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Background: Understanding the risk factors associated with Internet gaming disorder (IGD) is important to predict and diagnose the condition. The purpose of this study is to identify risk factors that predict IGD based on psychological factors and Internet gaming characteristics; Methods: Online surveys were conducted between 26 November and 26 December 2014. There were 3568 Korean Internet game users among a total of 5003 respondents. We identified 481 IGD gamers and 3087 normal Internet gamers, based on Diagnostic and Statistical Manual for Mental Disorders (DSM-5) criteria. Logistic regression analysis was applied to identify significant risk factors for IGD; Results: The following eight risk factors were found to be significantly associated with IGD: functional and dysfunctional impulsivity (odds ratio: 1.138), belief self-control (1.034), anxiety (1.086), pursuit of desired appetitive goals (1.105), money spent on gaming (1.005), weekday game time (1.081), offline community meeting attendance (2.060), and game community membership (1.393; p < 0.05 for all eight risk factors); Conclusions: These risk factors allow for the prediction and diagnosis of IGD. In the future, these risk factors could also be used to inform clinical services for IGD diagnosis and treatment.

As digital interventions gain prominence in mental health care, they present opportunities to improve access and scalability. Despite their potential, the overall impact of digital behavioral activation (BA) interventions across different formats and populations is not yet fully understood. This systematic review examines the characteristics and functions of digital BA interventions and evaluates their effectiveness for mental health and other patient-related outcomes. A comprehensive search of databases (PubMed, Embase, Web of Science, APA PsycInfo, and ClinicalTrials.gov) was performed in November 2023 to identify randomized controlled trials (RCTs) assessing the effectiveness of digital BA interventions for depression and anxiety. A total of 2 reviewers screened the studies for inclusion. Meta-analysis using a random-effects model assessed intervention impact on outcomes including depression, anxiety, quality of life (QoL), BA scores, functioning and disability, and stress. Statistical heterogeneity was evaluated with the I² statistic and statistical significance was evaluated with P values. Studies that did not meet the meta-analysis criteria underwent narrative synthesis. A total of 18 articles reporting 17 RCTs were included across three intervention types: (1) internet-based BA (n=12, 71%), delivering digital therapies to foster new behavioral activities for depression management; (2) electronic messaging-based BA (n=2, 12%), involving prompts to support behavior change; and (3) telehealth-based BA (n=3, 17%), providing remote health care services. We identified single-component and multicomponent interventions that combined BA with elements such as problem-solving therapy or cognitive behavioral therapy. A total of 12 RCTs were included in the meta-analysis, while the remaining studies were narratively synthesized. Risk of bias (RoB) was assessed in all included studies. Digital BA interventions significantly reduced depressive symptoms at 2 months (P<.001, I²=0%), 3 months (P=.001, I²=51%), and 6 months (P=.009, I²=29%) post treatment, but not at 12 months (P=.82, I²=89%). Significant improvements in BA scores at 6 months were observed (P<.001, I²=0%). QoL improved significantly at 3 months (P=.002, I²=22%) and 6 months (P=.009, I²=0%). Stress levels were also significantly reduced at 3 months (P<.001, I²=25%). However, no significant changes were identified in anxiety and functioning and disability outcomes at either 3 months (anxiety: P=.08, I²=68%) or 6 months (anxiety: P=.24, I²=44%; functioning and disability: P=.88, I²=90%). Across included studies, RoB was generally low, particularly for random sequence generation and allocation concealment. Digital BA interventions are effective in reducing depressive symptoms and improving QoL in the short- to midterm. However, these effects tend to diminish over time with no sustained benefits observed at 12 months. Future research should focus on developing and testing interventions with greater long-term efficacy, clarifying the role of BA within multicomponent digital approaches, and identifying the optimal intervention \"dose\" needed to maintain lasting effects.

Background Perinatal women with identified depression in prenatal care settings have low rates of engagement and adherence with depression‐specific psychotherapy. We report the feasibility and symptom outcomes of Cognitive Behavioral Therapy (CBT) modified (mCBT) to address the needs of perinatal, low‐income women with Major Depressive Disorder (MDD). Methods Pregnant women (n = 1421) were screened for depressive symptoms in obstetrics clinics in conjunction with prenatal care visits. A total of 59 women met diagnostic criteria for MDD; 55 women were randomly assigned to mCBT or Treatment as Usual (TAU). The mCBT intervention included an initial engagement session, outreach, specific perinatal content and interpersonal components. Measures were gathered at pre‐treatment, 16 week post‐randomization, and 3‐month follow‐up. Results Most participants attended at least one CBT session and met study criteria for treatment adherence. Active research staff outreach promoted engagement and retention in the trial. Treatment satisfaction was rated as very good. In both observed and multiple imputation results, women who received mCBT demonstrated greater improvement in depressed mood than those in TAU at 16‐week post‐randomization and 3‐month follow‐up, Cohen's d = –0.71 (95% CI –4.93, –5.70). Conclusions Modified CBT offers promise as a feasible and acceptable treatment for perinatal women with low‐incomes in prenatal care settings. Targeted delivery and content modifications are needed to engage populations tailored to setting and psychosocial challenges specific to the perinatal period.

In this study, the Adolescent Behavioral Activation Program (A-BAP) based on behavioral activation (BA) therapy to reduce depressive symptoms in adolescents was adapted to Turkish culture, and its effectiveness was tested with intervention design, one of the mixed method designs. In this direction, experimental and control groups were formed with 20 students studying in three different high schools in Turkey and with highly elevated depressive symptoms. The study group was determined by nested sampling from mixed-method sampling strategies. The starting point of this study is the absence of any BA-based practice to reduce adolescent depression in Turkey. In this direction, experimental and control groups were formed with 20 students studying in three different high schools in Turkey and with highly elevated depressive symptoms. The adapted A-BAP was applied individually to the students in the experimental group for 12 weeks. Three sessions were also held with the parents of the students in the experimental group. In the quantitative phase of the study, pre-test and post-test control groups paired patterns from semi-experimental designs, and a case study was used in the qualitative stage. The qualitative data of the study were collected from adolescents and their parents through semi-structured interviews and session evaluation forms. It was determined that the adapted BA-based A-BAP was an effective intervention in reducing depressive symptoms in the Turkish adolescent sample and provided a significant decrease in the depression scores of the participants in the experimental group . The qualitative findings show that adolescents perceive the A-BAP process as a factor contributing to making them feel better. Adolescents have reported that A-BAP is effective in reducing avoidance behavior, achieving anger control, and increasing self-esteem and social interaction. Parents consider A-BAP as a developer, educator, and practice that reduces depressive symptoms in their children. In addition, it was determined that the qualitative findings obtained supported the quantitative results. Since the study is the first application of BA therapy in Turkey, it is thought that it will contribute to new studies in Turkey and intercultural studies at the international level.

Background: Depression among those who have experienced childhood abuse is associated with earlier onset, more persistent and severe symptoms, more frequent relapse, and poorer treatment outcomes across a variety of psychiatric disorders. In addition, individuals with a history of childhood abuse are more likely to develop post-traumatic stress disorder (PTSD) co-occurring with depression. Objective: This study evaluated whether severity of depression moderated the outcome in a PTSD treatment for childhood abuse survivors. Specifically, we assessed whether individuals with significant depression obtained better outcomes when provided with a two-module treatment which included a skills training component with behavioral activation interventions, Skills Training in Affective and Interpersonal Regulation (STAIR) followed by a trauma-focused component, Narrative Therapy, as compared to two control conditions where one component (STAIR or Narrative Therapy) was replaced with Supportive Counseling. Method: Participants were 104 women with PTSD related to childhood abuse. Participants were randomized into three conditions: (1) STAIR plus Narrative Therapy (SNT), (2) STAIR plus Supportive Counseling (SSC), and (3) Supportive Counseling plus Narrative Therapy (SCNT). Clinician-Administered PTSD Scale for DSM-IV (CAPS-IV) PTSD symptom severity was assessed at pre-treatment, post-treatment, and 3 and 6 month follow-up. Results: Participants with severe depression showed superior PTSD symptom reduction following SNT, while those in the other two conditions experienced a loss of improvement after treatment ended. A similar finding was obtained among those with moderate depression, while among those with low levels of depression, outcomes did not differ across the three treatment conditions. Conclusions: Childhood abuse survivors with severe depression obtained superior outcomes in a treatment that combined skills training with trauma-focused work. Skills packages which contain behavioral activation interventions in combination with trauma-focused work may be particularly beneficial for patients with childhood abuse and severe depression.

Depression is a prevalent and impairing condition. Behavioral activation (BA) is a parsimonious, cost-effective, and easily disseminated psychological intervention for depression. The current meta-analysis expands on the existing literature supporting the efficacy of BA for depression by examining the effects of BA on additional relevant outcomes for patients with depression, namely the reduction in anxiety symptoms and increase in activation. Randomized controlled trials of BA for depression compared to active and inactive control were identified via a systematic review. Effect sizes using Hedges's g were calculated for each outcome compared to both active and inactive control using random effects models. Subgroup analyses were used to examine the inclusion of a discussion of values as a moderator of depression symptom outcome in BA. Twenty-eight studies were included. Meta-analyses of symptom change between groups from baseline-to-post intervention indicated that BA outperformed inactive control conditions for improvements in depression (g = 0.83), anxiety (g = 0.37), and activation (g = 0.64). The difference between BA and active control conditions was not significant for improvements in depression (g = 0.15), anxiety (g = 0.03), and activation (g = 0.04). There was no evidence for a discussion of values augmenting BA efficacy. Study quality was generally low, and there was evidence of publication bias. In addition to improving depression, BA shows efficacy for reducing symptoms of anxiety and increasing activation. BA may not offer better outcomes relative to other active interventions. There is room for improvement in the quality of research in this area.

Introduction The present study explored the role of resting state and personality component (BIS/BAS measure) on prefrontal cortical responsiveness to emotional cues. Indeed, we supposed that lateralized resting activity (right vs. left) and approach (BAS) versus avoidance (BIS) attitude may explain the successive emotional processing within the prefrontal cortex (PFC) based on the stimulus valence (positive and negative emotional cues). Methods Hemodynamic (functional near‐infrared spectroscopy, fNIRS) and electroencephalographic (EEG) measures were considered. The resting and experimental brain activity were registered when subjects (N = 21) viewed emotional positive versus negative stimuli (International Affective Picture System, IAPS). LIReeg and LIRnirs (lateralized Index Response) during resting state, and LIeeg and LInirs during emotional processing were acquired. Results A set of regression analyses was applied to the multiple measures. The predictive effect of resting activity and approach/avoidance dichotomy were elucidated. Indeed, more left/right resting activity (for both LIReeg and LIRnirs) predicted the successive more brain left/right response (LIeeg and LInirs) to emotional cues. Second, significant effects were revealed as a function of valence (increased right response to negative stimuli; increased left response to positive stimuli) during emotion processing. Third, higher BAS values explained an increased left cortical activity in resting state and in experimental condition for positive cues. In contrast, higher BIS values marked an increased right activity in resting state and in experimental condition in response to negative cues. Conclusion The significance of trait component for both resting and emotional cue processing was discussed at light of the present results. The present study explored the role of resting state and personality component (BIS/BAS measure) on prefrontal cortical responsiveness to emotional cues.

Behavioral activation is an effective treatment for reducing depression. As depressive disorders affect many people worldwide, internet-based behavioral activation (iBA) could provide enhanced treatment access. This study aimed to investigate whether iBA is effective in reducing depressive symptoms and to assess the impact on secondary outcomes. We systematically searched MEDLINE, PsycINFO, PSYNDEX, and CENTRAL up to December 2021 for eligible randomized controlled trials. In addition, a reference search was conducted. Title and abstract screening, as well as a full-text screening, was conducted by 2 independent reviewers. Randomized controlled trials that investigated the effectiveness of iBA for depression as a treatment or main component were included. Randomized controlled trials had to report depressive symptoms, with a quantitative outcome measure and assess an adult population with depressive symptoms above cutoff. Two independent reviewers performed the data extraction and risk of bias assessment. Data were pooled in random-effects meta-analyses. The primary outcome was self-reported depressive symptoms posttreatment. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. A total of 12 randomized controlled trials, with 3274 participants (88% female, 43.61 years) were included. iBA was more effective in reducing depressive symptom severity posttreatment than inactive control groups (standardized mean difference -0.49; 95% CI -0.63 to -0.34; P<.001). The overall level of heterogeneity was moderate to substantial (I =53%). No significant effect of iBA on depressive symptoms could be found at 6-month follow-up. Participants assigned to iBA also experienced a significant reduction of anxiety and a significant increase in quality of life and activation compared to the inactive control groups. The results remained robust in multiple sensitivity analyses. The risk of bias assessment revealed at least some concerns for all studies, and there was evidence of slight publication bias. This systematic review and meta-analysis implies that iBA is effective in reducing depressive symptoms. It represents a promising treatment option, providing treatment access where no treatment is available yet. International Prospective Register of Systematic Reviews CRD42021236822; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=236822.

Autistic youth are more likely to experience depression than their non-autistic peers, yet research on risk and protective factors to depression in this population is limited. Behavioral activation (i.e., prioritizing and engaging in meaningful activities), including social activities, is an important mechanism in the pathway to depression in non-autistic youth that is understudied in autism. Ratings of youth depressive symptoms and behavioral and social activation at one timepoint from 100 autistic youth without intellectual disability and 100 of their caregivers were analyzed. The study aims were to examine caregiver and youth ratings of youth internalizing symptoms and behavioral and social activation, inter-rater reliability on study variables, and associations between depressive symptoms and behavioral and social activation in autistic youth by rater. Results revealed significant differences in youth and caregiver ratings on all variables and inter-rater reliability ranged from poor to moderate. Across both raters, more severe anxiety symptoms and lower behavioral activation were associated with more severe depressive symptoms; social activation, specifically the number of friends youth have, was significant in caregiver ratings only. Findings can be leveraged to enhance risk stratification and intervention efforts for autistic youth experiencing depression.

Behavioral activation (BA) is rooted in the behavioral theory of depression, which states that increased exposure to meaningful, rewarding activities is a critical factor in the treatment of depression. Assessing constructs relevant to BA currently requires the administration of standardized instruments, such as the Behavioral Activation for Depression Scale (BADS), which places a burden on patients and providers, among other potential limitations. Previous work has shown that depressed and nondepressed individuals may use language differently and that automated tools can detect these differences. The increasing use of online, chat-based mental health counseling presents an unparalleled resource for automated longitudinal linguistic analysis of patients with depression, with the potential to illuminate the role of reward exposure in recovery. This work investigated how linguistic indicators of planning and participation in enjoyable activities identified in online, text-based counseling sessions relate to depression symptomatology over time. Using distributional semantics methods applied to a large corpus of text-based online therapy sessions, we devised a set of novel BA-related categories for the Linguistic Inquiry and Word Count (LIWC) software package. We then analyzed the language used by 10,000 patients in online therapy chat logs for indicators of activation and other depression-related markers using LIWC. Despite their conceptual and operational differences, both previously established LIWC markers of depression and our novel linguistic indicators of activation were strongly associated with depression scores (Patient Health Questionnaire [PHQ]-9) and longitudinal patient trajectories. Emotional tone; pronoun rates; words related to sadness, health, and biology; and BA-related LIWC categories appear to be complementary, explaining more of the variance in the PHQ score together than they do independently. This study enables further work in automated diagnosis and assessment of depression, the refinement of BA psychotherapeutic strategies, and the development of predictive models for decision support.