“Engage” therapy: Prediction of change of late-life major depression
Open accessAbstract
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 (F 1, 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.
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Initial studies suggest that ENGAGE engages its behavioral targets.
“Initial studies suggest that ENGAGE can be taught to community based therapists, is non-inferior to problem solving therapy171, and engages its behavioral targets172,173.”
From Mechanisms and treatment of late-life depression (2019) · cites this paper as [173]
Psychomotor activation appears to be an important protective factor, predicting subsequent persistence of treatment benefits in late-life depression.
“Despite these patients’ lower treatment response, psychomotor activation appears to be an important protective factor, predicting subsequent persistence of treatment benefits (22).”
From The Role of Exercise in Management of Mental Health Disorders: An Integrative Review (2021) · cites this paper as [22]
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Cites
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975) · Journal of Psychiatric Research · doi:10.1016/0022-3956(75)90026-6 · Cited by 88,282 · see citing works
Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987) · Journal of Chronic Diseases · doi:10.1016/0021-9681(87)90171-8 · Cited by 49,742 · see citing works
Hamilton, M. (1960) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp.23.1.56 · Cited by 32,817 · see citing works
Hirono, N., Mori, E., Ikejiri, Y., Imamura, T., Shimomura, T., Hashimoto, M., Yamashita, H., & Ikeda, M. (1997) · PubMed · Cited by 21,010 · see citing works
Kok, J. S., Berg, I. J., & Scherder, E. J. A. (2013) · Dementia and Geriatric Cognitive Disorders Extra · doi:10.1159/000353441 · Cited by 20,589 · see citing works
Older Adults' Reasons for Using Technology while Aging in Place
Peek, S. T. M., Luijkx, K. G., Rijnaard, M. D., Nieboer, M. E., van der Voort, C. S., Aarts, S., van Hoof, J., Vrijhoef, H. J., & Wouters, E. (2015) · Gerontology · doi:10.1159/000430949 · Cited by 19,803 · see citing works
Sensitivity and False Alarm Rate of a Fall Sensor in Long-Term Fall Detection in the Elderly
Kangas, M., Korpelainen, R., Vikman, I., Nyberg, L., & Jämsä, T. J. (2014) · Gerontology · doi:10.1159/000362720 · Cited by 19,003 · see citing works
Random-Effects Models for Longitudinal Data
Laird, N. M., & Ware, J. H. (1982) · Biometrics · doi:10.2307/2529876 · Cited by 8,923 · see citing works
Alexopoulos, G. S. (2005) · The Lancet · doi:10.1016/s0140-6736(05)66665-2 · Cited by 2,024 · see citing works
Self-citationThe brain reward circuitry in mood disorders
Russo, S. J., & Nestler, E. J. (2013) · Nature Reviews Neuroscience · doi:10.1038/nrn3381 · Cited by 1,870 · see citing works
Update on empirically validated therapies, II: (619622010-001)
Chambless, D. L., Baker, M. J., Baucom, D. H., Beutler, L. E., Calhoun, K. S., Crits-Christoph, P., Daiuto, A., DeRubeis, R., Detweiler, J., Haaga, D. A. F., et al. (1997) · PsycEXTRA Dataset · doi:10.1037/e619622010-001 · Cited by 1,488 · see citing works
Pizzagalli, D. A., Holmes, A. J., Dillon, D. G., Goetz, E. L., Birk, J. L., Bogdan, R., Dougherty, D. D., Iosifescu, D. V., Rauch, S. L., & Fava, M. (2009) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2008.08081201 · Cited by 1,232 · see citing works
(1974) · Cited by 1,195 · see citing works
Behavioral activation treatment for depression: returning to contextual roots
Jacobson, N. S., Martell, C. R., & Dimidjian, S. (2001) · Clinical Psychology: Science and Practice · doi:10.1093/clipsy.8.3.255 · Cited by 1,011 · see citing works
Ekers, D., Webster, L., Van Straten, A., Cuijpers, P., Richards, D., & Gilbody, S. (2014) · PLoS ONE · doi:10.1371/journal.pone.0100100 · Cited by 565 · see citing works
What is behavioral activation?
Kanter, J. W., Manos, R. C., Bowe, W. M., Baruch, D. E., Busch, A. M., & Rusch, L. C. (2010) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.04.001 · Cited by 515 · see citing works
Kanter, J. W., Mulick, P. S., Busch, A. M., Berlin, K. S., & Martell, C. R. (2007) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-006-9038-5 · Cited by 493 · see citing works
Pleasant events, activity schedules, and depressions.
Lewinsohn, P. M., & Libet, J. M. (1972) · Journal of Abnormal Psychology · doi:10.1037/h0033207 · Cited by 365 · see citing works
Behavioural activation for depression
Veale, D. (2008) · Advances in Psychiatric Treatment · doi:10.1192/apt.bp.107.004051 · Cited by 282 · see citing works
The effects of psychotherapy on neural responses to rewards in major depression
Dichter, G. S., Felder, J. N., Petty, C., Bizzell, J., Ernst, M., & Smoski, M. J. (2009) · Biological Psychiatry · doi:10.1016/j.biopsych.2009.06.021 · Cited by 278 · see citing works
Robinson, O. J., Cools, R., Carlisi, C. O., Sahakian, B. J., & Drevets, W. C. (2012) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2011.11010137 · Cited by 232 · see citing works
Neuromodulation of reward‐based learning and decision making in human aging
Eppinger, B., Hämmerer, D., & Li, S. (2011) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.2011.06230.x · Cited by 228 · see citing works
A critical review of assessment strategies to measure the behavioral activation model of depression
Manos, R. C., Kanter, J. W., & Busch, A. M. (2010) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.03.008 · Cited by 214 · see citing works
Dichter, G. S., Felder, J. N., & Smoski, M. J. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.03.022 · Cited by 139 · see citing works
Resting-State Connectivity Predictors of Response to Psychotherapy in Major Depressive Disorder
Crowther, A., Smoski, M. J., Minkel, J. D., Moore, T. M., Gibbs, D. E., Petty, C., Bizzell, J., Schiller, C. E., Sideris, J. H., Carl, H., et al. (2015) · Neuropsychopharmacology · doi:10.1038/npp.2015.12 · Cited by 137 · see citing works
Kanter, J. W., Rusch, L. C., Busch, A. M., & Sedivy, S. K. (2008) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-008-9088-y · Cited by 114 · see citing works
Kunisato, Y., Okamoto, Y., Ueda, K., Onoda, K., Okada, G., Yoshimura, S., Suzuki, S.-I., Samejima, K., & Yamawaki, S. (2012) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2012.05.007 · Cited by 113 · see citing works
Takahashi, T., Oono, H., Inoue, T., Boku, S., Kako, Y., Kitaichi, Y., Kusumi, I., Masui, T., Nakagawa, S., Suzuki, K., et al. (2011) · PubMed · doi:10.48550/arxiv.1111.6493 · Cited by 99 · see citing works
A model for streamlining psychotherapy in the RDoC era: the example of ‘Engage’
Alexopoulos, G. S., & Arean, P. (2014) · Molecular Psychiatry · doi:10.1038/mp.2013.150 · Cited by 95 · see citing works
Self-citation“Engage” Therapy: Behavioral Activation and Improvement of Late-Life Major Depression
Alexopoulos, G. S., Raue, P. J., Gunning, F., Kiosses, D. N., Kanellopoulos, D., Pollari, C., Banerjee, S., & Arean, P. A. (2016) · The American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2015.11.006 · Cited by 84 · see citing works
Self-citationThe effects of behavioral activation therapy with inpatient geriatric psychiatry patients.
Snarski, M., Scogin, F., Dinapoli, E. A., Presnell, A., Mcalpine, J., & Marcinak, J. (2011) · The Behavior Therapist · doi:10.1016/j.beth.2010.05.001 · Cited by 70 · see citing works
Fuhr, K., Hautzinger, M., Krisch, K., Berking, M., & Ebert, D. D. (2016) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2016.02.004 · Cited by 54 · see citing works
Comparing Engage with PST in Late-Life Major Depression: A Preliminary Report
Alexopoulos, G. S., Raue, P. J., Kiosses, D. N., Seirup, J. K., Banerjee, S., & Arean, P. A. (2015) · The American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2014.06.008 · Cited by 51 · see citing works
Self-citationA self-help behavioral activation treatment for geriatric depressive symptoms
Moss, K., Scogin, F., Di Napoli, E., & Presnell, A. (2012) · Aging & Mental Health · doi:10.1080/13607863.2011.651435 · Cited by 51 · see citing works
Raes, F., Hoes, D., Gucht, D. V., Kanter, J. W., & Hermans, D. (2010) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2010.02.001 · Cited by 43 · see citing works
Teismann, T., Ertle, A., Furka, N., Willutzki, U., & Hoyer, J. (2015) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.1948 · Cited by 38 · see citing works
Crabb, R. M., Areán, P., & Hegel, M. T. (2012) · Depression Research and Treatment · doi:10.1155/2012/986547 · Cited by 8 · see citing works
Flagged first, then by citations
Research works printed but not linked: 4
- England MJ Butler AS 2015 Psychosocial Interventions for Mental and Substance Use Disorders Washington, DC National Academies Press 26203478
- Epping-Jordan JA Ustun TB 2000 The WHODAS-II: leveling the playing field for all disorders WHO Mental Health Bulletin 6 5 6
- First MB Spitzer RL Williams JBW Gibbon M 1995 Structured clinical interview for DSM-IV - patient version (SCID-P) Washington American Psychiatric Press
- NIMH 2011 Positive Valence Systems: Workshop Proceedings Retrieved from http://www.nimh.nih.gov/research-priorities/rdoc/positive-valence-systems-workshop-proceedings.shtml
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Smith, P. J., & Merwin, R. M. (2021) · Annual Review of Medicine · doi:10.1146/annurev-med-060619-022943 · Cited by 360 · see citing works
Steffens, D. C., Fahed, M., Manning, K. J., & Wang, L. (2022) · Translational Psychiatry · doi:10.1038/s41398-022-02292-3 · Cited by 114 · see citing works
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Solomonov, N., Victoria, L. W., Dunlop, K., Respino, M., Hoptman, M. J., Zilcha‐Mano, S., Oberlin, L. E., Liston, C. M., Areán, P. A., Gunning, F. M., et al. (2020) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2020.04.008 · Cited by 34 · see citing works
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Shulman, R. W., Arora, R., Geist, R., Ali, A. A. A., Ma, J., Mansfield, E. D., Martel, S. L., Sandercock, J., & Versloot, J. (2021) · Canadian Geriatrics Journal · doi:10.5770/cgj.24.473 · Cited by 11 · see citing works
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Wijeratne, C. (2019) · Cambridge University Press eBooks · doi:10.1017/9781108593946.011
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- Authors
- Alexopoulos, G. S., O’Neil, R., Banerjee, S., Raue, P. J., Victoria, L. W., Bress, J. N., Pollari, C., & Arean, P. A.
- Affiliations
- Cornell University (US)
- Weill Cornell Medicine (US)
- University of Washington (US)
- Corresponding author
- Alexopoulos, George S.
- ORCID
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2017-10
- Volume
- 221
- Pages
- 192-197
- ISSN
- 0165-0327 (ISSN-L)
- PMC
- PMC5564217
- OpenAlex
- W2720071953
- Cited by
- 25
- References
- 38
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 4 · 2023: 1 · 2022: 3 · 2021: 4 · 2020: 4 · 2019: 5 · 2018: 2
- FWCI
- 3.92
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (P30MH085943, R01MH064099, R01MH075900, K24MH074717, R01MH102252, T32MH019132)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- geriatric depression, major depressive disorder, behavioral activation, reward system dysfunction, older adults, psychotherapy outcome prediction
- MeSH terms
- Aged, Behavior Therapy, Depressive Disorder, Major, Major Depressive Disorder, Female, Follow-Up Studies, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Reward, Treatment Outcome
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