Implementation of Behavioral Activation within a Care Pathway for Adolescent Depression at an Academic Medical Center
This paper describes the implementation of Behavioral Activation (BA) as the core psychotherapy treatment within a broader clinician-led effort to establish a care pathway for adolescent depression in an academic medical center that served public and private hospital systems. This quality improvement effort required a standardized yet flexible approach to psychotherapy to be used by clinicians with a range of experience and training backgrounds while serving diverse clinical populations in child psychiatry and pediatric clinics. This paper highlights implementation of BA in treating adolescent depression across these varying systems. In particular, the paper emphasizes the application of BA as a principle-driven, treatment that enables flexibility across settings while remaining rooted in scientific evidence. The paper also reviews lessons learned from this effort that may support efforts to implement BA in other clinical settings and systems.
Children's resilience and trauma-specific cognitive behavioral therapy: Comparing resilience as an outcome, a trait, and a process
Resilience, which is associated with relatively positive outcomes following negative life experiences, is an important research target in the field of child maltreatment (Luthar et al., 2000). The extant literature contains multiple conceptualizations of resilience, which hinders development in research and clinical utility. Three models emerge from the literature: resilience as an immediate outcome (i.e., behavioral or symptom response), resilience as a trait, and resilience as a dynamic process. The current study compared these models in youth undergoing trauma-specific cognitive behavioral therapy. Results provide the most support for resilience as a process, in which increase in resilience preceded associated decrease in posttraumatic stress and depressive symptoms. There was partial support for resilience conceptualized as an outcome, and minimal support for resilience as a trait. Results of the models are compared and discussed in the context of existing literature and in light of potential clinical implications for maltreated youth seeking treatment.
Dear enemies and nasty neighbors in crayfish: effects of social status and sex on responses to familiar and unfamiliar conspecifics
Our experiment examined the ability of crayfish (Procambarus clarkii) to discriminate between familiar and unfamiliar conspecifics of equivalent social status, and investigated whether this species displays dear enemy or nasty neighbor effects. Pairs of size and sex matched crayfish fought to establish social status and the resulting dominant and subordinate crayfish then participated in a choice phase in which they interacted with two conspecifics tethered in an arena. Both choice conspecifics had the same social status and sex, but one was familiar (the focal animal's previous opponent) and the other was novel. We found that subordinate focal animals of both sexes spent significantly more time in proximity to the unfamiliar choice animal, behavior inconsistent with the dear enemy and nasty neighbor hypotheses. In contrast, male and female dominant focals differed significantly: females spent more time close to and fighting with the familiar choice animal while male dominants responded equivalently to the two choice animals. Thus the response of crayfish toward familiar and unfamiliar conspecifics was complex and not explained by a single hypothesis. We suggest that, in addition to familiarity and unfamiliarity, the perceived threat-level of opponents influences the behavior of crayfish toward conspecifics.