Date of Award


Degree Name

Doctor of Philosophy



First Advisor

Dr. Scott T. Gaynor

Second Advisor

Dr. Galen Alessi

Third Advisor

Dr. Susan Baird

Fourth Advisor

Dr. Amy Damashek


motivational interviewing, behavior therapy, stepped-care approach, adolescent depression


Depression is a significant public health concern with a lifetime prevalence of 24.01 for adolescents in grades 9-12 (Lewinsohn, Hops, Roberts, Seeley, & Andrews, 1993) and a point prevalence of 4-6% (Kessler, Avenevoli, & Ries, 2001). The risks associated with adolescent onset depression include comorbidity, depressive episodes continuing into adulthood, and suicidality. These risks make it imperative to develop effective treatments to address adolescent depression. Stepped care is an approach to treatment which involves treatment of illness using the least invasive measures first and moving toward more invasive treatment as indicated by ongoing assessment. Through a single-participant design, the current study sought to determine the effectiveness of using a stepped care approach in the treatment of adolescents with depression using a motivational interviewing assessment (MIA), fun activities (FA), and values-based behavioral activation (VBBA) phases as treatment steps. Fourteen participants were subjected to varying levels of the independent variable based on cut off scores on the Child Depression Rating Scale-Revised (CDRS-R). That is, those who did not have a clinically robust response following MIA received FA and failure to respond to FA resulted in participants receiving VBBA. Nine participants experienced a clinically significant response during one of the three phases of treatment, while five dropped out of the study. Participants who received behavioral activation experienced increases on activation measures and decreases on depression measures following the behavioral activation steps, which provides support for the behavioral theory of depression.


Fifth Advisor: Dr. Amy Naugle

Access Setting

Dissertation-Open Access