Acceptance and Commitment Therapy Focused on Repetitive Negative Thinking for Child Depression: A Randomized Multiple-Ba
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ORIGINAL ARTICLE
Acceptance and Commitment Therapy Focused on Repetitive Negative Thinking for Child Depression: A Randomized Multiple-Baseline Evaluation Daniela M. Salazar 1 & Francisco J. Ruiz 1
&
Eduar S. Ramírez 1 & Verónica Cardona-Betancourt 2
# Association for Behavior Analysis International 2020
Abstract The current study analyzes the efficacy of acceptance and commitment therapy (ACT) focused on repetitive negative thinking (RNT) for child depression. A randomized, nonconcurrent, multiple-baseline design was conducted with nine children, aged between 8 and 13 years, who showed a main diagnosis of child depression. Measures of psychological inflexibility, RNT, and generalized pliance were administered on a weekly basis throughout the study, whereas measures of emotional symptoms and parents’ report of problematic behavior were applied at pretreatment, posttreatment, and the 4-week follow-up. All participants showed evidence of a treatment effect for psychological inflexibility and RNT. The standardized mean difference effect sizes for single-case experimental designs were very large for these measures. No participant showed the diagnosis of child depression or comorbid disorders at the 4-week follow-up. Pretreatment to follow-up changes in emotional symptoms and problematic behavior reported by parents were statistically significant, with large effect sizes. RNT-focused ACT interventions for child depression deserve further empirical tests. Keywords Child depression . Acceptance and commitment therapy . Relational frame theory . Repetitive negative thinking
Recent estimations show that approximately 1–3% of children suffer from depression (e.g., Costello, Erkanli, & Angold, 2006; Egger & Angold, 2006; Ford, Goodman, & Meltzer, 2003), with few gender differences. These rates of depression contrast significantly with those found in adolescents and adults, where females show higher rates of depression, and the prevalence is about 5–10% in most studies (e.g., Avenevoli, Swendsen, He, Burstein, & Merikangas, 2015; Kessler & Bromet, 2013; Kessler et al., 2003; Merikangas et al., 2010; Thapar, Collishaw, Pine, & Thapar, 2012). In spite of its lower prevalence, child depression is an important concern because of its high comorbidity with other emotional and
* Francisco J. Ruiz [email protected] 1
Fundación Universitaria Konrad Lorenz, Carrera 9 bis, N°62-43, Bogotá, Cundinamarca, Colombia
2
Universitat Oberta de Catalunya, Barcelona, Spain
behavioral disorders (Maughan, Collishaw, & Stringaris, 2013) and its persistence. For instance, one-third of the children identified with clinically significant levels of depressive symptoms remained symptomatic in a 2-year longitudinal study (DuBois, Felner, Bartels, & Silverman, 1995). In addition, child depression has been associated with important negative consequences such as low academic performance (DuBois et al., 1995), disrupted parent-child attachment (Brumariu & Kerns, 2010), poor physical health (Fekkes, Pijpers, Fredriks, Vogels, & Ver
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