The reward probability index: design and validation of a scale measuring access to environmental reward

The efficacy of behavioral activation treatment among depressed Spanish-speaking Latinos

OBJECTIVE

Major depressive disorder (MDD) is highly prevalent among U.S. Spanish-speaking Latinos, but the lack of empirically supported treatments precludes this population's access to quality mental health care.

METHOD

Following the promising results of an open-label trial of the Behavioral Activation Treatment for Depression (BATD) among Spanish-speaking Latinos, the authors conducted a randomized control trial (RCT; N = 46) that compared BATD to supportive counseling. Study outcomes included depression, BATD proposed mechanisms of change, and nonspecific psychotherapy factors.

RESULTS

Relative to supportive counseling, BATD led to greater decreases in depressive symptoms over time (p = .04) and greater MDD remission at the end of treatment (p = .01). Activity level (p = .01) and environmental reward (p = .05) showed greater increases over time among those who received BATD compared to supportive counseling. Treatment adherence, therapeutic alliance, and treatment satisfaction did not differ between the groups over time (ps > 0.17). The 1-month follow-up suggested sustained clinical gains across therapies.

CONCLUSIONS

The current study adds to a growing treatment literature and provides support that BATD is efficacious in reducing depression and increasing activity level and environmental reward in the largest, yet historically underserved U.S. ethnic minority population. This trial sets the stage for a larger RCT that evaluates the transportability and generalizability of BATD in an effectiveness trial. (PsycINFO Database Record

Relationships Among Valued Action, Behavioral Activation, Avoidance, and Reinforcement in a Sample of College Students

Behavioral activation is a validated intervention for depression, which helps depressed people re-engage overt behaviors to facilitate contacts with reinforcing environmental contingencies and subsequent reductions in depression. Moreover, behavioral activation deals with values that are based on acceptance and commitment therapy. However, there is no empirical study that examines the role of behavior in line with values in behavioral activation. This study examined the role of behavior in line with values in behavioral activation by examining the association between behavior in line with values and variables of behavioral activation intervention targets, as well as the mediating effect of behavioral commitment. Japanese versions of the Personal Values Questionnaire II, the Behavioral Activation for Depression Scale, the Environmental Reward Observation Scale, and the Center for Epidemiological Studies Depression were completed by 292 Japanese undergraduate students ( M age = 19.2 yr., SD = 1.7; 65 men, 226 women, 1 unknown). Results indicated that behavior in line with values was associated with focused, goal-directed activation and completion of scheduled activities, which were mediated by behavioral commitment to values.

Validation and Psychometric Properties of the French Versions of the Environmental Reward Observation Scale and of the Reward Probability Index

Background: Low levels of environmental rewards have been related to depression on a number of occasions in the scientific literature. Two scales have been created to assess environmental rewards: the Environmental Reward Observation Scale (EROS) and the Reward Probability Index (RPI). This study aims to validate the French versions of these two scales. Method: 466 non-clinical adults completed an online survey assessing environmental rewards, depression, anxiety, activation, avoidance and behavioural systems. Confirmatory factor analyses were performed to assess the factorial structures of the French EROS and RPI. Results: A one-factor solution for the EROS and a two-factor solution for the RPI best fitted the data. High levels of internal consistency were found for both the EROS and the RPI. Convergent validity was also examined, revealing that high environmental rewards appear to be related to activation and behavioural activation system. Conclusion: The French versions of the EROS and the RPI appear to be reliable assessments of environmental rewards.

Depressive symptoms, lifestyle structure, and ART adherence among HIV-infected individuals: a longitudinal mediation analysis

Despite the well-documented relationship between depression and antiretroviral therapy (ART) nonadherence, few studies have identified explanatory pathways through which depression affects adherence. The current study tested lifestyle structure-the degree of organization and routinization of daily activities-as a mediator of this relationship, given previous evidence of lifestyle structure being associated with both depression and ART nonadherence. HIV-infected individuals starting or re-starting ART in the California Collaborative Treatment Group 578 study (n = 199) were assessed over 48 weeks. Adherence was measured using electronic monitoring caps to determine dose timing and doses taken, and viral load was assessed. The mediating role of lifestyle structure was tested using generalized linear mixed-effects modeling and bootstrapping. Lifestyle significantly mediated the relationship between depression and both measures of ART adherence behavior. Interventions that minimize disruptions to lifestyle structure and link adherence to daily activities may be useful for individuals with depression and ART nonadherence.

Analog study investigating diary assessments of rewards and punishments for emotional states

Behavioral Activation is a treatment for depression relying on rewards from activities; but it is possible that the effects of punishments should also be considered, as should its generalizability to the healthy population. Effect of rewards and punishments on emotional states and depression were investigated by using the daily diary method. Participants (7 men, 21 women; M age = 19.4 yr.) recorded their daily activities and the intensity of rewards and punishments accompanying each activity for one week. Positive and negative affects of participants were assessed using the Japanese version of the Positive Affect and Negative Affect Schedule. Multiple regression analysis indicated that both rewards and punishments predicted depressive symptoms. Moreover, rewards (but not punishments) predicted positive affect, whereas punishments predicted negative affects (and rewards did not). These preliminary results suggest that the effects of both rewards and punishments given for activities should be considered in models of behavioral activation.

Can behavioral theory inform the understanding of depression and medication nonadherence among HIV-positive substance users?

Medication adherence is highly predictive of health outcomes across chronic conditions, particularly HIV/AIDS. Depression is consistently associated with worse adherence, yet few studies have sought to understand how depression relates to adherence. This study tested three components of behavioral depression theory--goal-directed activation, positive reinforcement, and environmental punishment--as potential indirect effects in the relation between depressive symptoms and medication nonadherence among low-income, predominantly African American substance users (n = 83). Medication nonadherence was assessed as frequency of doses missed across common reasons for nonadherence. Non-parametric bootstrapping was used to evaluate the indirect effects. Of the three intermediary variables, there was only an indirect effect of environmental punishment; depressive symptoms were associated with greater nonadherence through greater environmental punishment. Goal-directed activation and positive reinforcement were unrelated to adherence. Findings suggest the importance of environmental punishment in the relation between depression and medication adherence and may inform future intervention efforts for this population.

The efficacy of a behavioral activation intervention among depressed US Latinos with limited English language proficiency: study protocol for a randomized controlled trial

Background

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.

Methods/design

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 4^th and 5^th 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.

Discussion

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.

Trial registration

Clinical Trials Register: NCT01958840; registered 8 October 2013.

Pilot of the brief behavioral activation treatment for depression in latinos with limited english proficiency: preliminary evaluation of efficacy and acceptability

Latinos with limited English proficiency (LEP) experience multiple barriers to accessing efficacious mental health treatments. Using a stage model of behavior therapy research, this Stage I investigation evaluated the Brief Behavioral Activation Treatment for Depression (BATD), an intervention that may be well equipped to address existing treatment barriers. A sample of 10 Latinos with LEP and depressive symptomatology participated in a 10-session, direct (i.e., literal) Spanish-language translation of BATD, with no other cultural modifications. Participants were assessed at each session for depressive symptomatology and for the proposed BATD mechanisms: activity engagement and environmental reward. One month after treatment, participants were reassessed and interviewed to elicit feedback about BATD. Hierarchical linear model analyses were used to measure BATD outcomes. Results showed depressive symptomatology decreased (p<.001), while both activation (p=.04) and environmental reward (p=.02) increased over the course of BATD. Increases in activation corresponded concurrently with decreases in depression (p=.01), while environmental reward preceded decreases in depressive symptomatology (all p's ≤ .04). Follow-up analyses revealed sustained clinical gains in depression and activation, and an increase in environmental reward at follow-up. Participant interviews conducted 1 month after treatment conclusion indicated that BATD is an acceptable treatment for our sample of interest. Despite the limitations inherent in a study restricted to a sample of 10, preliminary outcomes of this Stage I research suggest that members of this otherwise underserved group showed improvements in depressive symptomatology and are willing to participate in and adhere to BATD. The study's positive outcomes suggest that a Stage II randomized clinical trial is a logical next step.

Behavioral excesses in depression: a learning theory hypothesis

This paper reviews two learning theory-based models of experiential contributions to depression: response contingent positive reinforcement and learned helplessness. The authors argue that these models connect to a phenomenon that may explain why symptoms of behavioral excess (e.g. rumination) often occur in depression that is otherwise marked by symptoms of behavioral deficit (e.g. anhedonia). Specifically, the authors illustrate that that concept of schedule strain (or low rates of response contingent reinforcement giving rise to low frequencies of behavior) unites these models. Depression is more likely, or more severe, when schedule strain conditions occur in situations containing reinforcers important to the individual and/or when they simultaneously occur in a number of situations. Conditions of schedule strain are known to give rise to adjunctive behaviors: apparently irrelevant, easy behaviors that deliver immediate reinforcement. This paper suggests that, for some depressed individuals, behavioral excess symptoms like rumination and overeating might serve adjunctive functions. Implications of this hypothesis are discussed.

Theory-driven intervention for changing personality: expectancy value theory, behavioral activation, and conscientiousness

Considerable evidence suggests that personality traits may be changeable, raising the possibility that personality traits most linked to health problems can be modified with intervention. A growing body of research suggests that problematic personality traits may be altered with behavioral intervention using a bottom-up approach. That is, by targeting core behaviors that underlie personality traits with the goal of engendering new, healthier patterns of behavior that, over time, become automatized and manifest in changes in personality traits. Nevertheless, a bottom-up model for changing personality traits is somewhat diffuse and requires clearer integration of theory and relevant interventions to enable real clinical application. As such, this article proposes a set of guiding principles for theory-driven modification of targeted personality traits using a bottom-up approach, focusing specifically on targeting the trait of conscientiousness using a relevant behavioral intervention, Behavioral Activation (BA), considered within the motivational framework of expectancy value theory (EVT). We conclude with a real case example of the application of BA to alter behaviors counter to conscientiousness in a substance-dependent patient, highlighting the EVT principles most relevant to the approach and the importance and viability of a theoretically driven, bottom-up approach to changing personality traits.

Gender Differences in Depression: Assessing Mediational Effects of Overt Behaviors and Environmental Reward through Daily Diary Monitoring

Gender differences in the prevalence of depression are well documented. To further explore the relation between gender and depression, this study used daily diaries to examine gender differences within thirteen behavioral domains and whether differential frequency of overt behaviors and environmental reward mediated the relationship between gender and depression severity. The sample included 82 undergraduate students [66% females; 84% Caucasian; Mean age = 20.2 years]. Overall, females engaged in a significantly greater breadth of behavioral domains and reported a higher level of environmental reward. Females spent more time in the domains of health/hygiene, spiritual activities, and eating with others. Males spent more time in the domains of physical activity, sexual activity, and hobbies and recreational experiences. Females found social activities, passive/sedentary behaviors, eating with others, and engagement in "other" activities more rewarding. Gender had a significant direct effect on depression severity, with females reporting increased depression. This effect was attenuated by the mediator (total environmental reward) such that to the extent females exhibited increased environmental reward, the gender effect on depression was attenuated. These data support behavioral models of depression, indicate increased reinforcement sensitivity among females, and have clinical relevance in the context of assessment and behavioral activation interventions for depression.

The behavioral activation for depression scale-short form: development and validation

Following a landmark component analysis of cognitive therapy by Jacobson and colleagues (1996), there has been renewed interest in behavioral activation (BA) treatments for depression. The Behavioral Activation for Depression Scale (BADS) was developed to measure when and how clients become activated over the course of BA treatment. Multiple studies have provided initial support for the BADS but have also identified several potential problems. Four studies were conducted in order to develop and provide initial evaluation of a short form of the BADS that addresses these concerns. In Study 1, an exploratory factor analysis was conducted on existing data using the original BADS in order to identify items to retain for the short form. In Study 2, these items were administered to a new sample of college students with elevated depressive symptoms and were analyzed with exploratory and confirmatory factor analyses. Study 3 examined the predictive validity of the BADS-SF by examining the BADS-SF and depression scores in relation to activity tracking and reward-value ratings over the course of 1 week. Study 4 examined BADS-SF data over the course of BA treatment for two clients using cross-lagged panel correlations. With one client, changes in BADS-SF scores led changes in depression scores by 1 week, whereas with the other client changes in BADS-SF and depression scores occurred concurrently. These studies resulted in a nine-item scale that demonstrated good item characteristics as well as acceptable internal consistency reliability, construct validity, and predictive validity.

A rating scale for housing-based health hazards

OBJECTIVES

This study investigated the validity and responsiveness of a rating scale designed to assess the housing-based hazards and their relationships to burden of disease symptoms in the building occupants.

STUDY DESIGN

A population-based cross-sectional survey.

METHODS

Random-digit dialing with computer-assisted phone interviews was conducted to obtain information from 642 households in the City of Saginaw, Michigan about 71 housing-based hazards, symptoms of 43 diseases often associated with environmental exposures and demographic characteristics. The housing-based hazard index (HHI) was calculated from scores of hazards across the following eight dimensions: structural scale (18 items); moisture/mold scale (8 items), electrical scale (7 items), ventilation and combustion appliances scale (6 items); pest scale (6 items); pets scale (4 items), fire scale (6 items) and lifestyle-associated factors scale (12 items). Each item was assigned a relative score based on the likelihood that the housing occupants would be exposed to the hazard, the potential for serious health impacts, and the reported strength of its association with childhood lead poisoning and respiratory diseases. The psychometric properties of HHI and individual domains (scales) were assessed along with the associations between these indicators and the inventory of disease symptoms.

RESULTS

The reliability of HHI was demonstrated by assessments of its dimensionality and internal consistency. Analysis of the predictive validity and responsiveness indicates that HHI and scores for most of the individual scales can discriminate between households in relation to the burden of reported disease symptoms.

CONCLUSIONS

The HHI represents a valid, reasonably reliable, and parsimonious measure of hazards that are congruent with the burden of symptoms generally associated with housing-related diseases.