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


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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    • "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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    • "An implicit assumption was that a treatment , once successful in efficacy and effectiveness tests, was deemed ready for widespread dissemination (i.e., the targeted distribution of an EBT; Chambers, Ringeisen , & Hickman, 2005; Fixsen et al., 2005). Some researchers had argued that psychosocial treatment development and evaluation requires more than three stages (e.g., Chorpita & Nakamura, 2004; Hogue, 2010; Schoenwald & Hoagwood, 2001), an assertion supported by the fact that some EBTs have progressed to the third stage but have not been successful in effectiveness tests (e.g., Clarke et al., 2005; Southam-Gerow et al., 2010; Weisz et al., 2009). Thus, an emerging consensus is that treatment development and evaluation models need additional stages that assess fit between EBTs and different practice contexts (Schoenwald & Hoagwood, 2001). "
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