Dynamic processes in behavioral activation therapy for anhedonic adolescents: Modeling common and patient-specific relations.

IF 4.5 1区心理学 Q1 PSYCHOLOGY, CLINICAL Journal of consulting and clinical psychology Pub Date : 2024-08-01 Epub Date: 2023-06-05 DOI:10.1037/ccp0000830

Christian A Webb, Laura Murray, Anna O Tierney, Kathleen M Gates

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Abstract

Objective: Behavioral activation (BA) is a brief intervention for depression encouraging gradual and systematic re-engagement with rewarding activities and behaviors. Given this treatment focus, BA may be particularly beneficial for adolescents with prominent anhedonia, a predictor of poor treatment response and common residual symptom. We applied group iterative multiple model estimation (GIMME) to ecological momentary assessment (EMA) treatment data to investigate common and person-specific processes during BA for anhedonic adolescents.

Method: Thirty-nine adolescents (M_age = 15.7 years old, 67% female, 81% White) with elevated anhedonia (Snaith-Hamilton Pleasure Scale) were enrolled in a 12-week BA trial, with weekly anhedonia assessments. EMA surveys were triggered every other week (2-3 surveys per day) throughout treatment assessing current positive affect (PA) and negative affect (NA), engagement in pleasurable activities and social interactions, anticipatory pleasure, rumination, and recent pleasurable and stressful experiences.

Results: A multilevel model revealed significant decreases in anhedonia, t(25.5) = -4.76, p < .001, over the 12-week trial. GIMME results indicated substantial heterogeneity in variable networks across patients. PA was the variable with the greatest number (22% of all paths vs. 11% for NA) of predictive paths to other symptoms (i.e., highest out-degree). Higher PA (but not NA) out-degree was associated with greater anhedonia improvement, t(25.8) = -2.22, p = .035.

Conclusions: Results revealed substantial heterogeneity in variable relations across patients, which may obscure the search for common processes of change in BA. PA may be a particularly important treatment target for anhedonic adolescents in BA. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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青少年享乐缺乏症行为激活疗法的动态过程:共同关系和患者特定关系的建模。

目的:行为激活(Behavioral activation, BA)是一种针对抑郁症的短期干预方法，鼓励患者逐渐、系统地重新参与有益的活动和行为。鉴于这种治疗重点，BA可能对有明显快感缺乏症的青少年特别有益，这是治疗反应差和常见残留症状的预测因子。我们将群体迭代多模型估计(GIMME)应用于生态瞬间评估(EMA)治疗数据，以研究青少年快感缺乏症BA期间的共同和个人特异性过程。方法:39名青少年(年龄15.7岁，67%女性，81%白人)快感缺缺性升高(Snaith-Hamilton快乐量表)，参加为期12周的BA试验，每周进行快感缺缺性评估。在整个治疗过程中，每隔一周触发一次EMA调查(每天2-3次调查)，评估当前的积极影响(PA)和消极影响(NA)，参与愉快活动和社会互动，预期愉悦，反刍以及最近的愉快和压力体验。结果:在12周的试验中，多水平模型显示快感缺乏症显著降低，t(25.5) = -4.76, p < 0.001。GIMME结果表明，患者之间的可变网络存在很大的异质性。PA是其他症状预测路径(即最高输出度)最多的变量(占所有路径的22%，NA为11%)。较高的PA(而非NA)输出度与快感缺乏症改善程度相关，t(25.8) = -2.22, p = 0.035。结论:结果显示患者之间的变量关系存在很大的异质性，这可能会模糊对BA共同变化过程的研究。PA可能是BA中快感缺乏症青少年的一个特别重要的治疗靶点。(PsycInfo数据库记录(c) 2023 APA，版权所有)。

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来源期刊

Journal of consulting and clinical psychology PSYCHOLOGY, CLINICAL-

CiteScore

9.00

自引率

3.40%

发文量

期刊介绍： The Journal of Consulting and Clinical Psychology® (JCCP) publishes original contributions on the following topics: the development, validity, and use of techniques of diagnosis and treatment of disordered behaviorstudies of a variety of populations that have clinical interest, including but not limited to medical patients, ethnic minorities, persons with serious mental illness, and community samplesstudies that have a cross-cultural or demographic focus and are of interest for treating behavior disordersstudies of personality and of its assessment and development where these have a clear bearing on problems of clinical dysfunction and treatmentstudies of gender, ethnicity, or sexual orientation that have a clear bearing on diagnosis, assessment, and treatmentstudies of psychosocial aspects of health behaviors. Studies that focus on populations that fall anywhere within the lifespan are considered. JCCP welcomes submissions on treatment and prevention in all areas of clinical and clinical–health psychology and especially on topics that appeal to a broad clinical–scientist and practitioner audience. JCCP encourages the submission of theory–based interventions, studies that investigate mechanisms of change, and studies of the effectiveness of treatments in real-world settings. JCCP recommends that authors of clinical trials pre-register their studies with an appropriate clinical trial registry (e.g., ClinicalTrials.gov, ClinicalTrialsRegister.eu) though both registered and unregistered trials will continue to be considered at this time.