Cognitive-Behavioral Therapy Versus Usual Clinical Care for Youth Depression: An Initial Test of Transportability to Community Clinics and Clinicians

Department of Psychology, Harvard University and Judge Baker Children's Center, Cambridge, MA 02138, USA.
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 07/2009; 77(3):383-96. DOI: 10.1037/a0013877
Source: PubMed

ABSTRACT Community clinic therapists were randomized to (a) brief training and supervision in cognitive-behavioral therapy (CBT) for youth depression or (b) usual care (UC). The therapists treated 57 youths (56% girls), ages 8-15, of whom 33% were Caucasian, 26% were African American, and 26% were Latino/Latina. Most youths were from low-income families and all had Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) depressive disorders (plus multiple comorbidities). All youths were randomized to CBT or UC and treated until normal termination. Session coding showed more use of CBT by CBT therapists and more psychodynamic and family approaches by UC therapists. At posttreatment, depression symptom measures were at subclinical levels, and 75% of youths had no remaining depressive disorder, but CBT and UC groups did not differ on these outcomes. However, compared with UC, CBT was (a) briefer (24 vs. 39 weeks), (b) superior in parent-rated therapeutic alliance, (c) less likely to require additional services (including all psychotropics combined and depression medication in particular), and (d) less costly. The findings showed advantages for CBT in parent engagement, reduced use of medication and other services, overall cost, and possibly speed of improvement--a hypothesis that warrants testing in future research.

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Available from: Bryce D McLeod, Mar 07, 2014
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    • "They also compare favorably with the findings in Oei & Boschen's (2009) study of group CBT for anxiety disorders , although not as large as those found in previous formal efficacy studies with all the standard controls (e.g., Chambless & Gillis, 1993). Gains in this study were observed on multiple measures, adding to the growing literature of evidence-based treatments (Weisz et al., 2009). Also of note is the finding that age, gender, previous group experience, a history of substance abuse in the record, and comorbid depression did not predict outcome on any measure. "
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    ABSTRACT: The efficacy, and to a lesser extent, effectiveness, of individual cognitive behavioral therapy (CBT) for anxiety disorders has been demonstrated, but whether manualized treatments work in a group format in community settings is less established. We investigated the predictors of retention and outcome in 26 groups (11 Generalized Anxiety Disorder, 11 Panic, 4 Social Phobia groups), conducted for more than 10 years in a semirural community mental health center by 19 therapists. Members of the Anxiety Disorders Treatment Team delivered manualized group CBT treatments. Analysis of standard symptom measures at pre- and post-treatment and archival data revealed significant pre–post decreases in anxiety, retention rates comparable to past findings on group retention, and several significant predictors of retention and outcome. Manualized group CBT for anxiety appears to be a viable treatment in community settings. Limitations of the study as well as related practice–research implications of the findings are discussed.
    Journal of Cognitive Psychotherapy 05/2014; 28(2). DOI:10.1891/0889-8391.28.2.117
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    • "Because PTSD often co-occurs with other disorders, this is an important finding for clinicians. The reduction in depression is particularly interesting to note, as some evidence-based treatments for depression reported in other studies do not outperform treatment as usual (Kerfoot, Harrington, Harrington, Rogers, & Verduyn, 2004; Weisz et al., 2009). Although we did not specifically examine which components may have been particularly beneficial for treatment outcomes in this study, teaching skills with which to regulate emotions and correct maladaptive appraisals appears to be fundamental for many effective interventions (Berliner, 2005). "
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    ABSTRACT: The efficacy of trauma-focused cognitive behavioral therapy (TF-CBT) has been shown in several randomized controlled trials. However, few trials have been conducted in community clinics, few have used therapy as usual (TAU) as a comparison group, and none have been conducted outside of the United States. The objective of this study was to evaluate the effectiveness of TF-CBT in regular community settings compared with TAU. One hundred fifty-six traumatized youth (M age = 15.1 years, range = 10-18; 79.5% girls) were randomly assigned to TF-CBT or TAU. Intent-to-treat analysis using mixed effects models showed that youth receiving TF-CBT reported significantly lower levels of posttraumatic stress symptoms (est. = 5.78, d = 0.51), 95% CI [2.32, 9.23]; depression (est. = 7.00, d = 0.54), 95% CI [2.04, 11.96]; and general mental health symptoms (est. = 2.54, d = 0.45), 95% CI [0.50, 4.58], compared with youth in the TAU group. Youth assigned to TF-CBT showed significantly greater improvements in functional impairment (est. = -1.05, d = -0.55), 95% CI [-1.67, -0.42]. Although the same trend was found for anxiety reduction, this difference was not statistically significant (est. = 4.34, d = 0.30), 95% CI [-1.50, 10.19]. Significantly fewer youths in the TF-CBT condition were diagnosed with posttraumatic stress disorder compared to youths in the TAU condition, χ(2)(1, N = 116) = 4.61, p = .031, Phi = .20). Findings indicate that TF-CBT is effective in treating traumatized youth in community mental health clinics and that the program may also be successfully implemented in countries outside the United States.
    Journal of Clinical Child & Adolescent Psychology 08/2013; 43(3). DOI:10.1080/15374416.2013.822307 · 1.92 Impact Factor
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    • "continue to use therapeutic interventions not found in the EBT ( Weisz et al . , 2009 ) , and the use of such pro - scribed interventions may dilute treatment effects ( Perepletchikova & Kazdin , 2005 ) . As with treatment adherence , we propose that the distillation and matching model can be used to guide the measurement of treatment differentiation in D&I research . Using this approach with treatment for child anxiety "
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    ABSTRACT: Measures of treatment integrity are needed to advance clinical research in general and are viewed as particularly relevant for dissemination and implementation research. Although some efforts to develop such measures are underway, a conceptual and methodological framework will help guide these efforts. The purpose of this article is to demonstrate how frameworks adapted from the psychosocial treatment, therapy process, healthcare, and business literatures can be used to address this gap. We propose that components of treatment integrity (i.e., adherence, differentiation, competence, alliance, client involvement) pulled from the treatment technology and process literatures can be used as quality indicators of treatment implementation and thereby guide quality improvement efforts in practice settings. Further, we discuss how treatment integrity indices can be used in feedback systems that utilize benchmarking to expedite the process of translating evidence-based practices to service settings.
    Clinical Psychology Science and Practice 03/2013; 20(1):14-32. DOI:10.1111/cpsp.12020 · 2.92 Impact Factor
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