George S Alexopoulos1, Robert O'Neil2, Samprit Banerjee3, Patrick J Raue4, Lindsay W Victoria5, Jennifer N Bress5, Cristina Pollari5, Patricia A Arean4. 1. Weill-Cornell Institute of Geriatric Psychiatry, United States. Electronic address: gsalexop@med.cornell.edu. 2. Weill Cornell Medical College, Department of Healthcare Policy and Research, United States. 3. Weill-Cornell Institute of Geriatric Psychiatry, United States; Weill Cornell Medical College, Department of Healthcare Policy and Research, United States. 4. University of Washington, Department of Psychiatry and Behavioral Sciences, United States. 5. Weill-Cornell Institute of Geriatric Psychiatry, United States.
Abstract
OBJECTIVE: Engage grew out of the need for streamlined psychotherapies that can be accurately used by community therapists in late-life depression. Engage was based on the view that dysfunction of reward networks is the principal mechanism mediating depressive symptoms. Accordingly, Engage uses "reward exposure" (exposure to meaningful activities) and assumes that repeated activation of reward networks will normalize these systems. This study examined whether change in a behavioral activation scale, an index of reward system function, predicts change in depressive symptomatology. METHODS: The participants (N = 48) were older adults with major depression treated with 9 weekly sessions of Engage and assessed 27 weeks after treatment. Depression was assessed with the 24-item Hamilton Depression Rating Scale (HAM-D) and behavioral activation with the four subscales of Behavioral Activation for Depression Scale (activation, avoidance/rumination, work impairment, social impairment) at baseline, 6 weeks (mid-treatment), 9 weeks (end of treatment), and 36 weeks. RESULTS: Change only in the Activation subscale during successive periods of assessment predicted depression severity (HAM-D) at the end of each period (F1, 47 = 21.05, p<0.0001). An increase of one standard deviation in the Activation score resulted in a 2.04 (95% CI: 1.17-2.92) point decrease in HAM-D. For every one point increase in the Activation score, HAM-D was decreased by 0.22 points (95% CI: 0.12-0.31). LIMITATIONS: No comparison group. Partial overlap of Activation Subscale with HAM-D, lack of detailed neurocognitive assessment and social support. CONCLUSION: Change in behavioral activation predicts improvement of depressive symptoms and signs in depressed older adults treated with Engage.
OBJECTIVE: Engage grew out of the need for streamlined psychotherapies that can be accurately used by community therapists in late-life depression. Engage was based on the view that dysfunction of reward networks is the principal mechanism mediating depressive symptoms. Accordingly, Engage uses "reward exposure" (exposure to meaningful activities) and assumes that repeated activation of reward networks will normalize these systems. This study examined whether change in a behavioral activation scale, an index of reward system function, predicts change in depressive symptomatology. METHODS: The participants (N = 48) were older adults with major depression treated with 9 weekly sessions of Engage and assessed 27 weeks after treatment. Depression was assessed with the 24-item Hamilton Depression Rating Scale (HAM-D) and behavioral activation with the four subscales of Behavioral Activation for Depression Scale (activation, avoidance/rumination, work impairment, social impairment) at baseline, 6 weeks (mid-treatment), 9 weeks (end of treatment), and 36 weeks. RESULTS: Change only in the Activation subscale during successive periods of assessment predicted depression severity (HAM-D) at the end of each period (F1, 47 = 21.05, p<0.0001). An increase of one standard deviation in the Activation score resulted in a 2.04 (95% CI: 1.17-2.92) point decrease in HAM-D. For every one point increase in the Activation score, HAM-D was decreased by 0.22 points (95% CI: 0.12-0.31). LIMITATIONS: No comparison group. Partial overlap of Activation Subscale with HAM-D, lack of detailed neurocognitive assessment and social support. CONCLUSION: Change in behavioral activation predicts improvement of depressive symptoms and signs in depressed older adults treated with Engage.
Authors: Oliver J Robinson; Roshan Cools; Christina O Carlisi; Barbara J Sahakian; Wayne C Drevets Journal: Am J Psychiatry Date: 2012-02 Impact factor: 18.112
Authors: Diego A Pizzagalli; Avram J Holmes; Daniel G Dillon; Elena L Goetz; Jeffrey L Birk; Ryan Bogdan; Darin D Dougherty; Dan V Iosifescu; Scott L Rauch; Maurizio Fava Journal: Am J Psychiatry Date: 2009-05-01 Impact factor: 18.112
Authors: Lindsay W Victoria; Faith M Gunning; Jennifer N Bress; Danielle Jackson; George S Alexopoulos Journal: Int J Geriatr Psychiatry Date: 2018-03-24 Impact factor: 3.485
Authors: Nili Solomonov; Jennifer N Bress; Jo Anne Sirey; Faith M Gunning; Christoph Flückiger; Patrick J Raue; Patricia A Areán; George S Alexopoulos Journal: Am J Geriatr Psychiatry Date: 2019-01-10 Impact factor: 4.105
Authors: Natalie C Benda; George S Alexopoulos; Patricia Marino; Jo Anne Sirey; Dimitris Kiosses; Jessica S Ancker Journal: AMIA Annu Symp Proc Date: 2021-01-25
Authors: Jo Anne Sirey; Patrick J Raue; Nili Solomonov; Clara Scher; Alexandra Chalfin; Paula Zanotti; Jacquelin Berman; George S Alexopoulos Journal: Transl Behav Med Date: 2020-08-07 Impact factor: 3.046
Authors: Richard Shulman; Reenu Arora; Rose Geist; Amna Ali; Julia Ma; Elizabeth Mansfield; Sara Martel; Jane Sandercock; Judith Versloot Journal: Can Geriatr J Date: 2021-09-01