Rachel Vaughn-Coaxum, Ph.D.
Fellow In Depression
Tina Goldstein, Ph.D.
Alison Hipwell, Ph.D., Clin.Psy.D.
University of Pittsburgh
Investigating the effects of childhood adversity on the engagement of depression treatment targets
Exposure to childhood adversity (e.g. child abuse, neglect, living in poverty, witnessing violence) is a robust risk factor for youth onset depression and non-response to front-line depression treatments. Although adversity exposure accounts for 30-50% of the risk for youth-onset depression, it is currently unclear why treatments are less effective for these youths. A recent theoretical model grounded in neurobiological research suggests that certain targeted, evidence-based psychotherapies (EBPs), such as Behavioral Analysis (BA), may be optimally matched to the cognitive-behavioral deficits in the context of adversity, and importantly, disruptions in reward are a unique risk for youth depression. BA targets improvement in reward processing through positive reinforcement via engagement in meaningful activities. To test the hypothesis that reward processes are a well-matched treatment mechanism for adversity-exposed youths, it is critical to determine the specificity of BA for improving reward processing, comparing BA to an alternate EBP with a distinct target mechanism is ideal. One such intervention is Problem-Solving Therapy (PST), which targets improvements in cognitive functioning (e.g., executive functions) by training patients in adaptive problem-solving skills and approaches. Executive functions are a well-suited comparator intervention target, as disruptions in these cognitive domains are also linked with adversity exposure and generally targeted by psychotherapy skills — though executive function disruptions are common in but not specific to depression. Elucidating whether depression specific intervention targets (reward processes) and modalities (BA) are well-matched for adversity-exposed youths advances efforts to personalize interventions and enhance outcomes.
We propose a preliminary investigation of the hypothesis that reward processes (improved via BA) are a well-matched treatment mechanism for depression among youths exposed to adversity. We will explore the influence of adversity on change in the target mechanisms in each treatment, and test whether change in reward processing is specific to BA. If BA is a well-matched intervention for these youths, we would expect change in reward processes in the BA condition only, and across levels of adversity exposure. Depressed adolescents (12-15 years of age) with population-distributed lifetime history will be randomized to brief (four session) BA12 (n=20) or PST13 (n=20). Reward sensitivity and responsiveness and executive functions (planning, task switching) will be assessed via validated computerized tasks at baseline and post-intervention to test the change in reward and change in each proposed treatment mechanism.