Major depressive disorder (MDD) is a severe and disabling disorder afflicting 7% of individuals in the United States annually and approximately 17% of individuals across their lifetime. Despite multiple investigations demonstrating that both medications and psychotherapeutic interventions are effective in the treatment of MDD, response rates in well-done efficacy trials still reach only 40 to 60%. Response rates in the public sector are even lower. One psychosocial treatment that holds promise for use in the publicly-funded community mental health centers (CMHC) is Behavioral activation (BA). This treatment has been found to be efficacious in the treatment of MDD, particularly severe MDD, and has been used effectively by the types of non-doctoral level clinicians that often deliver treatment in CMHC settings. The purpose of the study proposed here is to examine the feasibility of conducting a study of behavioral activation when implemented in community mental health settings where many patients suffer from severe MDD. In the first phase of the project, consumers, clinicians, and staff at a CMHC will provide input on an existing BA treatment model to tailor it to the CMHC environment. In the second phase of the project, the final treatment manual will be used to train clinicians in BA at the CMHC through workshops, training cases, and a novel online training module designed for training CMHC clinicians in BA. In the third phase of the project, a total of 80 patients with MDD who score 14 or above on the 17-item Hamilton Rating Scale for Depression (HAM-D) will be randomly assigned in a 3:1 ratio to 9 sessions of BA or treatment-as-usual (TAU) at a community mental health center (CMHC). In addition to feasibility/acceptability of BA and TAU, the study is designed to test whether theoretically important targets of BA (increased activation; increased reward value of activities) change over the course of BA treatment, and whether such changes as associated with changes in depressive symptoms. Patients will also be assessed at baseline and then weekly using the BASIS-24 and at week 6 and week 12 using the HAM-D administered by independent raters. A measure of trait reward processing will be measured at baseline using the Effort- Expenditure for Rewards Task to pilot the use of this measure as a potential moderator of BA treatment effects. The ability of CMHC therapists to adequately implement BA will be assessed by rating taped sessions on BA adherence and competence scales. Successful completion of this project will lead a larger scale effectiveness study of BA in the CMHC setting.
Major depressive disorder is a severe and disabling disorder afflicting 7% of individuals in the United States annually and approximately 17% of individuals across their lifetime. This application proposes a feasibility study of Behavioral Activation for patients with major depressive disorder seeking care in community mental health settings. In addition, the study will test whether Behavioral Activation changes theoretically important target variables that lead to changes in depressive symptoms.
