Randomized Controlled Trial

. 2022 Jun:157:110781.

doi: 10.1016/j.jpsychores.2022.110781. Epub 2022 Mar 10.

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

Lauren D Gulley¹, Lauren B Shomaker², Nichole R Kelly³, Kong Y Chen⁴, Cara H Olsen⁵, Marian Tanofsky-Kraff⁶, Jack A Yanovski⁷

Affiliations

¹ Human Development & Family Studies, Colorado State University, Campus Delivery 1570, Fort Collins, CO 80523, USA; Pediatrics, Section of Endocrinology, University of Colorado Anschutz Medical Campus/Children's Hospital Colorado, 13123 E 16th Avenue, B265, Aurora, CO 80045, USA. Electronic address: lauren.gulley@colostate.edu.
² Human Development & Family Studies, Colorado State University, Campus Delivery 1570, Fort Collins, CO 80523, USA; Pediatrics, Section of Endocrinology, University of Colorado Anschutz Medical Campus/Children's Hospital Colorado, 13123 E 16th Avenue, B265, Aurora, CO 80045, USA; Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD 20892, USA.
³ Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD 20892, USA; Counseling Psychology & Human Services and the Prevention Science Institute, College of Education, University of Oregon, 1215 University of Oregon, Eugene, OR 97403, USA.
⁴ Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), NIH, 10 Center Drive, Bethesda, MD 20892, USA.
⁵ Preventative Medicine & Biometrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
⁶ Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD 20892, USA; Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
⁷ Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD 20892, USA.

PMID: 35367918
PMCID: PMC9339242
DOI: 10.1016/j.jpsychores.2022.110781

Randomized Controlled Trial

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

Lauren D Gulley et al. J Psychosom Res. 2022 Jun.

. 2022 Jun:157:110781.

doi: 10.1016/j.jpsychores.2022.110781. Epub 2022 Mar 10.

Authors

Lauren D Gulley¹, Lauren B Shomaker², Nichole R Kelly³, Kong Y Chen⁴, Cara H Olsen⁵, Marian Tanofsky-Kraff⁶, Jack A Yanovski⁷

Affiliations

¹ Human Development & Family Studies, Colorado State University, Campus Delivery 1570, Fort Collins, CO 80523, USA; Pediatrics, Section of Endocrinology, University of Colorado Anschutz Medical Campus/Children's Hospital Colorado, 13123 E 16th Avenue, B265, Aurora, CO 80045, USA. Electronic address: lauren.gulley@colostate.edu.
² Human Development & Family Studies, Colorado State University, Campus Delivery 1570, Fort Collins, CO 80523, USA; Pediatrics, Section of Endocrinology, University of Colorado Anschutz Medical Campus/Children's Hospital Colorado, 13123 E 16th Avenue, B265, Aurora, CO 80045, USA; Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD 20892, USA.
³ Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD 20892, USA; Counseling Psychology & Human Services and the Prevention Science Institute, College of Education, University of Oregon, 1215 University of Oregon, Eugene, OR 97403, USA.
⁴ Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), NIH, 10 Center Drive, Bethesda, MD 20892, USA.
⁵ Preventative Medicine & Biometrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
⁶ Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD 20892, USA; Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
⁷ Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD 20892, USA.

PMID: 35367918
PMCID: PMC9339242
DOI: 10.1016/j.jpsychores.2022.110781

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Adolescent psychotherapy; Depression (emotion); Metabolic syndrome; Obesity; Randomized controlled trials.

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Conflict of interest statement

Competing Interest Statement: All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf. J. A. Yanovski is a Commissioned Officer in the United States Public Health Service (PHS). J.A. Yanovski reports his institution (NIH) has received grants to support clinical trials for which he is Principal Investigator unrelated to this research from Rhythm Pharmaceuticals, Zafgen Inc., and Soleno Therapeutics. No other authors have any financial or personal relationships to declare.

Figures

**Figure 1.**
Path diagrams of the moderated mediation model

See this image and copyright information in PMC

References

1. Marmorstein NR, Iacono WG, Legrand L. Obesity and depression in adolescence and beyond: reciprocal risks. Int J Obes (Lond). 2014;38(7):906–911. - PMC - PubMed
1. Hannon TS, Rofey DL, Lee S, Arslanian SA. Depressive symptoms and metabolic markers of risk for type 2 diabetes in obese adolescents. Pediatric Diabetes. 2013;14(7):497–503. - PMC - PubMed
1. Mannan M, Mamun A, Doi S, Clavarino A. Prospective associations between depression and obesity for adolescent males and females: a systematic review and meta-analysis of longitudinal studies. PLoS One. 2016;11(6):e0157240. - PMC - PubMed
1. Shomaker LB, Tanofsky-Kraff M, Stern EA, et al. Longitudinal study of depressive symptoms and progression of insulin resistance in youth at risk for adult obesity. Diabetes Care. 2011;34(11):2458–2463. - PMC - PubMed
1. Mayer-Davis EJ, Lawrence JM, Dabelea D, et al. Incidence Trends of Type 1 and Type 2 Diabetes among Youths, 2002–2012. N Engl J Med. 2017;376(15):1419–1429. - PMC - PubMed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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Associated data

Grants and funding

LinkOut - more resources

Full Text Sources

Medical