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Brief Behavioural Activiation for Adolescent Depression (Brief BA)

Brief Behavioural Activiation for Adolescent Depression (Brief BA)

Overview

Level: Enhanced

Impact Assessments:

Reaction

Learning

Behaviour

Results

Brief BA is a manualised intervention based on behavioural theory and the behavioural approach to depression aimed at treating low mood or mild or moderate to severe depression symptoms in young people aged 12-18 years to help them recover as quickly as possible. BA practitioners will work with young people to identify how they are spending their time, what is important to them (their values), how they can spend more of their time doing things that are important to them to establish a positive cycle of behaviour and involves structured parental involvement at key points.

Brief BA is delivered by a certified practitioner over 6-8, 1- hour sessions in a one-to-one format with a review one month after completion of session 8 and is suitable for delivery in schools, colleges, communities and health settings.

While delivering this programme to young people, risks associated with suicide and self-harm may present and therefore a pre-requisite Risk Management training has been developed by NES particularly aimed ti support staff working in school and community settings.  Brief BA practitioners manage these risks through coaching and individual Safety Plans which include in and out of school contacts.

This training allows suitably experienced staff to gain the knowledge and skills required to deliver this psychological intervention to young people experiencing low mood and depression.  

The training is blending learning approach of pre-reading, workshop and ongoing coaching and/or supervision

Is there a cost for this learning resource? :

No

Has this resource been accredited or endorsed by any organisation? :

NHS Education for Scotland

Training model:

This training is available through a number of training routes. Staff need to have experience of working with children and young people who are experiencing distress or mental health difficulities, and need to have access to coaching and/or supervision focused on Brief Behavioural Activiation. Current training routes available are:

Training in psychological skills - early intervention for children (TIPS-EIC) in which NES fund and train psychology staff, who are embedded within local CAMHS teams, to deliver Brief BA training and coaching. These psychology staff offer the Brief BA training, accompanied by an additional risk assessment traing, and follow-up small group coaching to staff in children services, e.g., School Nurses etc., who then deliver the 8 session Brief BA intervention to targeted children and young people.

Specialist CAMHS services - multi-professional clinicals in CAMHS services are trained by local health board trainers, or via the one year development plan.

Coaches need to have skills and competence in CBT/Brief BA, such as a CBT qualification or be a qualified Applied Psychologist, and skills and competence in supervision or coaching. In addition, completion of the NES Brief BA (CYP) training for trainers workshop is required to deliver the training.

Staff capacity and time commitment:

Staff need time to attend the training workshop (1 day) and associated risk assessment workshop (1/2 day) and time to read the manual (1/2 day) and attend follow up coaching and/or supervision sessions. Within TIPS-EIC sites, staff need to attend coaching with their NES TIPS-EIC psychologist. Within CAMHS Brief BA skills coaching may occur within specific coaching sessions, or within individual clinical supervision.

Coaches and supervisors need to time to become skilled in this model of Brief BA, and have time to deliver coaching/supervision

Author/developer:

Professor Shirley Reynolds, University of Reading and Dr Laura Pass, University of developed the Brief BA for Adolescent Depression manual and session guide and NES have adapted their training resources for use within NHS Scotland and developed the accompanying risk management training.

Contact for Further Development

Turas learn page: CYP: Brief Behavioural Activation for Adolescent Depression

Contact psychology@nes.scot.nhs.uk for more information

Link to resource

Quality dimensions

Usability

The Intended Learning Outcomes are:

  • Understand the key characteristics and experience of depression in young people
  • Be able to explain the Brief BA rationale and model to a young person (and parent) and make it relevant to their experience of depression
  • Explain why activity monitoring is helpful and help a young person to figure out a way to monitor their activity that works for them
  • Help a young person to identify what matters to them
  • Plan, scaffold, and review valued activities with the young person
  • Involve important others in Brief BA for young people with depression
  • Understand how adolescent depression interferes with engaging in therapy and have strategies to overcome this
  • Provide positive reinforcement to a young person and model this behaviour to others
  • Be able to use Brief BA tools for self-practice and reflect on how this process will inform your approach to delivering Brief BA to a young person
  • Understand & use ROMs in a clinically meaningful way in Brief BA
  • Understand the importance of identifying and managing risk to self through Brief BA therapy  

The training has specified content, in the form of the manual "Brief Behavioural Activiation for Adolescent Depression, Pass & Reynolds, 2021", and training slides.

Supports

Supports - Workforce

Staff will need ring-fenced time to attend training and coaching and deliver the Brief BA intervention to CYP. Extensive implementation supports are provided by NES consistent with Implementation Science principles. The Brief BA training is fully operationalised within a delivery manual that includes all training materials, session plans, workbooks, details about routine clinical outcome measures. All of this is consolidated and and behaviourally rehearsed during coaching sessions.

Supports - Technology

For delivery of the training, trainers need access to a training room or facilities to deliver online, and the ability to collect the training data via MS Forms.

The intervention can be delivered remotely , and staff would need technological infrastructure to deliver this.

Data collection is a key part of the overall implementation of the training and psychological intervention.

Supports - Administrative

The intervention requires support in the delivery setting to arrange appointments, source and book rooms. Support is also required in collecting and returning the implementation data to NES.

Supports - Financial

All manuals and training / coaching materials are provided by NES. Trainers in the intervention and coaches time is funded by NES in TIPS-EIC and local NHS boards in CAMHS.

Evidence base

All BA treatments are based on behavioural theory and the behavioural approach to depression (Lewisohn, 1974) Early evidence for BA came from a study investigating the active components of CBT to try and ascertain the most effective part Jacobson et al (1996) who found in their RCT that BA as effective as cognitive restructuring and full CBT in treating depression.

Martell et al (2001) developed 16-20 session BA treatment for depression. Studies have found BA to be an effective treatment for depression with a number of populations including working age adults, older adults, new mums, people with pain and women with breast cancer and more recently people with ID

Lejeuz, Hopko and Hopko, 2001 and Lejeuz et al, 2011 developed brief BA (BATD) as a structured, practical behavioural treatment for low mood/depression to be delivered in 5- 10 sessions by a therapist who did not have formal training in psychotherapy

Brief BA for Adolescents has been adapted for young people from BATD (same as BA for people with ID)

The matrix (2015) states the strongest evidence for treating depression in young people is individual psychological treatments, CBT and Interpersonal Psychotherapy (IPT) and Brief BA very similar to the behavioural part of CBT

https://www.nes.scot.nhs.uk/media/420chmra/matrix_-_children_youngpeopletablesfinal_2015.pdf

There have been 2 small RCT's into Brief BA (McCauley et al 2015 and Chu et al, 2016, in the USA) along with case series and case studies. 2 reviews (Martin and Oliver, 2017 and Tindall et al, 2017) supported effectiveness of BA in YP (while acknowledging the scarcity of high-quality research). Statistically significant improvement from pre-treatment to end of treatment in depression, global functioning, and activation and avoidance. (McCauley, E. et al 2016).

The developers of Brief BA for adolescents have written a number of papers and case studies detailing the use of their model and demonstrating its effectiveness in case illustrations. Significant decrease in depression symptoms and significant increase in functioning symptoms - self and parent reported.  (Pass. L et al 2018) (Hodgson, E.J. 2019)

NICE 2019 Evidence Review of Psychological Interventions for treatment of depression made research recommendation to investigate effectiveness of BA as may meet needs of some YP with mild, or moderate to severe depression not already covered by other recommended psychological therapies, specifically, YP who might find it difficult to engage with concepts of CBT as well as young people with learning disabilities or neurodiversity.

References 

RCT's

McCauley, E., Gudmundsen, G., Schloredt, K., Martell, C., Rhew, I., Hubley, S., & Dimidjian, S. (2015).  The Adolescent Behavioral Activation Program: Adapting Behavioral Activation as a Treatment for Depression in Adolescence.  Journal of Clinical Child & Adolescent Psychology, doi: 10.1080/15374416.2014.979933

Chu, B. C. , Crocco, S. T. , Esseling, P. , Areizaga, M. J. , Lindner, A. M. , & Skriner, L. C. (2016). Transdiagnostic group behavioural activation and exposure therapy for youth anxiety and depression: Initial randomized controlled trial. Behavior Research and Therapy, 76(65), 65–75. https://pubmed.ncbi.nlm.nih.gov/26655958/

Reviews

Martin, F. & Oliver, T. (2019) Behavioural activation for children and adolescents: a systemic review of progress and promise. Eur Child Adolesc Psychiatry. 2019; 28(4): 427–441. Published online 2018 Feb 23.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6445819/

Tindall, L., Mikocka‐Walus, A,  McMillan, D., Wright, B.,Hewitt, C., Gascoyne. S. (2017) Is behavioural activation effective in the treatment of depresison in young people? A systematic review and meta-analysis. Psychol Psychother. Dec; 90(4): 770–796. doi: 10.1111/papt.12121

 

Other references

Jacobson N, Dobson K, Traux P, Addis M, Koerner K, Gollan J, Gortner E, Prince S (1996). A component analysis of cognitive-behavioural treatment of depression. Journal of Consulting and Clinical Psychology, 64, 295–304

Lejuez, C. W., Hopko, D. R., Acierno, R., Daughters, S. B., & Pagoto, S. L. (2011). Ten Year Revision of the Brief Behavioral Activation Treatment for Depression (BATD): Revised Treatment Manual (BATD-R). Behavior Modification.

Martell, C. R., Addis, M. E., & Jacobson, N. S. (2001). Depression in context: Strategies for guided action. New York: Norton

https://www.nice.org.uk/guidance/ng134/evidence/evidence-review-a-psychological-interventions-for-the-treatment-of-depression-pdf-6834544094

Pass, L., Sancho, M., Brett, S., Jones, M., & Reynolds, S. (2018). Brief Behavioural Activation (Brief BA) in secondary schools: a feasibility study examining acceptability and practical considerations. Educational & Child Psychology, 35.

Pass, L., Lejuez, C. W., & Reynolds, S. (2018). Brief behavioural activation (Brief BA) for adolescent depression: A pilot study. Behavioural and cognitive psychotherapy, 46(2), 182-194.

Pass, L., Hodgson, E., Whitney, H., & Reynolds, S. (2017). Brief Behavioral Activation Treatment for Depressed Adolescents Delivered by Nonspecialist Clinicians: A Case Illustration. Cognitive and Behavioral Practice. http://www.sciencedirect.com/science/article/pii/S1077722917300536

Pass, L., Brisco, G., & Reynolds, S. (2015).  Adapting brief Behavioural Activation (BA) for adolescent depression: A case example.  The Cognitive Behaviour Therapist, 8, e17

Pass, L., Whitney, H. & Reynolds, S. (2016). Brief behavioral activation for adolescent depression: Working with complexity and risk. Clinical Case Studies. http://ccs.sagepub.com/content/early/2016/04/20/1534650116645402?papetoc

Thesis: Hodgson, E.J. (2019).  Brief BA for Depression Symptoms in Adolescents: Development of the Brief BA Fidelity Scale, Psychometric Evaluation, and Link to Outcome and Alliance. University of Southampton, Faculty of Social, Human and Mathematical Sciences., PhD Thesis.  pp. 1- 100.

Impact assessments

Reaction

The REACTS questionnaire is completed at the end of training.  

Learning

Pre and post knowledge and confidence questionnaires are completed by each learner at each training. 

Behaviour

This is assessessed and developed during coaching and or supervision sessions.

Results

ROMS are completed pre and post intervention (Revised Anxiety and Depression Scale and the Evaluation of Service Questionnaire) as well as at each session to measure progress (Goal Based Outcomes) and governance / risk (depression subscale and additional risk question) All measures can be seen here: https://www.corc.uk.net/ and here https://learn.nes.nhs.scot/38905

NES collects these data from the regional boards and analyses impact. GDPR UK permissions are in place.

KSF dimension information in relation to the learning resource

Child Development and Attachment

Mental Health in Children, Young People and their Families

Engagement, Containment and Communication

Identification and Understanding of Need

Supports and Interventions

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