Association for Behavior Analysis International

Depression is a significant public health concern. The collection of papers making up this symposium describe studies examining the process and outcome of contemporary behavior therapies. Riley and Gaynor will present data from a behavioral skills training intervention (provided to parents and youth) targeting depressive symptoms among elementary school children. Hinton et al. present the results of a randomized clinical trial comparing 2 components of acceptance and commitment therapy to supportive therapy for young adults with depressive symptoms. Maitland and Gaynor will present data from an alternating treatments design study comparing sessions of functional analytic psychotherapy to nondirective therapeutic support. Finally, Broten et al. describe a randomized clinical trial comparing a brief acceptance and commitment protocol added to treatment as usual to treatment as usual for individuals hospitalized for depression.

Cognitive-behavioral therapy (CBT) for youth depression has proven moderately efficacious, but little is understood about the mechanisms through with CBT exerts change. An emphasis on multi-element treatment packages and large-scale randomized controlled trials has prevented fine grained analysis of mechanisms of action. Mechanisms of change may be studied at the single-case level by controlling for non-specific early responses, identifying potential mechanisms of action a priori, taking frequent measures of mechanisms and dependent variables, rigorously evaluating internal validity, and using a variety of analytic methods. Eleven depressed youths were recruited to receive first a non-directive therapy (NDT), followed by a behavioral therapy (BT) for those still displaying high levels of symptoms. Four participants responded to NDT. Of the remaining seven, all showed some improvement during BT. For five participants, symptom change appeared related to the targeted mechanisms; however, in only three cases was evidence sufficient to suggest the targeted mechanisms mediated the relationship between BT and symptom change. Future implications of these findings relevant to youth depression research will be discussed.

The necessary and sufficient treatment strategies involved in Acceptance and Commitment Therapys (ACT) multi-component treatment package have only begun to be dismantled via component analog studies. There is empirical evidence supporting cognitive defusion and valued action, specific components of ACTs total treatment package. Together, these processes directly attempt to increase awareness of thoughts as ideas (rather than concrete facts), thereby allowing for increased psychological and behavioral flexibility to move toward valued goals. Fifty-two university students reporting significant distress, low self-esteem, and depressive symptoms were randomized to six weekly therapy sessions of cognitive defusion (3 sessions) plus values-based activity scheduling (3 sessions) versus six weeks of supportive therapy. During the cognitive defusion sessions, two main strategies were utilized: vocalizing techniques (e.g., Titcheners repetition) and Contents on Cards. Values-based activity scheduling focused on values clarification and activity scheduling. Intent-to-treat analyses exploring reductions in depressive symptoms and distress taken at pre-, mid-, and post-treatment found significant time*treatment interactions for participants meting criteria for depression (n = 34) suggesting that ACT techniques produced greater change over supportive therapy. These findings contribute to the literature in determining the specific, active agents of ACT and the theoretically specified technique-to-process-to-outcome relations.

There is currently little research to inform the inpatient care of depressed adults. Additionally, it has been found that up to 57% of those that are hospitalized with a diagnosis of depression are re-hospitalized within one year of discharge (Lin et al., 2010). This suggests that current programs are not successfully preventing relapse and re-hospitalization. Acceptance and Commitment Therapy (ACT) has shown promise as an adjunctive treatment in inpatient settings with co-morbid depression and substance abuse (Petersen & Zettle, 2009) and psychosis (Bach & Hayes, 2002; Gaudiano & Herbert, 2006). The purpose of the current study is to implement a randomized-controlled trial in an inpatient settings of treatment as usual (TAU) vs. TAU plus individual sessions of ACT. A primary outcome is re-hospitalization rates at 3 months after discharge. Secondary measures include psychological functioning at discharge and follow-up. Roughly 60 participants admitted to the mood disorder unit for depressive symptoms will completed the study. Currently 20 have been enrolled and given the participant flow it is fully expected that 60 will have been enrolled by December allowing for 3 month re-hospitalization data to be available for presentation at the conference.

FAP is a behavior analytic approach to interpersonal psychotherapy. It shares with client-centered approaches an emphasis on establishing a therapeutic relationship marked by positive regard and empathic attunement. It shares with other interpersonal approaches a focus on the clients interactions in important social relations and how she/he engages the social milieu. It also shares with both of these approaches the notion that much psychological distress and dysfunction is linked to difficulties forming and maintaining meaningful social relationships, such that therapy may address distress/dysfunction by targeting social relating. FAP is conceptually unique from these other approaches in the explicit importance it places on using the in-session interactions between the therapist and the client as the basis for shaping a more adaptive social repertoire. In the present study 10 individuals, of either sex, who report difficulty with social relating and who consent to participate, will each be provided 10 therapy sessions. Using an alternating treatments design, each participant will receive 5 sessions of non-directive support focused on establishing empathic attunement and understanding (and reflecting an understanding of) the clients social behavior. The other 5 sessions will consist of FAP. In the FAP sessions the therapist will add an emphasis on the in-vivo behavior of the client, attempting to preempt (or extinguish) CRB1s and to prompt and reinforce CRB2s.