Abstract
The relations among clinical factors after behavioral activation for subthreshold depression remain unclear. This study was designed to assess relations among clinical factors after behavioral activation for subthreshold depression. This randomized controlled trial study examined 51 university students with subthreshold depression who had completed pre-treatment, post-treatment, and 1-year follow-up assessments. We examined relations among variables using structural equation modeling (SEM) based on maximum likelihood estimation. Fitted index values suggest that the proposed model is valid. Results indicate that the greater increase in activation from post-treatment to 1-year follow-up was associated with increased positive reinforcement from post-treatment to 1-year follow-up. Furthermore, the greater increase in positive reinforcement from post-treatment to 1-year follow-up was associated with decreased depressive symptoms from post-treatment to 1-year follow-up. To prevent worsening of depressive symptoms after behavioral activation, more attention must be devoted to changes in activation and positive reinforcement.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Armento, M. E., & Hopko, D. R. (2007). The Environmental Reward Observation Scale (EROS): Development, validity, and reliability. Behavior Therapy, 38, 107–119. https://doi.org/10.1016/j.beth.2006.05.003.
Balazs, J., Miklosi, M., Kereszteny, A., Hoven, C. W., Carli, V., Wasserman, C., et al. (2013). Adolescent subthreshold-depression and anxiety: Psychopathology, functional impairment and increased suicide risk. Journal of Child Psychology and Psychiatry, 54, 670–677.
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory: Manual (2nd ed.). The Psychological Corp.
Benton, S. A., Robertson, J. M., Tseng, W., Newton, F. B., & Benton, S. L. (2003). Changes in counseling center client problems across 13 years. Professional Psychology: Research and Practice, 34, 66–72. https://doi.org/10.1037/0735-7028.34.1.66.
Bertha, E. A., & Balazs, J. (2013). Subthreshold depression in adolescence: a systematic Review. European Child & Adolescent Psychiatry, 22, 589–603. https://doi.org/10.1007/s00787-013-0411-0.
Cuijpers, P., van Straten, A., & Warmerdam, L. (2007). Behavioral activation treatments of depression: A meta-analysis. Clinical Psychology Review, 27, 318–326. https://doi.org/10.1016/j.cpr.2006.11.001.
Cuijpers, P., Koole, S. L., van Dijke, A., Roca, M., Li, J., & Reynolds, C. F. (2014). Psychotherapy for subclinical depression: meta-analysis. The British Journal of Psychiatry, 205, 268–274. https://doi.org/10.1192/bjp.bp.113.138784.
Dimidjian, S., Barrera Jr., M., Martell, C., Munoz, R. F., & Lewinsohn, P. M. (2011). The origins and current status of behavioral activation treatment for depression. Annual Review of Clinical Psychology, 7, 1–38. https://doi.org/10.1146/annurev-clinpsy-032210-104535.
Gearing, R. E., Schwalbe, C. S., Lee, R., & Hoagwood, K. E. (2013). The effectiveness of booster sessions in CBT treatment for child and adolescent mood and anxiety disorders. Depression and Anxiety, 30, 800–808. https://doi.org/10.1002/da.22118.
Georgiades, K., Lewinsohn, P. M., Monroe, S. M., & Seeley, J. R. (2006). Major depressive disorder in adolescence: The role of subthreshold symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 45, 936–944.
Hooper, D., Coughlan, J., & Mullen, M. R. (2008). Structural equation modeling: Guidelines for determining model fit. The Electronic Journal of Business Research Methods, 6, 53–60.
Johnson, J. G., Cohen, P., & Kasen, S. (2009). Minor depression during adolescence and mental health outcomes during adulthood. The British Journal of Psychiatry, 195, 264–265.
Kanter, J.W., Mulick, P.S., Busch, A. M., Berlin, K.S., & Martell, C. R. (2007). The Behavioral Activation for Depression Scale (BADS): psychometric properties and factor structure. Journal of Psychopathology and Behavioral Assessment, 29, 191–202. https://doi.org/10.1007/s10862-006-9038-5.
Kawakami, N., Takeshima, T., Ono, Y., Uda, H., Hata, Y., Nakane, Y., et al. (2005). Twelve-month prevalence, severity, and treatment of common mental disorders in communities in Japan: Preliminary finding from the World Mental Health Japan Survey 2002–2003. Psychiatry and Clinical Neurosciences, 59, 441–452. https://doi.org/10.1111/j.1440-1819.2005.01397.x.
Kessler, R. G., & Ustun, T. B. (2004). The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research, 13, 93–121. https://doi.org/10.1002/mpr.168.
Kojima, M., & Furukawa, T. (2003). Japanese Version of the Beck Depression Inventory (2nd ed.). Nippon-Hyoron-sha Co..
Kunisato, Y., Takagaki, K., Okajima, I., Nakajima, S., Ishikawa, S., Kanai, Y., et al. (2011). Development of Japanese version of Environmental Reward Observation Scale (EROS). Japan Journal of Behavior. Therapy, 37, 21–31.
Lewinsohn, P. M., Sullivan, L. M., & Grosscup, S. (1980). Changing reinforcing events: an approach to the treatment to depression. Psychotherapy: Theory, Research & Practice, 17, 322–334.
MacKinnon, D. P., Lockwood, C. M., & Williams, J. (2004). Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivariate Behavioral Research, 39, 99–128.
Manos, R. C., Kanter, J. W., & Busch, A. M. (2010). A critical review of assessment strategies to measure the behavioral activation model of depression. Clinical Psychology Review, 30, 547–561. https://doi.org/10.1016/j.cpr.2010.03.008.
Martell, C. R., Addis, M. E., & Jacobson, N. S. (2001). Depression in context: Strategies for guided action. W. W. Norton & Company.
Martell, C. R., Dimidjian, S., & Herman-Dunn, R. (2010). Behavioral activation for depression – A clinician’s guide. The Guilford Press.
Mazzucchelli, T., Kane, R., & Rees, C. (2009). Behavioral activation treatments for depression in adults: A meta-analysis and review. Clinical Psychology: Science and Practice, 16, 383–411. https://doi.org/10.1111/j.1468-2850.2009.01178.x.
Pincus, H. A., Davis, W. W., & McQueen, L. E. (1999). Subthreshold mental disorders. A review and synthesis of studies on minor depression and other brand names. British Journal of Psychiatry, 174, 288–296.
Richards, D. A., Ekers, D., McMillan, D., Taylor, R. S., Byford, S., Warren, F. C., et al. (2016). Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): A randomised, controlled, non-inferiority trial. Lancet, 388, 871–880. https://doi.org/10.1016/S0140-6736(16)31140-0.
Takagaki, K., Okajima, I., Kunisato, Y., Nakajima, S., Kanai, Y., Ishikawa, S., et al. (2013a). Preliminary assessment of the behavioral activation model in Japanese undergraduate students. Psychological Reports, 112, 47–59. https://doi.org/10.2466/02.15.21.PR0.112.1.47-59.
Takagaki, K., Okajima, I., Kunisato, Y., Nakajima, S., Kanai, Y., Ishikawa, S., et al. (2013b). Development and validation of the Japanese version of the Behavioral Activation for Depression Scale (BADS). Archives of Psychiatric Diagnostics and Clinical Evaluation, 6, 76–85.
Takagaki, K., Okamoto, Y., Jinnin, R., Mori, A., Nishiyama, Y., Yamamura, T., et al. (2014). Behavioral characteristics of subthreshold depression. Journal of Affective Disorders, 168, 472–475.
Takagaki, K., Okamoto, Y., Jinnin, R., Mori, A., Nishiyama, Y., Yamamura, T., et al. (2016a). Behavioral activation for late adolescents with subthreshold depression: a randomized controlled trial. European Child Adolescent Psychiatry, 25, 1171–1182. https://doi.org/10.1007/s00787-016-0842-5.
Takagaki, K., Okamoto, Y., Jinnin, R., Mori, A., Nishiyama, Y., Yamamura, T., et al. (2016b). Mechanisms of behavioral activation for late adolescents: Positive reinforcement mediates the relationship between activation and depressive symptoms from pre-treatment to post-treatment. Journal of Affective Disorders, 204, 70–73. https://doi.org/10.1016/j.jad.2016.06.046.
Takagaki, K., Okamoto, Y., Jinnin, R., Mori, A., Nishiyama, Y., Yamamura, T., et al. (2018). Enduring effects of a 5-week behavioral activation program for subthreshold depression among late adolescents: An exploratory randomized controlled trial. Neuropsychiatric Disease and Treatment, 14, 2633–2641. https://doi.org/10.2147/NDT.S172385.
Tomoda, A., Mori, K., Kimura, M., Takahashi, T., & Kitamura, T. (2000). One-year incidence and prevalence of depression among first-year university students in Japan: A preliminary study. Psychiatry and Clinical Neurosciences, 54, 583–588. https://doi.org/10.1046/j.1440-1819.2000.00757.x.
Acknowledgements
The authors thank all participants.
Funding
This study was supported by Grants-in-Aid for Scientific Research on Innovative Areas, Grant Numbers 16H06395 and 16H06399 from JSPS, and Grant Number 23118004 from the Ministry of Education, Culture, Sports, Science and Technology, Japan.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical Approval and Informed Consent
Approval for the study was obtained from the ethics committee of Hiroshima University. All participants gave written informed consent before participation.
Conflict of Interest
The authors declare no competing interests.
Disclaimer
No funding entity influenced the results or presentation of the study results.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Takagaki, K., Jinnin, R., Yokoyama, S. et al. Relations Among Clinical Factors After Behavioral Activation for Subthreshold Depression. J Cogn Ther 14, 612–622 (2021). https://doi.org/10.1007/s41811-021-00108-8
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s41811-021-00108-8