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Open Access 01-04-2019 | Review

Behavioral activation for children and adolescents: a systematic review of progress and promise

Authors: Faith Martin, Thomas Oliver

Published in: European Child & Adolescent Psychiatry | Issue 4/2019

Abstract

Behavioral activation (BA) effectively treats depression in adults, and shows promise in treating anxiety. Research into its application to children and adolescents is emerging. This review aimed to explore the scope of studies, current evidence of effectiveness and how the intervention has been delivered and adapted, to inform future research. A systematic review was undertaken searching PsycInfo, PubMed including Medline, EMBASE, and Scopus for terms relating to BA and children and adolescents. Two researchers scored abstracts for inclusion. Data extraction was completed by one researcher and checked by another. 19 studies were identified, across 21 published articles. 12 were case studies, with three pre–post pilot designs and four randomized-controlled trials. Case studies found early support for the feasibility and potential effectiveness of BA to address both anxiety and depression. The RCTs reported largely positive outcomes. Meta-analysis of depression scores indicated that BA may be effective; however, high heterogeneity was observed. Sample sizes to date have been small. BA has been delivered by trained therapists, doctoral trainee psychologists, social workers, or psychology graduates. Studies are uniquely in high-income settings. Adaptations include flexibility in content delivery, youth friendly materials, and parental involvement. There is some limited evidence to support BA as effective for young people. Feasibility and acceptability are supported. Fully powered trials are now required, with expansion to delivery in low- and middle-income settings, and detailed consideration of implementation issues that consider culture and environment.

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Patton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB, Arora M, Azzopardi P, Baldwin W, Bonell C, Kakuma R, Kennedy E, Mahon J, McGovern T, Mokdad AH, Patel V, Petroni S, Reavley N, Taiwo K, Waldfogel J, Wickremarathne D, Barroso C, Bhutta Z, Fatusi AO, Mattoo A, Diers J, Fang J, Ferguson J, Ssewamala F, Viner RM (2016) Our future: a Lancet commission on adolescent health and wellbeing. Lancet. https://doi.org/10.1016/S0140-6736(16)00579-1 PubMedPubMedCentralCrossRef

Erskine H, Moffitt T, Copeland W, Costello E, Ferrari A, Patton G, Degenhardt L, Vos T, Whiteford H, Scott J (2015) A heavy burden on young minds: the global burden of mental and substance use disorders in children and youth. Psychol Med 45(07):1551–1563PubMedCrossRef

Baxter A, Vos T, Scott K, Ferrari A, Whiteford H (2014) The global burden of anxiety disorders in 2010. Psychol Med 44(11):2363–2374CrossRefPubMed

Garber J, Weersing VR (2010) Comorbidity of anxiety and depression in youth: implications for treatment and prevention. Clin Psychol Sci Pract 17(4):293–306CrossRef

Ekers D, Webster L, Van Straten A, Cuijpers P, Richards D, Gilbody S (2014) Behavioural activation for depression; an update of meta-analysis of effectiveness and sub group analysis. PLoS ONE 9(6):e100100PubMedPubMedCentralCrossRef

Richards DA, Ekers D, McMillan D, Taylor RS, Byford S, Warren FC, Barrett B, Farrand PA, Gilbody S, Kuyken W, O’Mahen H, Watkins ER, Wright KA, Hollon SD, Reed N, Rhodes S, Fletcher E, Finning K (2016) Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a randomised, controlled, non-inferiority trial. Lancet 388(10047):871–880. https://doi.org/10.1016/S0140-6736(16)31140-0 PubMedPubMedCentralCrossRef

Das JK, Salam RA, Lassi ZS, Khan MN, Mahmood W, Patel V, Bhutta ZA (2016) Interventions for adolescent mental health: an overview of systematic reviews. J Adolesc Health 59(4 Supplement):49–60. https://doi.org/10.1016/j.jadohealth.2016.06.020 CrossRef

Creswell C, Waite P, Cooper PJ (2014) Assessment and management of anxiety disorders in children and adolescents. Arch Dis Child. https://doi.org/10.1136/archdischild-2013-303768 PubMedCrossRef

NICE (2015) CG28 depression in children and young people: identification and management. National Institute Clinical Excellence, London

10.

Knapp M, Ardino V, Brimblecombe N, Evans-Lacko S, Lemmi V, King D, Snell T (2016) Youth mental health: new economic evidence. Personal social services research unit. http://www.pssru.ac.uk/archive/pdf/5160.pdf. Accessed on April 2017

11.

Kovess-Masfety V, Van Engelen J, Stone L, Otten R, Carta MG, Bitfoi A, Koc C, Goelitz D, Lesinskiene S, Mihova Z (2017) Unmet need for specialty mental health services among children across Europe. Psychiatr Serv 68(8):789–795PubMedCrossRef

12.

Patel V, Flisher AJ, Nikapota A, Malhotra S (2008) Promoting child and adolescent mental health in low and middle income countries. J Child Psychol Psychiatry 49(3):313–334PubMedCrossRef

13.

Dimidjian S, McCauley E (2016) Modular, scalable, and personalized: priorities for behavioral interventions for adolescent depression. Clin Psychol Sci Pract 23(1):58–61CrossRef

14.

Fernando S (2014) Mental health worldwide: culture, globalization and development. Macmillan, PalgraveCrossRef

15.

Lund C, Tomlinson M, De Silva M, Fekadu A, Shidhaye R, Jordans M, Petersen I, Bhana A, Kigozi F, Prince M, Thornicroft G, Hanlon C, Kakuma R, McDaid D, Saxena S, Chisholm D, Raja S, Kippen-Wood S, Honikman S, Fairall L, Patel V (2012) PRIME: a programme to reduce the treatment gap for mental disorders in five low- and middle-income countries. PLoS Med 9(12):e1001359. https://doi.org/10.1371/journal.pmed.1001359 PubMedPubMedCentralCrossRef

16.

Dimidjian S, Hollon SD, Dobson KS, Schmaling KB, Kohlenberg RJ, Addis ME, Gallop R, McGlinchey JB, Markley DK, Gollan JK (2006) Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. J Consul Clin Psychol 74(4):658CrossRef

17.

Kanter J, Puspitasari AJ, Santos MM, Nagy GA (2012) Behavioural activation: history, evidence and promise. Br J Psychiatry 200(5):361–363PubMedCrossRef

18.

Ekers D, Richards D, McMillan D, Bland JM, Gilbody S (2011) Behavioural activation delivered by the non-specialist: phase II randomised controlled trial. Br J Psychiatry 198(1):66–72. https://doi.org/10.1192/bjp.bp.110.079111 PubMedCrossRef

19.

Kanter JW, Manos RC, Bowe WM, Baruch DE, Busch AM, Rusch LC (2010) What is behavioral activation? a review of the empirical literature. Clin Psychol Rev 30(6):608–620. https://doi.org/10.1016/j.cpr.2010.04.001 PubMedCrossRef

20.

Martell CR, Addis ME, Jacobson NS (2001) Depression in context: strategies for guided action. WW Norton & Co, New York

21.

Lejuez C, Hopko DR, LePage JP, Hopko SD, McNeil DW (2001) A brief behavioral activation treatment for depression. Cogn Behav Pract 8(2):164–175CrossRef

22.

Dimidjian S, Barrera M Jr, Martell C, Muñoz RF, Lewinsohn PM (2011) The origins and current status of behavioral activation treatments for depression. Ann Rev Clin Psychol 7:1–38CrossRef

23.

Hopko DR, Lejuez CW, Ryba MM, Shorter RL, Bell JL (2016) Support for the efficacy of behavioural activation in treating anxiety in breast cancer patients. Clin Psychol 20(1):17–26CrossRef

24.

Chen J, Liu X, Rapee RM, Pillay P (2013) Behavioural activation: a pilot trial of transdiagnostic treatment for excessive worry. Behav Res Ther 51(9):533–539. https://doi.org/10.1016/j.brat.2013.05.010 PubMedCrossRef

25.

Hopko DR, Robertson S, Lejuez C (2006) Behavioral activation for anxiety disorders. Behav Anal Today 7(2):212CrossRef

26.

LeBlanc LA, Gillis JM (2012) Behavioral interventions for children with autism spectrum disorders. Pediatr Clin N Am 59(1):147–156. https://doi.org/10.1016/j.pcl.2011.10.006 CrossRef

27.

Tindall L, Mikocka Walus A, McMillan D, Wright B, Hewitt C, Gascoyne S (2017) Is behavioural activation effective in the treatment of depression in young people? a systematic review and meta analysis. Psychol Psychother Theor Res Pract 90(4):770–796CrossRef

28.

Leon AC, Davis LL, Kraemer HC (2011) The role and interpretation of pilot studies in clinical research. J Psychiatr Res 45(5):626–629PubMedCrossRef

29.

Fletcher A, Jamal F, Moore G, Evans RE, Murphy S, Bonell C (2016) Realist complex intervention science: applying realist principles across all phases of the medical research council framework for developing and evaluating complex interventions. Evaluation 22(3):286–303PubMedCrossRef

30.

WHO (2015) Adolescent Health Research Priorities: Report of a Technical Consultation. vol Accessed online March 2016 from http://apps.who.int/iris/bitstream/10665/203564/1/WHO_FWC_MCA_15_07_eng.pdf?ua=1. World Health Organization (WHO), Geneva

31.

Higgins JPT, Green S (eds) (2008) Cochrane handbook for systematic review of interventions. Wiley, Chicester

32.

Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savović J, Schulz KF, Weeks L, Sterne JA (2011) The cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928PubMedPubMedCentralCrossRef

33.

Moher D, Liberati A, Tetzlaff J, Altman DG (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8(5):336–341. https://doi.org/10.1016/j.ijsu.2010.02.007 PubMedCrossRef

34.

Davidson TM, Yuen EK, Felton JW, McCauley J, Gros KS, Ruggiero KJ (2014) Feasibility assessment of a brief, web-based behavioral activation intervention for adolescents with depressed mood. Int J Psychiatry Med 48(1):69–82PubMedCrossRef

35.

Welsh P, Kitchen CEW, Ekers D, Webster L, Tiffin PA (2016) Behavioural activation therapy for adolescents ‘at risk’ for psychosis? Early Intervention in Psychiatry 10(2):186–188PubMedCrossRef

36.

Spirito A, Russo DC, Masek BJ (1984) Behavioral interventions and stress management training for hospitalized adolescents and young adults with cystic fibrosis. Gen Hosp Psychiatry 6(3):211–218. https://doi.org/10.1016/0163-8343(84)90042-2 PubMedCrossRef

37.

Weersing VR, Rozenman M, Gonzalez A, Jeffreys M, Porta G, Brent DA (2016) Brief behavioral therapy for pediatric anxiety and depression in primary care: a randomized clinical trial. J Am Acad Child Adolesc Psychiatry 55(10):S336. https://doi.org/10.1016/j.jaac.2016.07.406 CrossRef

38.

MacPherson L, Collado A, Ninnemann A, Hoffman E (2017) Development of a behavioral activation−based intervention for cigarette-smoking young adults. Cogn Behav Pract 24(1):101–114. https://doi.org/10.1016/j.cbpra.2016.03.004 CrossRef

39.

Chu BC, Merson RA, Zandberg LJ, Areizaga M (2012) Calibrating for comorbidity: clinical decision-making in youth depression and anxiety. Cogn Behav Pract 19(1):5–16CrossRef

40.

Manglick M, Rajaratnam SM, Taffe J, Tonge B, Melvin G (2013) Persistent sleep disturbance is associated with treatment response in adolescents with depression. Aus N Zeal J Psychiatry 47(6):556–563. https://doi.org/10.1177/0004867413481630 CrossRef

41.

Curtis DF (2010) ADHD symptom severity following participation in a pilot, 10-week, manualized, family-based behavioral intervention. Child Fam Behav Ther 32(3):231–241. https://doi.org/10.1080/07317107.2010.500526 CrossRef

42.

Curtis DF, Chapman S, Dempsey J, Mire S (2013) Classroom changes in ADHD symptoms following clinic-based behavior therapy. J Clin Psychol Med Settings 20(1):114–122PubMedCrossRef

43.

Rudd MD, Rajab MH, Orman DT, Joiner T, Stulman DA, Dixon W (1996) Effectiveness of an outpatient intervention targeting suicidal young adults: preliminary results. J Consult Clin Psychol 64(1):179–190. https://doi.org/10.1037/0022-006X.64.1.179 PubMedCrossRef

44.

Harper JM, Iwata BA, Camp EM (2013) Assessment and treatment of social avoidance. J Appl Behav Anal 46(1):147–160PubMedCrossRef

45.

Ruggiero KJ, Morris TL, Hopko DR, Lejuez CW (2007) Application of behavioral activation treatment for depression to an adolescent with a history of child maltreatment. Clin Case Stud 6(1):64–78CrossRef

46.

Gaynor ST, Harris A (2008) Single-participant assessment of treatment mediators: strategy description and examples from a behavioral activation intervention for depressed adolescents. Behav Modif 32(3):372–402PubMedCrossRef

47.

Weersing VR, Gonzalez A, Campo JV, Lucas AN (2008) Brief behavioral therapy for pediatric anxiety and depression: piloting an integrated treatment approach. vol 15. Assoc Adv Behav Ther. https://doi.org/10.1016/j.cbpra.2007.10.001 CrossRef

48.

Chu BC, Colognori D, Weissman AS, Bannon K (2009) An initial description and pilot of group behavioral activation therapy for anxious and depressed youth. Cogn Behav Pract 16(4):408–419CrossRef

49.

McCauley E, Schloredt K, Gudmundsen G, Martell C, Dimidjian S (2011) Expanding behavioral activation to depressed adolescents: lessons learned in treatment development. Cogn Behav Pract 18(3):371–383CrossRef

50.

Wallis A, Roeger L, Milan S, Walmsley C, Allison S (2012) Behavioural activation for the treatment of rural adolescents with depression. Aus J Rural Health 20(2):95–96CrossRef

51.

Jacob M, Keeley ML, Ritschel L, Craighead WE (2013) Behavioural activation for the treatment of low-income, African American adolescents with major depressive disorder: a case series. Clin Psychol Psychother 20(1):87–96PubMedCrossRef

52.

Riley AR, Gaynor ST (2014) Identifying mechanisms of change: Utilizing single-participant methodology to better understand behavior therapy for child depression. Behav Modif 38(5):636–664PubMedCrossRef

53.

Chu BC, Hoffman L, Johns A, Reyes-Portillo J, Hansford A (2015) Transdiagnostic behavior therapy for bullying-related anxiety and depression: initial development and pilot study. Cogn Behav Pract 22(4):415–429CrossRef

54.

Pass L, Brisco G, Reynolds S (2015) Adapting brief behavioural activation (BA) for adolescent depression: a case example. Cogn Behav Ther 8:e17CrossRef

55.

Pass L, Whitney H, Reynolds S (2016) Brief behavioral activation for adolescent depression: working with complexity and risk. Clin Case Stud 15(5):360–375CrossRef

56.

Pass L, Hodgson E, Whitney H, Reynolds S (2017) Brief behavioral activation treatment for depressed adolescents delivered by nonspecialist clinicians: a case illustration. Cogn Behav Pract. https://doi.org/10.1016/j.cbpra.2017.05.003

57.

Ritschel LA, Ramirez CL, Jones M, Craighead W (2011) Behavioral activation for depressed teens: a pilot study. Cogn Behav Pract 18(2):281–299CrossRef

58.

Ritschel LA, Ramirez CL, Cooley JL, Craighead W (2016) Behavioral activation for major depression in adolescents: results from a pilot study. Clin Psychol Sci Pract 23(1):39–57CrossRef

59.

Pass L, Lejuez CW, Reynolds S (2017) Brief behavioural activation (Brief BA) for adolescent depression: A pilot study. Behav Cogn Psychother 1–13. https://doi.org/10.1017/s1352465817000443

60.

Chu BC, Crocco ST, Esseling P, Areizaga MJ, Lindner AM, Skriner LC (2016) Transdiagnostic group behavioral activation and exposure therapy for youth anxiety and depression: initial randomized controlled trial. Behav Res Ther 76:65–75PubMedCrossRef

61.

McCauley E, Gudmundsen G, Schloredt K, Martell C, Rhew I, Hubley S, Dimidjian S (2016) The adolescent behavioral activation program: adapting behavioral activation as a treatment for depression in adolescence. J Clin Child Adolesc Psychol 45(3):291–304PubMedCrossRef

62.

Takagaki K, Okamoto Y, Jinnin R, Mori A, Nishiyama Y, Yamamura T, Yokoyama S, Shiota S, Okamoto Y, Miyake Y, Ogata A, Kunisato Y, Shimoda H, Kawakami N, Furukawa TA, Yamawaki S (2016) Behavioral activation for late adolescents with subthreshold depression: A randomized controlled trial. Eur Child Adolesc Psychiatry 25(11):1171–1182PubMedCrossRef

63.

Weersing VR, Brent DA, Rozenman MS, Gonzalez A, Jeffreys M, Dickerson JF, Lynch FL, Porta G, Iyengar S (2017) Brief behavioral therapy for pediatric anxiety and depression in primary care: a randomized clinical trial. JAMA Psychiatry 74(6):571–578. https://doi.org/10.1001/jamapsychiatry.2017.0429 PubMedPubMedCentralCrossRef

64.

Takagaki K, Jinnin R, Mori A, Nishiyama Y, Yamamura T, Yokoyama S, Shiota S, Okamoto Y, Miyake Y, Ogata A, Shimoda H, Kawakami N, Furukawa TA, Yamawaki S (2016) Mechanisms of behavioral activation for late adolescents: positive reinforcement mediate the relationship between activation and depressive symptoms from pre-treatment to post-treatment. J Affect Disord 204:70–73PubMedCrossRef

65.

Mori A, Okamoto Y, Okada G, Takagaki K, Jinnin R, Takamura M, Kobayakawa M, Yamawaki S (2016) Behavioral activation can normalize neural hypoactivation in subthreshold depression during a monetary incentive delay task. J Affect Disord 189:254–262PubMedCrossRef

66.

Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4(6):561–571CrossRefPubMed

67.

Beck AT, Steer RA, Brown GK (1996) Beck depression inventory-II. San Antonio 78(2):490–498

68.

Kojima M, Furukawa TA (2003) Japanese version of the beck depression inventory. Nippon-Hyoron-sha Co., Tokyo

69.

Shaffer D, Fisher P, Lucas CP, Dulcan MK, Schwab-Stone ME (2000) NIMH diagnostic interview schedule for children version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. J Am Acad Child Adolesc Psychiatry 39(1):28–38PubMedCrossRef

70.

Silverman WK, Albano AM (1996) Anxiety disorders interview schedule for DSM-IV: child interview schedule, vol 2. Graywind Publications

71.

March JS, Parker JD, Sullivan K, Stallings P, Conners CK (1997) The multidimensional anxiety scale for children (MASC): factor structure, reliability, and validity. J Am Acad Child Adolesc Psychiatry 36(4):554–565PubMedCrossRef

72.

Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1(3):385–401CrossRef

73.

Poznanski EO, Mokros HB (1996) Children’s depression rating scale, revised (CDRS-R). Western Psychological Services, Los Angeles

74.

Angold A, Costello EJ, Messer SC, Pickles A (1995) Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. Int J Methods Psychiatr Res

75.

Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, Williamson D, Ryan N (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36(7):980–988PubMedCrossRef

76.

Rapoport J, Conners C (1985) Rating scales and assessment instruments for use in pediatric psychopharmacology research—introduction. National Institute of Mental Health, Washington

77.

Birmaher B, Khetarpal S, Brent D, Cully M, Balach L, Kaufman J, Neer SM (1997) The screen for child anxiety related emotional disorders (SCARED): scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry 36(4):545–553PubMedCrossRef

78.

Chorpita BF, Yim L, Moffitt C, Umemoto LA, Francis SE (2000) Assessment of symptoms of DSM-IV anxiety and depression in children: a revised child anxiety and depression scale. Behav Res Ther 38(8):835–855CrossRefPubMed

79.

Achenbach T, Rescorla L (2001) Manual for the Achenbach system of empirically based assessment school-age forms profiles. Aseba, Burlington

80.

Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates Inc, New Jersey

81.

Douleh TN (2014) Motivational interviewing assessment and behavior therapy as a stepped-care approach to the treatment of adolescent depression. Dissertation Abstracts International: section B: The Sciences and Engineering 74 (11-B(E)): No Pagination Specified

82.

Stark KD (1985) A comparison of the relative efficacy of self-control therapy and behaviour therapy for the reduction of depression in children. University of Wisconsin, Madison, WI. Unpublished doctoral dissertation

83.

Thabrew H, Stasiak K, Hetrick SE, Wong S, Huss JH, Merry SN (2017) Psychological therapies for anxiety and depression in children and adolescents with longterm physical conditions. Accessed online June 2017 from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD012488/full, The Cochrane Library

84.

Singla DR, Weobong B, Nadkarni A, Chowdhary N, Shinde S, Anand A, Fairburn CG, Dimijdan S, Velleman R, Weiss H, Patel V (2014) Improving the scalability of psychological treatments in developing countries: an evaluation of peer-led therapy quality assessment in Goa, India. Behav Res Ther 60(100):53–59. https://doi.org/10.1016/j.brat.2014.06.006 PubMedPubMedCentralCrossRef

85.

Kieling C, Baker-Henningham H, Belfer M, Conti G, Ertem I, Omigbodun O, Rohde LA, Srinath S, Ulkuer N, Rahman A (2011) Child and adolescent mental health worldwide: evidence for action. The Lancet 378(9801):1515–1525CrossRef

86.

Michie S, Fixsen D, Grimshaw J, Eccles M (2009) Specifying and reporting complex behaviour change interventions: the need for a scientific method. Implement Sci 4(1):40. https://doi.org/10.1186/1748-5908-4-40 PubMedPubMedCentralCrossRef

87.

Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, Eccles MP, Cane J, Wood CE (2013) The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med 46(1):81–95. https://doi.org/10.1007/s12160-013-9486-6 CrossRefPubMed

88.

Breinholst S, Esbjørn BH, Reinholdt-Dunne ML, Stallard P (2012) CBT for the treatment of child anxiety disorders: a review of why parental involvement has not enhanced outcomes. J Anxiety Disord 26(3):416–424. https://doi.org/10.1016/j.janxdis.2011.12.014 PubMedCrossRef

Title: Behavioral activation for children and adolescents: a systematic review of progress and promise
Authors: Faith Martin
Thomas Oliver
Publication date: 01-04-2019
Publisher: Springer Berlin Heidelberg
Published in: European Child & Adolescent Psychiatry / Issue 4/2019
Print ISSN: 1018-8827
Electronic ISSN: 1435-165X
DOI: https://doi.org/10.1007/s00787-018-1126-z

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Behavioral activation for children and adolescents: a systematic review of progress and promise

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