Abstract
Anxiety and depressive disorders are common conditions for adolescents and are associated with significant impairments in functioning. Cognitive behavior therapy (CBT) is an effective treatment modality for these youth, and the behavioral components of CBT protocols, in particular, are thought to be one of the active mechanisms through which positive symptom changes are produced. However, few procedures are available to measure the behavioral changes taking place in adolescents’ daily lives as they make therapeutic progress. This study examined adolescents’ “behavioral engagement” throughout treatment, a construct defined as time spent in social, athletic and academic activities. Behavioral engagement was measured using the Daily Phone Diary (DPD), a validated measure of daily activities utilized in the child health literature, which employs the principles of Ecological Momentary Assessment (EMA). Twenty-four adolescents reported each activity they engaged in throughout the day, in chronological order, over the past 24 hours. Participants were diverse in their ages, ethnicities, socioeconomic statuses and internalizing disorder diagnoses. Activities were reported during phone calls scheduled before, during, and after treatment using a transdiagnostic formulation of CBT and, for a randomized subset of the sample (N=8), both before and following a Waitlist comparison condition. Results indicated that “behavioral engagement” is a construct that is measurable and that daily phone diaries are an acceptable method of data collection for this population. Based on theoretical and empirical literature, three key categories of activities on the DPD comprised behavioral engagement: 1) Time spent socially engaged with others; 2) Time spent on any physical or athletic activity; and 3) Time doing homework. Results supported good inter-rater reliability and potentially reasonable test-retest reliability; data collection via the DPD was feasible and acceptable in this context. Tests of convergent validity with other measures of anxiety and depressive symptoms suggested that prior to treatment, more time spent in some activity categories was associated with more internalizing symptoms for those with anxiety disorders only, but fewer internalizing symptoms for those with depression as well as anxiety. Tests of convergent validity with other measures of weekly mood were promising. Future studies will explore alternate definitions of behavioral engagement, examine this construct in a larger sample that has completed a full course of CBT, and explore this construct’s potential role as a mediator of clinical improvement.