Latino immigrants with depression: an initial examination of treatment issues at a community clinic.

The objective of this study is to investigate specific characteristics that may affect the psychological treatment retention of Latinos diagnosed with depression in a community mental health clinic that provides culturally responsive services. Thirty-six Latino clients participated in the pilot study. Descriptive statistics were generated on acculturation, acculturative stress, familismo (the importance of the family), specific demographic variables, and other factors potentially related to treatment outcome. Two specific groups were compared: regular attendees (RAs; n = 18) and premature terminators (PTs; n = 18). RAs were significantly less likely to be employed, and more likely to have medications prescribed at the clinic compared to PTs. Acculturation, acculturative stress, and familismo did not differentiate between groups but were found to characterize the entire sample. The results support the premise that psychological treatment combined with medication keeps clients in treatment. Knowledge of perceived and actual barriers encountered by Latino clients are necessary to guide community-based mental health clinics in developing effective service delivery alternatives that will enhance treatment engagement.

What is behavioral activation? A review of the empirical literature.

Behavioral Activation (BA) for depression is an empirically supported psychotherapy with a long history dating back to the 1970s. To date there have been no systematic reviews of how BA treatment packages and their accompanying components have evolved over the years. This review sought to identify and describe the specific treatment components of BA based on the descriptions of techniques provided in empirical articles on BA and referenced treatment manuals when available. The following component techniques were identified: activity monitoring, assessment of life goals and values, activity scheduling, skills training, relaxation training, contingency management, procedures targeting verbal behavior, and procedures targeting avoidance. The implementation of these techniques is reviewed, along with their empirical support both as stand-alone components and as components of larger treatment packages. Whereas activity scheduling, relaxation, and skills training interventions have received empirical support on their own, other procedures have shown effectiveness as parts of larger treatment packages. Although BA interventions differed in tools used, activity monitoring and scheduling were shown to be constant components across interventions. Possible directions for the future evolution of BA are discussed.

Initial outcomes of a culturally adapted behavioral activation for Latinas diagnosed with depression at a community clinic.

Latinos demonstrate high rates of depression, often do not seek treatment, and terminate prematurely for a variety of reasons, including lack of sensitivity to contextual and cultural factors in treatment approaches. For decades researchers have suggested a behavioral approach to Latinos diagnosed with depression because such an approach targets the complex environmental stressors experienced by these populations with a simple, pragmatic approach. Recently, behavioral activation has been culturally and linguistically adapted for Latinos/Latinas diagnosed with depression (BA-Latino or BAL). The current study consists of a pilot evaluation of BAL at a bilingual (Spanish-English) community mental health clinic (N = 10 Latinas). Results provide preliminary support for the feasibility and effectiveness of BAL for Latinas in a community setting in terms of treatment adherence, retention, and outcomes. Implications and future directions are discussed.

A comparison of contextual and biomedical models of stigma reduction for depression with a nonclinical undergraduate sample.

Stigma reduction programs are dominated by a biomedical model that presents depression as a medical illness. Alternately, a contextual model emphasizes that one should not be blamed for environmental influences. This study compared biomedical, contextual, and control stigma reduction programs to each other and to a no-program control. The main hypotheses were that the contextual program would have the greatest impact and that a match between participants' beliefs about depression and the model presented would moderate this effect. Seventy-four participants were randomized to the 3 programs and 12 participants served as a no-program control. The contextual and control programs reduced stigma significantly compared with the no-program control, whereas the biomedical program did not. Beliefs about depression moderated this effect only for the biomedical condition. Contextual and control programs seem to be effective but a biomedical model may be risky for those who disagree with the model. Theoretical implications are discussed.

The Use and Nature of Present-Focused Interventions in Cognitive and Behavioral Therapies for Depression.

To improve cognitive and behavioral therapies (CBT) for depression, several approaches recommend an increased focus on the occurrence of problems as they occur in the therapeutic relationship or in relation to the live therapy process, referred to as present-focused. A lingering question has been the degree to which CBT therapists already engage in present-focused work. This study utilized sessions from recent trials of CBT for depression and, in Phase I, raters identified present-focused interventions on a turn-by-turn basis. Phase II raters used a qualitative analysis to determine categories of present-focused interventions. Results indicated that therapists rarely focused on the therapeutic relationship; when they did it was often transient and lacking in the elaborations suggested by newer approaches. Therapists more often performed therapy process and emotion focused interventions, but these also tended to lack elaboration.

Depression stigma in a predominantly low income African American sample with elevated depressive symptoms.

It is widely recognized that stigmatization of depression leads individuals with depression to avoid treatment and discontinue treatment prematurely. However, this research has been conducted with predominantly White samples and there is limited research on stigma of depression and how it relates to previous treatment seeking among African Americans. The current study examined stigma of depression and related constructs in a predominantly low income African American sample with elevated depressive symptoms. Specifically, general self-stigma, secrecy, public stigma, treatment stigma, and stigmatizing experiences, as well as depression severity, and whether these factors predicted previous treatment seeking for depression were explored. Previous treatment seeking significantly predicted decreased public stigma and increased self-stigma. Implications and future directions are discussed.

Depression self-stigma: a new measure and preliminary findings.

It is widely recognized that stigmatization of mental disorders leads stigmatized individuals to avoid treatment altogether or discontinue treatment prematurely. Literature suggests that the impact of stigma may differ by diagnosis; however, previous attempts to measure self-stigma have not been disorder specific. This study sought to develop the Depression Self-Stigma Scale (DSSS) and identify distinct constructs associated with depression self-stigma. Items for the initial administration of the DSSS were developed through careful review of existing measures and the literature on stigma and depression. Items were administered to undergraduates and community members with self-reported depression (N = 391). Results indicated 5 factors (general self-stigma, secrecy, public stigma, treatment stigma, and stigmatizing experiences) with good factor structure, internal consistency, and evidence for construct validity.

Making behavioral activation more behavioral.

Behavioral Activation, an efficacious treatment for depression, presents a behavioral theory of depression--emphasizing the need for clients to contact positive reinforcement--and a set of therapeutic techniques--emphasizing provision of instructions rather than therapeutic provision of reinforcement. An integration of Behavioral Activation with another behavioral treatment, Functional Analytic Psychotherapy, addresses this mismatch. Functional Analytic Psychotherapy provides a process for the therapeutic provision of immediate and natural reinforcement. This article presents this integration and offers theoretical and practical therapist guidelines on its application. Although the integration is largely theoretical, empirical data are presented in its support when available. The article ends with a discussion of future research directions.

The effect of contingent reinforcement on target variables in outpatient psychotherapy for depression: a successful and unsuccessful case using functional analytic psychotherapy.

The current study investigated a behavior-analytic treatment, functional analytic psychotherapy (FAP), for outpatient depression utilizing two single-subject A/A+B designs. The baseline condition was cognitive behavioral therapy. Results demonstrated treatment success in 1 client after the addition of FAP and treatment failure in the 2nd. This study highlights the challenges in measuring treatment progress and outcome idiographically in this population.