Behavioral activation (BA) has received much attention in recent years. Although traditional BA focused on increasing pleasant activities, modern BA has emphasized the role of cognitive/behavioral avoidance (Kanter et al., 2009). Because avoidance is a central target for treatment of anxiety disorders, recent studies have indicated that BA is effective for both depression and anxiety as a transdiagnostic treatment (Chen et al., 2013; Chu et al., 2016). However, previous works focused only on adults and adolescents, not on children due to lack of measurements. In the current study, we developed the new self-report measures to assess pleasant activities and cognitive/behavioral avoidance in children. In addition, based on the development of the scales, we validated a transdiagnostic behavioral activation model in which pleasant activities affect depression and cognitive/behavioral avoidance affect both depression and anxiety.
In study 1, 129 children aged 9-12 from a public elementary school completed the two measures which were developed in this study: The Children’s Pleasant Activity Scale (CPAS) and the Children’s Avoidance Behavior Scale (CABS), as well as the Positive and Negative Affect Schedule for Children (PANAS-C: Laurent et al., 1999).
In study 2, 138 children aged 9-12 from a public elementary school completed the CPAS, the CABS, the Depression Self-Rating Scale for Children (Birleson, 1981), and the Short Children’s Anxiety Scale (Spence et al., 2014).
In study 1, we developed the CPAS and the CABS. Internal consistency and test-retest reliability of the CPAS and the CABS were acceptable (α = .91, ICC = .52; α = .79, ICC = .52). In addition, the CPAS was positively related to positive affect (r = .69) and the CABS was positively related to negative affect (r = .36). These results indicated that the CPAS and the CABS have adequate reliability and validity.
In study 2, a transdiagnostic behavioral activation model was examined using structural equation modeling. Results indicated that the goodness of fit indices was satisfactory for the hypothetical model (GFI = 1.000, AGFI = .995, CFI = 1.000, RMSEA = .000). Specifically, pleasant activities negatively affected depressive symptom (path coefficient = -.39), whereas avoidance positively affected both depressive and anxiety symptoms (path coefficient = .42, .52).
These findings suggest that both cognitive and behavioral avoidance can be transdiagnostic risk factors for depressive/anxiety symptoms in Japanese children. Although previous studies primary focused on behavioral avoidance in children (Chu et al, 2013: e.g. isolation, withdrawal), results indicated that cognitive avoidance can also affect depression and anxiety in children. Therefore, this study suggests that interventions focusing on cognitive avoidance can improve internalizing problem in Japanese children.
Graduate School of Psychology, Doshisha University
Sakai, Osaka, Japan