“Engage” Therapy: Behavioral Activation and Improvement of Late-Life Major Depression
Open accessAbstract
Objective Engage is a treatment for late-life depression developed to match the skills of community clinicians based on the theory that dysfunction in the Research Domain Criteria Project positive valence systems is a critical mechanism of late-life depression. Accordingly, it uses "reward exposure" (engagement in meaningful, rewarding activities) as its principal intervention. This study tests the hypothesis that change in behavioral activation, an index of positive valence systems function, during successive treatment periods with Engage and during follow-up predicts depression at the end of each period.Methods Forty-eight nondemented, older adults with unipolar major depression were treated openly with 9 weekly sessions of Engage and assessed 36 weeks after entry. Depression severity was assessed with the 24-item Hamilton Depression Rating Scale (HAM-D) and behavioral activation with the Behavioral Activation for Depression Scale (BADS) at baseline, 6 weeks (mid-treatment), 9 weeks (end of treatment), and 36 weeks.Results A mixed-effects model examined whether change in BADS in successive periods occurring during Engage treatment and during follow-up predicts depression at the end of each period. Both BADS change (F1,52 = 18.63, p < 0.0001) and time (F2,52 = 7.68, p = 0.0012) predicted HAM-D scores at the end of each observation period. Every point of increase in BADS change reduced the HAM-D by 0.105 points. HAM-D at each point did not predict subsequent change in BADS (F1,52 = 2.17, p = 0.146).Conclusion During Engage treatment and follow-up, change in behavioral activation is followed by improvement of depressive symptoms and signs.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
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 [172]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
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
Toward the future of psychiatric diagnosis: the seven pillars of RDoC
Cuthbert, B. N., & Insel, T. R. (2013) · BMC Medicine · doi:10.1186/1741-7015-11-126 · Cited by 3,053 · see citing works
The 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
The stroop color and word test
Scarpina, F., & Tagini, S. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.00557 · Cited by 1,661 · 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
Behavioral activation treatments of depression: a meta-analysis.
Cuijpers, P., van Straten, A., & Warmerdam, L. (2007) · Clinical Psychology Review · doi:10.1016/j.cpr.2006.11.001 · Cited by 1,144 · see citing works
The Origins and Current Status of Behavioral Activation Treatments for Depression
Dimidjian, S., Barrera, M., Martell, C., Muñoz, R. F., & Lewinsohn, P. M. (2011) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-032210-104535 · Cited by 785 · cited 1× · see citing works
““Reward exposure” is informed by Behavioral Activation Therapy (BAT)(9), a treatment with strong evidence of efficacy in depressed younger adults.”
BackgroundYamada, M., Mitsuno, S., Kato, S., & Hirano, H. (1997) · PubMed · Cited by 683 · 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
(2007) · Encyclopedia of Measurement and Statistics · doi:10.4135/9781412952644.n441 · Cited by 416 · see citing works
Hopkins Verbal Learning Test--Revised
Benedict, R. H. B., Schretlen, D. J., Groninger, L. D., & Brandt, J. (1991) · PsycTESTS Dataset · doi:10.1037/t10851-000 · Cited by 375 · 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
Dombrovski, A. Y., Siegle, G. J., Szántó, K., Clark, L., Reynolds, C. F., & Aizenstein, H. J. (2011) · Psychological Medicine · doi:10.1017/s0033291711002133 · Cited by 206 · see citing works
Behavioral Activation Is an Evidence-Based Treatment for Depression
Sturmey, P. (2009) · Behavior Modification · doi:10.1177/0145445509350094 · Cited by 164 · 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
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-citationBehavioural activation for depression: Efficacy, effectiveness and dissemination
Soucy Chartier, I., & Provencher, M. D. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.07.023 · Cited by 90 · cited 1× · see citing works
“(10-12) In addition to encouraging patients to re-engage in rewarding activities, Engage incorporates simplified strategies for ease of training community-based clinicians of varying educational levels and older adults of varying backgrounds and cognitive function.”
BackgroundComparing 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-citationRaes, 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
Flagged first, then by citations
Research works printed but not linked: 3
- [14]NIMH Positive Valence Systems 2011 Workshop Proceedings Rockville, Maryland
- [15]First MB Spitzer RL Williams JBW Gibbon M Structured clinical interview for DSM-IV - patient version (SCID-P) 1995 American Psychiatric Press Washington
- [23]Epping-Jordan JA Ustun TB The WHODAS-II: leveling the playing field for all disorders WHO Mental Health Bulletin 2000 6 5 6
Cited by
Sorted by citations
Mechanisms and treatment of late-life depression
Alexopoulos, G. S. (2019) · Translational Psychiatry · doi:10.1038/s41398-019-0514-6 · Cited by 592 · see citing works
Self-citation“Engage” therapy: Prediction of change of late-life major depression
Alexopoulos, G. S., O’Neil, R., Banerjee, S., Raue, P. J., Victoria, L. W., Bress, J. N., Pollari, C., & Arean, P. A. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.06.037 · Cited by 25 · see citing works
Self-citationMechanisms and treatment of late-life depression
Alexopoulos, G. S. (2021) · Focus · doi:10.1176/appi.focus.19304 · Cited by 22 · see citing works
Self-citation
- Authors
- Alexopoulos, G. S., Raue, P. J., Gunning, F., Kiosses, D. N., Kanellopoulos, D., Pollari, C., Banerjee, S., & Arean, P. A.
- Affiliations
- Cornell University (US)
- Corresponding author
- Alexopoulos, George S.
- ORCID
- Venue
- The American Journal of Geriatric Psychiatry
- Publisher
- Elsevier BV
- Published
- 2016-04
- Volume
- 24
- Issue
- 4
- Pages
- 320-326
- ISSN
- 1064-7481 (ISSN-L)
- PMC
- PMC4818673
- OpenAlex
- W2207811989
- Cited by
- 84
- References
- 33
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 8 · 2023: 7 · 2022: 7 · 2021: 13 · 2020: 15 · 2019: 9 · 2018: 5 · 2017: 4 · 2016: 2
- FWCI
- 2.65
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- NIMH (P30 MH085943, R01 MH064099, K24 MH074717, R01 MH075900)
- Sanchez Foundation
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- behavioral activation, geriatric depression, positive valence systems, Research Domain Criteria, meaningful activities, treatment response prediction, Hamilton Depression Rating Scale
- MeSH terms
- Aged, Aged, 80 and over, Behavior Therapy, Depressive Disorder, Major, Major Depressive Disorder, Female, Follow-Up Studies, Humans, Male, Reward, Outcome Assessment, Health Care
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
