
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    BRIEF BEHAVIORAL ACTIVATION TREATMENT FOR DEPRESSION IN SPANISH-SPEAKING LATINOS: ACCEPTABILITY AND PRELIMINARY EVALUATION
    (2012) Collado-Rodriguez, Anahi D.; MacPherson, Laura; Lejuez, Carl W; Psychology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)
    Although depression is highly treatable, disparities in mental health treatment in the US have prevented Latinos who lack English language proficiency from accessing efficacious interventions. Reasons cited for these disparities include language barriers, high cost of services, lack of culturally sensitive treatments, and stigma toward mental health treatment. A direct Spanish translation of the Brief Behavioral Activation Treatment for Depression (BATD) may be well-equipped to address the existing barriers through its focus on individual and cultural values, its efficiency and straight-forward nature, itsfocus on developing existing and new strengths, and conceptualization of depression as a consequence of clients' environments and not of cognitive processes, which may serve to decrease stigma associated with care. Using this translation, the current study sought to establish preliminary efficacy and acceptability of BATD in a group of depressed Spanish-speaking Latinos (N=10) . Results showed that over time there was a significant decrease in self-reported depression and a significant increase in activation as indicated by multiple self-report measures. Further, increases in activation corresponded to decreases in depression. Sustained clinical gains through a one-month follow-up were observed. Taken together, these results provide preliminary support for BATD as an efficacious treatment for depression. Consideration of the results combined with interview-based feedback obtained from participants provide several domains for modification of this treatment for future studies, and suggest that the next logical step is to include a treatment control group and a larger sample size in future investigations.