RecruitingNot ApplicableNCT05548244

Mechanisms of Behavioral Activation (BA)

Multi-level Mechanisms of Behavioral Activation Therapy for Adolescent Depression

Sponsor

Emory University

Enrollment

136 participants

Start Date

Jan 30, 2023

Study Type

INTERVENTIONAL

Conditions

Depression

Summary

The investigators will be comparing brain (neural) activation of depressed adolescent patients before, during and after a course of Behavioral Activation (BA) therapy using functional magnetic resonance imaging (fMRI). In particular, the project seeks to determine whether BA targets different neural mechanisms for behavioral avoidance associated with low motivation as compared to threat avoidance. A group of healthy controls will also be scanned as a comparator group for behavioral and imaging measures.

Eligibility

Min Age: 15 YearsMax Age: 17 Years

Inclusion Criteria9

Male and female adolescents ages 15-17;
current MDD diagnosis as determined by K-SADS-PL,
CDRS-R raw score \> 45 (T-score \> 65) at baseline;
estimated full scale IQ \> 80 as determined by the WASI-II;
able to receive outpatient care;
willing to not partake in other psychosocial treatments;
not taking psychotropic medications in the two weeks (four weeks for fluoxetine) prior to consent, with the exception of psychostimulant medication prescribed for the treatment of ADHD.
Additionally, depressed patients must have access to required technology (e.g. smart phone, tablet, or desktop computer) to complete the EMA portion of the study.
Healthy controls cannot not meet criteria for MDD and their CDRS-R raw score must be below 28; T-score \< 52).

Exclusion Criteria16

Current or past diagnosis of bipolar, schizophrenia, schizophreniform, schizoaffective disorders, or psychosis NOS;
current diagnosis of developmental disorder, severe conduct disorder, life-threatening anorexia, OCD, or autism-spectrum disorders;
taking psychotropic medications prior to entry;
estimated IQ \< 80; alcohol/drug dependence or abuse within the last 3 months;
potential/confirmed neurological disorder or epilepsy;
claustrophobia;
presence of a medical condition that precludes fMRI;
endorsement of imminent and serious suicidality;
medical conditions that take precedence over the presence of MDD;
pregnancy;
substance use (excluding nicotine) within two weeks of the fMRI scan;
left-handedness;
nicotine use within 3 hours of the fMRI scan;
history of traumatic brain injury or of being unconscious for more than 30 minutes;
a stimulant regime for ADHD which has changed within 30 days of the fMRI scan.
Non-compliance (i.e. \<70% completion) or inability (i.e. lack of smartphone device) to complete the 3 assessment periods of EMA.

Interventions

BEHAVIORALBehavioral Activation Therapy

Participants will be seen for a maximum of 16 sessions of therapy focused on increasing rewarding behaviors (16 individual therapy sessions of 1-hour, 2 of which include the BSIS component) over 16 weeks. BA intervention includes monthly booster sessions offered throughout 6-month follow up. If needed, two extra sessions will be allowed during treatment.

BEHAVIORALBaseline assessment procedures

Completion of the K-SADS and CDRS-R to assess MDD, and the Wechsler Abbreviated Scale of Intelligence - 2nd Edition to assess IQ.