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The Adolescent Coping With Depression Course: A Cognitive-Behavioral Approach to the Treatment of Adolescent Depression.
Abstract
The goal of this chapter is to describe the authors' program of research evaluating a cognitive-behavioral group treatment approach for adolescent depression. Since 1982, their group has been involved in a major research effort to develop and test the efficacy and effectiveness of the Adolescent Coping With Depression Course (CWD-A). They begin the chapter by briefly reviewing psychosocial treatments for adolescent depression. Next, they review the rationale and theoretical background for their treatment approach, describe the CWD-A course and its companion course for the parents of depressed adolescents, and summarize results from two randomized clinical trials with 24-month follow-up. A clinical vignette is provided to illustrate the changes that have occurred with this intervention. To better understand the mechanisms of therapeutic change in depressed adolescents, they next address several issues related to treatment response. The authors conclude by describing more recent research with the CWD-A intervention and future directions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Studies have shown that the CWD-A is effective (Clarke, Rohde, Lewinsohn, Hops, & Seeley, 1999;Rohde, Lewinsohn, Clarke, Hops, & Seeley, 2005) and significant preventative effects have been found (2008), no strong conclusions for the CWD-A can be drawn until further research is conducted utilizing an at-risk population. It is also important to note that Clarke, DeBar, and Lewinsohn (2003) and Clarke et al. (1995) recommended that "outside" researchers further explore the CWD-A because unaffiliated researchers have conducted limited research. ...
... Studies have shown that the CWD-A is effective (Clarke, Rohde, Lewinsohn, Hops, & Seeley, 1999;Rohde, Lewinsohn, Clarke, Hops, & Seeley, 2005) and significant preventative effects have been found . However, the literature has revealed two separate theories regarding the success of the CWD-A with an at-risk for depression group, and no study explored altering the CWD-A curriculum to adapt to the school environment. ...
... The course therefore also includes sessions regarding increasing the engagement in pleasant activities and decreasing the frequency with which punishing events are experienced. The adolescent version of the Coping with Depression course Lewinsohn, Clarke, Rohde, Hops, & Seeley, 1996;Rohde, Lewinsohn, Clarke, Hops, & Seeley, 2005 Efficacy of the CWD. Over the last 30 years, the CWD course has been translated into several languages including Spanish, German, Dutch, and French and is being used in many countries such as the United States, Canada Mexico, Peru, Germany, Finland, and The Netherlands. ...
... 83,84 Individual evaluations of psychoeducation treatments for depressed adolescents demonstrate positive effects. [85][86][87] Practice Implications ...
Adolescent depression is a prevalent and disabling condition resulting in emotional suffering and social and educational dysfunction. Care for adolescent depression is suboptimal and could be improved through the development and use of quality indicators (QIs). This article reports on the development of a care pathway and QIs for the primary and specialty care management of adolescent depression from case identification through symptom remission. It presents evidence from a review of adolescent clinical practice guidelines and research literature to support QIs at critical nodes in the pathway, and describes implications for practice based on existing evidence. Barriers to measure development are identified, including gaps in empirical evidence, and a research agenda is suggested.
... Cognitive-behavioral therapy (CBT) targets the negative cognitive, coping and problemsolving patterns that are associated with depression in adolescents and adults, enabling individuals to manage difficult experiences both during and after therapy. Many studies have demonstrated CBT's effectiveness in treating depression in adults and adolescents (Compton et al., 2004;Hollon & DeRubeis, 2004;Rohde, Lewinsohn, Clarke, Hops, & Seeley, 2005;Stark et al., 2005). Moreover, CBT may prevent depression from recurring. ...
... One principle of the formulation-based approach is expressed by the saying that " If it ain't broke, don't fix it. " For example, although pleasant event scheduling is an empirically supported intervention for depression (e.g., Rohde, Lewinsohn, Clarke, Hops, & Seeley, 2005), if a depressed client already engages in numerous recreational activities, this technique probably cannot contribute much to his or her treatment. Unrealistically pessimistic thinking is a well-documented characteristic of depression (Beck, 1995), but if careful assessment fails to reveal significant irrational thoughts, cognitive therapy might not have much to offer. ...
This article reviews the strengths and weaknesses of outcome research and clinical reasoning as bases of treatment planning and presents a synthesis in which these two types of information complement each other. The author proposes that therapy planning should begin with a review of the relevant outcome literature and also that divergence from research-based guidelines might be warranted under several conditions, including (a) when the client is demographically or culturally dissimilar to the study samples, (b) when assessment suggests a mismatch between the etiologies of the client's disturbance and the processes addressed by empirically supported treatments, and (c) when use of such treatments is followed by a lack of progress that signals the advisability of midcourse correction. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... With regard to early intervention for childhood depression, Stark and colleagues reported clinically important outcomes using an approach that incorporates problem-solving training, coping skills, cognitive restructuring, and parent education (e.g., Stark et al., 2005). The "Adolescent Coping with Depression Course" has been effective as a secondary and tertiary prevention tool (Clarke et al., 1995;Rohde, Lewinsohn, Clarke, Hops & Seeley, 2005). ...
Children with disabilities receive most of their support from families. While most family caregivers are mothers or fathers, grandparents are increasingly providing care for children with disabilities. In addition, family caregivers come from diverse cultural backgrounds that impact their views on disability. This paper reviews the literature on parent and grandparent caregivers of children with disabilities as well as the literature on parenting children with disabilities across cultures. Drawing from a literature review, the paper discusses emerging directions in intervention.
This manuscript focuses on the recruitment efforts and pilot testing of a culturally tailored motivational interviewing intervention associated with the AAKOMA Project, a 2-phase treatment engagement intervention trial for depressed African American adolescents and families. The research team used strategic community engagement as reported in other research derived from AAKOMA. For the pilot study, the research team recruited 23 youth, enrolled 17 youth and randomized 16 of those youth to either the intervention or a delayed control group. Findings indicated that success in recruiting and retaining African American youth was sustained from earlier strategic engagement during Phase I of the project and that schools and self referrals were the largest referral sources. Pilot intervention findings highlight the preliminary utility of the intervention (100% of youth completing the intervention initiated depression treatment compared to 75% of the delayed control group) and factors that support the recruitment and engagement of a typically difficult to reach population (depressed African American youth and families). Overall, findings set the stage for further intervention development and testing in larger samples.
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Fox, Halpern, and Forsyth (2008) offer a compelling case for school-based mental health checkups for children at risk for developing anxiety and depressive disorders. Although the concept of universal mental health screening has obvious merits, a number of important issues in clinical science, practice, and training need to be addressed in order to promote successful implementation. With regard to clinical science, issues pertaining to risk assessment, screening implementation, and prevention effects for anxiety and depression deserve additional attention. Many of the challenging issues involved in the dissemination and utilization of evidence-based treatments, including current training of school-based clinicians, apply to screening and prevention efforts. We highlight some of what needs to be done in order to transport the concept of mental health checkups into school-based practice.
This book offers school social work students and veteran practitioners a new framework for choosing their interventions, based on the best available evidence. It synthesizes the evidence-based practice (EBP) process with recent conceptual frameworks of school social work clinical practice offered by leading scholars and policymakers. Many other books on EBP try to fit empirically validated treatments into practice contexts without considering the multiple barriers to implementing evidence-based practices in places as complicated and multi-faceted as schools. Additionally, there are vital questions in the literature about what the best levels for intervention are in school social work. Responding to the complexity of applying EBP in schools, this volume offers a conceptual framework that addresses the real-world concerns of practitioners as they work to provide the best services to their school clients. For each domain of school social work practice, the authors critically review interventions, presenting the current research with guidelines for addressing such implementation issues as cost, school culture, adaptations for special populations, and negotiating multiple arenas of practice. In addition, the chapters are grounded in the process of evidence-based practice, illustrating how school practitioners can pose useful questions, search for relevant evidence, appraise the evidence, apply it in keeping with client values, and monitor the results.
The majority of mental, emotional, and behavioral (MEB) disorders have an initial onset before age 24, with 20% annual incidence, and with major depressive disorder (MDD) being the most common MEB. Health systems may be able to reduce costs by transitioning from the current treatment-focused model for MDD to a prevention model. However, evidence is needed for (1) the comparative effectiveness of a “scalable intervention” and (2) an implementation model for such a scalable intervention in the primary care setting. This paper describes a comparative effectiveness trial evaluating the efficacy of two evidence-based cognitive-behavioral prevention (CBP) programs: Teens Achieving Mastery over Stress (TEAMS), the “gold standard,” group therapy model, and Competent Adulthood Transition with Cognitive Behavioral, Humanistic and Interpersonal Training (CATCH-IT), a scalable, self-directed, technology-based model. Eligible adolescents, age 13–19, are offered one of these two depression prevention programs across five health systems (30 clinics) in urban and suburban Chicago, IL, rural Western IL, and Louisville, KY. We are comprehensively evaluating patient-centered outcomes and stakeholder-valued moderators of effect versus baseline at two, six, 12, and 18-month assessment points. Using a hybrid clinical trial design that simultaneously examines the implementation process, the study is also assessing adolescents', parents', and providers' experiences (e.g., efficacy, time commitment, cultural acceptability) within each intervention approach.
Depression during adolescence represents a significant public health concern. It is estimated that up to 20% of adolescents experience an episode of depression that interferes with academic and social functioning and is associated with an increased risk for self-harm. Although significant progress has been made in the last decade in treating mental health problems in young people, effective treatment of depression has been harder to demonstrate. In this paper, we describe the application of a promising evidence-based treatment for adult depression, behavioral activation (BA), to the treatment of depressed adolescents. We briefly present the history and overview of the standard BA approach to adult depression and discuss the rationale for the extension of this approach to adolescent depression. We then focus in detail on the process of adapting the treatment to be adolescent-specific by presenting an early client whom we treated without success. The paper closes with a discussion of lessons learned from our experience of treatment failure, including the need to (a) take a more nuanced view of rumination with a focus on shaping brooding into reflective problem solving, (b) maintain a structured but flexible approach that allows for early introduction of treatment skills most relevant to the individual adolescent, (c) build in careful tracking of suicide risk, and (d) attend to family engagement. Implications for future research and clinical practice also are addressed.
Background:
A generation has passed since the literature on the conceptualisation, assessment and treatment of school refusal was reviewed in this journal (Elliott, ). In the light of considerable gaps in the literature, identified at that time, and growing international interest, the current paper sought to identify progress subsequently made this century.
Methods:
We open with discussion of continuing conceptual uncertainty as to whether school refusal should incorporate both truancy and absenteeism marked by anxiety and distress. We then consider progress in treatment, and conclude by examining prognosis and subsequent adult functioning. In selecting intervention studies for review, our primary focus has been upon RCTS, systematic reviews and meta-analyses.
Results:
The literature review indicates that, since the turn of the century, there has been little substantial advance in knowledge that can guide practitioners. Many of the issues raised in the 1999 paper, in particular, conceptual confusion over this heterogeneous condition, a dearth of rigorous RCT designs, limited knowledge of underlying mechanisms and uncertainty as to the long-term effects of specific forms of intervention, are little clearer than before.
Conclusions:
While several sound publications are available to guide intervention for school refusal, there is a continuing need for rigorous studies that can provide evidence to support individualised and tailored responses to an incapacitating problem with many causes and manifestations. While a multisystemic response to intervention approach is considered attractive, the practicalities of operating this across disparate professional borders are likely to present a long-term challenge.
What Works with Children, Adolescents, and Adults? provides an up-to-date review of research on the effectiveness of psychotherapy and psychological interventions with children, adolescents, adults, people in later life, and people with intellectual and pervasive developmental disabilities. Drawing on recent meta-analyses, systematic reviews, and key research studies in psychotherapy, this volume presents evidence for: the overall effectiveness and cost-effectiveness of psychotherapy the contribution of common factors to the outcome of successful psychotherapy the effectiveness of specific psychotherapy protocols for particular problems. This comprehensive, user-friendly guide will inform clinical practice, service development and policy. It will be invaluable to psychotherapists, service managers, policymakers, and researchers. What Works with Children, Adolescents, and Adults? offers a review of the evidence base for three Handbooks published by Routledge: The Handbook of Child and Adolescent Clinical Psychology (Carr, 2006), The Handbook of Adult Clinical Psychology (Carr & McNulty, 2006), and The Handbook of Intellectual Disability and Clinical Psychology Practice (O'Reilly, Carr, Walsh, & McEvoy, 2007).
Literature ReviewDeveloping and Evaluating the Penn Resiliency ProgramPenn Resiliency ProgramEvidence of EffectivenessPreventing Depression in GirlsConclusions
“This text addresses the basics of developmental psychopathology in a clear manner, with enough detail to facilitate a real understanding of the concepts and their relevance to clinical work with children.” —Christie P. Karpiak, University of Scranton This introductory undergraduate text on child and adolescent psychopathology adopts a developmental psychopathology approach to understanding child disorders. The author examines the emergence of disorders over time, pays special attention to risk and protective factors that influence developmental processes and trajectories, and examines child psychopathology in the context of normal development. The author has four main goals: to show students why an understanding of child psychopathology and its treatment might be important to them as future psychologists, social workers, educators, and/or parents; to introduce students to the developmental psychopathology perspective and how it can help organize understanding of childhood disorders; to help students appreciate the interdependence of psychological research and clinical practice; and to engage students in higher-level thinking necessary to analyze information, critically evaluate ideas, and create solutions to real-world problems based on empirically validated findings. Key Features Links research with clinical practice via a focus on evidence-based therapies for childhood disorders, balancing solid empirical science and clinical insights and thus helping students filter clinically valuable findings from those lacking utility; Emphasizes the developmental perspective to better understand psychopathology, with use of normal development as a lens through which to view abnormal behavior or emotional problems; Provides case studies and real-life examples in each chapter, allowing the student to understand how the material relates to specific situations; Incorporates assessment methods into specific content modules rather than isolating assessment as a separate and discrete chapter; Utilizes smaller, more focused modules to allow for greater flexibility for instructors and students and to avoid the problem (seen in other texts) of lumping dissimilar problems into longer chapters; Offers end-of-chapter review questions that help students apply, analyze, and evaluate the information in the chapter, requiring them to critically think about the material; Includes suggested additional readings describing etiological models, empirical studies, or treatment approaches, as well as current research articles.; Accompanied by an Instructor's Resource CD-Rom (for qualified adopters of the text) with a computerized test bank; sample syllabi; chapter overview and outline; PowerPoint slides; discussion questions and classroom activities; chapter-specific video resources; and chapter-specific web resources; Features a student study site at with interactive quizzes; e-flashcards; Internet exercises; 3–5 journal articles per chapter with discussion/critical thinking questions; list of recommended websites; links to video clips and film suggestions.
The symptoms of depression can be manifested in several ways, most often presenting as a sad or depressed mood but also as irritability or a loss of interest in activities (anhedonia). Suicidal ideation in depressed youths is of concern as it is a particularly common symptom in this population (Rohde, Beevers, Stice, & O’Neil, 2009). Importantly, depression is one of the most commonly occurring mental health disorders in children and adolescents. Up to 17 % of females may experience a depressive episode that meets diagnostic criteria by the time they reach age 20, with the peak point incidence of clinical depression near 5 % in 16-year-old females (Rohde et al., 2009). Youth in high-risk communities, including non-Caucasian ethnic groups (Rohde et al., 2009) and youths from poverty-stricken areas are at even greater risk for depressive symptoms (Riolo, Nguyen, Greden, & King, 2005). In low-risk community samples, between 8 % and 20 % of children aged 11–18 may be experiencing depressive symptoms (Diamantopoulou, Verhulst, & van der Ende, 2011). While both male and female youth experience clinical depression, females have a typically higher prevalence rates for the disorder at the onset of adolescence.
School psychologists are uniquely positioned to support the delivery of evidence-based mental health practices (EBMHPs) to address the overwhelming mental health needs of children and youth. Graduate training programs can promote EBMHPs in schools by ensuring school psychologists enter the workplace prepared to deliver and support high-quality, effective services. Despite the remarkable growth of effective interventions to address a range of mental health problems, more work is needed to develop and adapt existing graduate training curricula to address this pressing issue. Using a problem-solving framework, we sequentially identify and analyze current challenges in training the next generation of school psychologists in EBMHPs. These challenges include how EBMHPs are packaged and structured, researchers' limited understanding of how culture affects efficacy, and continual shifts in evidence-based practice designations. These challenges provide a basis for the adaptation and future direction of training in EBMHPs. System-level changes and adaptations to professional practice standards are also discussed.
The literature on depression in children and adolescents was reviewed to provide an update for clinicians. REVIEW PROCESS: Literature of particular relevance to evidence-based practice was selected for critical review. Meta-analyses and controlled trials were prioritized for review along with key assessment instruments.
An up-to-date overview of clinical features, epidemiology, prognosis, aetiology, assessment and intervention was provided.
Depression in children and adolescence is a relatively common, multifactorially determined and recurring problem which often persists into adulthood. Psychometrically robust screening questionnaires and structured interviews facilitate reliable assessment. There is growing evidence for the effectiveness of cognitive behaviour therapy, psychodynamic therapy, interpersonal therapy and family therapy in the treatment of paediatric depression. There is also evidence that SSRIs may be particularly effective for severe depression, although they may carry the risk of increased suicidality.
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