Examining cognitive-behavioral therapy change mechanisms for decreasing depression, weight, and insulin resistance in adolescent girls at risk for type 2 diabetes

• Published in: Journal of psychosomatic research Vol. 157; p. 110781
• Main Authors: Gulley, Lauren D., Shomaker, Lauren B., Kelly, Nichole R., Chen, Kong Y., Olsen, Cara H., Tanofsky-Kraff, Marian, Yanovski, Jack A.
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.06.2022; Elsevier Science Ltd
• Subjects: Activation; Adolescent; Adolescent girls; Adolescent psychotherapy; At risk populations; Behavior change; Behavior modification; Body fat; Body mass index; Body weight; Body weight gain; Clinical trials; Cognitive ability; Cognitive Behavioral Therapy; Cognitive restructuring; Cognitive therapy; Cognitive-behavioral factors; Depression (emotion); Depression - complications; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - prevention & control; Dual energy X-ray absorptiometry; Female; Girls; Glucose; Glucose tolerance; Health education; Humans; Indirect effects; Insulin; Insulin Resistance; Insulins; Intervention; Mental depression; Metabolic syndrome; Obesity; Overweight; Physical activity; Randomized controlled trials; Resistance; Symptoms; Tolerance; Type 2 diabetes mellitus; Weight gain; Obesity; Depression (emotion); Metabolic syndrome; Adolescent psychotherapy; Randomized controlled trials
• ISSN: 0022-3999; 1879-1360
• DOI: 10.1016/j.jpsychores.2022.110781

Depression in adolescence is linked to risk for type 2 diabetes (T2D). In this secondary data analysis of a randomized controlled trial comparing cognitive-behavioral therapy (CBT) to a control program to ameliorate insulin resistance via reducing depression symptoms, we examine which CBT change mechanisms (e.g., behavioral activation, cognitive restructuring) contributed to decreased depression and subsequent improvements in body mass index (BMI), percent body fat, and insulin resistance. Girls 12-17y with overweight/obesity and family history of T2D were randomized to six-week group CBT (n = 61) or health education (HealthEd; n = 58). At baseline and post-treatment, adolescents completed questionnaires assessing activities, thoughts, and depression symptoms. At baseline, post-treatment, and one-year, BMI was calculated and insulin outcomes were derived from two-hour oral glucose tolerance testing. At baseline and one-year, percent body fat was assessed with dual-energy x-ray absorptiometry. Indirect effects of CBT components were tested on one-year changes in BMI, percent body fat, and insulin indices through decreases in depression symptoms during treatment. Intervention was tested as a moderator. In CBT, but not HealthEd, there was an indirect effect of increased physical activity during treatment on decreased one-year BMI via reductions in depression symptoms during treatment. Also, there were conditional indirect effects in CBT of increased pleasantness of physical and social activity during treatment on decreased one-year BMI via decreased depression symptoms during treatment. Behavioral activation may be a useful intervention to decrease depression and reduce excess weight gain in the targeted prevention of T2D in at-risk adolescent girls. NCT01425905, clinicaltrials.gov •Increased physical activity related to decreased depression in overweight girls.•Increased pleasantness of activities correlated with decreased depression.•Decreased depression correlated with decreased body mass index, one year later.•Pleasant activities may help decrease depression and prevent excess weight gain.