BRIEF BEHAVIORAL ACTIVATION TREATMENT FOR DEPRESSION IN SPANISH-SPEAKING LATINOS: ACCEPTABILITY AND PRELIMINARY EVALUATION

Although depression is highly treatable, disparities in mental health treatment in the US have prevented Latinos who lack English language proficiency from accessing efficacious interventions. Reasons cited for these disparities include language barriers, high cost of services, lack of culturally sensitive treatments, and stigma toward mental health treatment. A direct Spanish translation of the Brief Behavioral Activation Treatment for Depression (BATD) may be well-equipped to address the existing barriers through its focus on individual and cultural values, its efficiency and straight-forward nature, itsfocus on developing existing and new strengths, and conceptualization of depression as a consequence of clients' environments and not of cognitive processes, which may serve to decrease stigma associated with care. Using this translation, the current study sought to establish preliminary efficacy and acceptability of BATD in a group of depressed Spanish-speaking Latinos (N=10) . Results showed that over time there was a significant decrease in self-reported depression and a significant increase in activation as indicated by multiple self-report measures. Further, increases in activation corresponded to decreases in depression. Sustained clinical gains through a one-month follow-up were observed. Taken together, these results provide preliminary support for BATD as an efficacious treatment for depression. Consideration of the results combined with interview-based feedback obtained from participants provide several domains for modification of this treatment for future studies, and suggest that the next logical step is to include a treatment control group and a larger sample size in future investigations

Evaluating the Efficacy of Behavioral Activation Among Spanish-Speaking Latinos

Major depressive disorder (MDD) is highly prevalent among U.S. Spanish-speaking Latinos. Although MDD is very treatable, the lack of empirically-supported treatments precludes this population's access to quality mental health care. Following the promising results of a small open-label pilot study in which we tested the efficacy of Behavioral Activation Treatment for Depression (BATD) in a sample Latinos with Spanish-speaking preference, we conducted a randomized control trial (RCT; N = 46) that compared BATD (N = 23) to supportive counseling (N = 23) across various domains, including depression, BATD proposed mechanisms (activity level and environmental reward), and non-specific psychotherapy factors. Results indicated that relative to SC, BATD led to greater decreases in depressive symptoms over time (p = 0.04) and greater MDD remission at the end of treatment and at the one-month follow-up (p = 0.01). Activity level (p = 0.01) and environmental reward (p = 0.05) showed greater increases over time among participants who received BATD compared to SC. Further, proposed BATD mechanisms of change did not correspond over time with depressive symptomatology. Treatment adherence, therapeutic alliance, and treatment satisfaction did not differ between the groups (ps > 0.17). The one-month follow-up suggested sustained clinical gains across therapies. The current study adds to a limited treatment research literature and suggests that BATD, a time-limited and straightforward intervention, is efficacious in reducing depression and increasing activity level and environmental reward in this important, yet underserved population of the U.S. The current study sets the stage for a larger RCT to examine BATD against an empirically-supported treatment, with additional moderators of treatment and mechanisms of change

The indirect effects of trait anxiety on drug use via emotion dysregulation in a low-income sample

This is an Accepted Manuscript of an article published by Taylor & Francis in Substance Use & Misuse on 2020 Mar 18, available online: http://www.tandfonline.com/10.1080/10826084.2020.1741631.Background: Research has demonstrated consistent associations between anxiety and illicit drug use. However, few studies to date have examined the shared risk factors that may contribute to this common comorbidity. Therefore, the current investigation tested the indirect effect of trait anxiety on drug use disorder symptoms via emotion dysregulation, a widely recognized transdiagnostic risk factor found to be relevant across both anxiety and illicit drug use. Method: The sample was comprised of 241 adults (Mage = 50.56, SDage = 5.90; 76.8% Black) recruited from a community center serving low-income and homeless individuals. Results: Consistent with our hypothesis, structural equation modeling demonstrated an indirect effect of trait anxiety on drug use disorder symptoms through emotion dysregulation. Conclusions: The current findings show initial support for emotion dysregulation as an explanatory vulnerability factor indirectly underlying the relationship between anxiety and drug use

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

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. 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 4th and 5th 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. 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.https://doi.org/10.1186/1745-6215-15-23

Risk and Protective Factors of Substance Use

Substance use disorders are recalcitrant by nature and constitute a great source of suffering. Most adults with a substance use disorder report having started to misuse substances during adolescence. Thus, the current pilot aims to examine the modifiable correlates of positive substance use expectancies, a robust predictor of adolescent substance use, generally. The results could inform larger studies testing the putative, malleable vulnerability and protective factors that lead to adolescent substance use with the ultimate goal of targeting them via focused interventions. In a previous pilot trial submitted to the Character Lab Research Network, we targeted high school students. This time, using the same methodology, we would like to enroll middle school students, as there is evidence that the substance use risk factors precede high school. Once we receive these data, we will be ready to submit a proposal for a full-powered trial

Working Memory Training Reduces Cigarette Smoking among Low-Income Individuals with Elevated Delay Discounting

INTRODUCTION: The competing neurobehavioral decision systems theory conceptualizes addictive behavior, such as cigarette smoking, as arising from the imbalance between stronger impulsive relative to weaker executive decision processes. Working memory trainings may enhance executive decision processes, yet few studies have evaluated its efficacy on substance misuse, with mixed evidence. The current study is the first to evaluate the efficacy of a working memory training on cigarette smoking. We consider the moderating role of delay discounting, or the preference for smaller, immediately available rewards relative to larger, delayed rewards, which has been associated with smoking onset, progression, and resumption. The investigation focuses on individuals living in high-poverty, low-resource environments due high burden of tobacco-related disease they experience. METHOD: The study utilized a subset of data (N = 177 individuals who smoke) generated from a randomized clinical trial that is evaluating the efficacy of working memory training for improving health-related outcomes. Participants were randomized to complete up to 15 sessions of the active, working memory training or a control training. RESULTS: Findings showed that among participants who were randomized to the working memory condition, those with higher rates of baseline delay discounting demonstrated decreases in cigarette smoking (p = .05). Conversely, individuals randomized to the control condition, who had higher rates of baseline delay discounting exhibited increases in cigarette smoking (p = .025). CONCLUSIONS: Results suggest that DD may be an important indicator of working memory training outcomes and a possible approach for effectively targeting treatments in the future. IMPLICATIONS: Delay discounting is important indicator of working memory training outcomes on cigarette smoking. The findings suggest the possibility to effectively target treatments considering the impact of delay discounting. Given that rates of DD tend to be higher among individuals from low-resource communities, and that computer-based working memory training programs are relatively low-cost and scalable, these findings suggest this approach may have specific utility for adults at heightened risk for cigarette use