Cognitive and family therapies for adolescent depression: treatment specificity, mediation, and moderation.

The specificity of cognitive and family therapies, and potential treatment mediators and moderators, was examined in a randomized clinical trial for adolescent depression. After acute treatment, cognitive-behavioral therapy (CBT) exerted specific effects on cognitive distortions relative to either systemic-behavioral family therapy (SBFT) or nondirective supportive therapy (NST). At 2-year follow-up, SBFT was found to impact family conflict and parent-child relationship problems more than CBT; NST and CBT tended to show a greater reduction in anxiety symptoms than SBFT. Nonspecific therapist variables qualified few outcome analyses. No measures of cognitive distortion or family dysfunction mediated or moderated treatment outcome. As in adult studies, relatively few areas of treatment specificity or mediation were identified. The implications of these findings for clinical treatment and research in adolescent depression are discussed.

[1]  A. Rush,et al.  Short-term psychotherapy of depressive disorders: current status and future directions. , 1994, Psychiatry.

[2]  S. Spaccarelli,et al.  Measuring abuse stress and negative cognitive appraisals in child sexual abuse: Validity data on two new scales , 1995, Journal of abnormal child psychology.

[3]  D. Hedeker,et al.  MIXOR: a computer program for mixed-effects ordinal regression analysis. , 1996, Computer methods and programs in biomedicine.

[4]  Judith Cohen,et al.  Factors that mediate treatment outcome of sexually abused preschool children: six- and 12-month follow-up. , 1998, Journal of the American Academy of Child and Adolescent Psychiatry.

[5]  Philip C. Kendall,et al.  Handbook of research methods in clinical psychology , 1982 .

[6]  K. Ronan,et al.  Self-talk in distressed youth: states-of-mind and content specificity. , 1997, Journal of clinical child psychology.

[7]  S Iyengar,et al.  A clinical psychotherapy trial for adolescent depression comparing cognitive, family, and supportive therapy. , 1997, Archives of general psychiatry.

[8]  K. Hawton,et al.  Motivational Aspects of Deliberate Self-Poisoning in Adolescents , 1982, British Journal of Psychiatry.

[9]  N. Blum,et al.  Case study: audio feedforward treatment of selective mutism. , 1998, Journal of the American Academy of Child and Adolescent Psychiatry.

[10]  P. Lewinsohn,et al.  Major depression in community adolescents: age at onset, episode duration, and time to recurrence. , 1994, Journal of the American Academy of Child and Adolescent Psychiatry.

[11]  Benjamin B. Lahey,et al.  Advances in Clinical Child Psychology , 1980, Advances in Clinical Child Psychology.

[12]  H. Locke,et al.  SHORT MARITAL ADJUSTMENT AND PREDICTION TESTS: THEIR RELIABILITY AND VALIDITY , 1959 .

[13]  T. Jacob,et al.  Adaption of the areas of change questionnaire for parent-child relationship assessment , 1985 .

[14]  K. Howard,et al.  The Therapeutic Bond Scales: Psychometric Characteristics and Relationship to Treatment Effectiveness , 1989 .

[15]  H. Leitenberg,et al.  Negative cognitive errors in children: questionnaire development, normative data, and comparisons between children with and without self-reported symptoms of depression, low self-esteem, and evaluation anxiety. , 1986, Journal of consulting and clinical psychology.

[16]  T. Wilkes.  Cognitive Therapy with Depressed Adolescents , 1988 .

[17]  M. J. Rogers,et al.  Effects of interparental aggression on children's adjustment : The moderating role of cognitive appraisal and coping , 1997 .

[18]  A. Beck,et al.  Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation , 1988 .

[19]  J. F. Alexander,et al.  Short-term behavioral intervention with delinquent families: impact on family process and recidivism. , 1973, Journal of abnormal psychology.

[20]  N. Ryan,et al.  Cognitive-behavioral therapy of depression and depressive symptoms during adolescence: a review and meta-analysis. , 1998, Journal of the American Academy of Child and Adolescent Psychiatry.

[21]  D. Kupfer,et al.  Recent developments in the pharmacotherapy of mood disorders. , 1996, Journal of consulting and clinical psychology.

[22]  M. Shea,et al.  Mode-specific effects among three treatments for depression. , 1990, Journal of consulting and clinical psychology.

[23]  J. Swanson,et al.  Analog classroom assessment of Adderall in children with ADHD. , 1998, Journal of the American Academy of Child and Adolescent Psychiatry.

[24]  R. Harrington,et al.  Randomized trial of a home-based family intervention for children who have deliberately poisoned themselves. , 1998, Journal of the American Academy of Child and Adolescent Psychiatry.

[25]  K. Dobson,et al.  The Cognitive Therapy Scale: psychometric properties. , 1986, Journal of consulting and clinical psychology.

[26]  D. Brent,et al.  Psychotherapy: Definitions, Mechanisms of Action, and Relationship to Etiological Models , 1998, Journal of abnormal child psychology.

[27]  S. Jackson,et al.  Family experiences as moderators of the relationship between eating symptoms and personality disturbance , 1996 .

[28]  J. Beck,et al.  Comparison of cognitive therapy and relaxation training for panic disorder. , 1994, Journal of consulting and clinical psychology.

[29]  P. Lewinsohn,et al.  Cognitive-behavioral treatment for depressed adolescents* , 1990 .

[30]  R. Harrington,et al.  Which depressed patients respond to cognitive-behavioral treatment? , 1998, Journal of the American Academy of Child and Adolescent Psychiatry.

[31]  James Robert Brašić,et al.  A children's global assessment scale (CGAS). , 1983, Archives of general psychiatry.

[32]  B. Efron.  Forcing a sequential experiment to be balanced , 1971 .

[33]  P. Lewinsohn,et al.  Cognitive-behavioral group treatment of adolescent depression: Prediction of outcome , 1992 .

[34]  D. A. Kenny,et al.  The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. , 1986, Journal of personality and social psychology.

[35]  D. Hedeker,et al.  Application of random-effects probit regression models. , 1994, Journal of consulting and clinical psychology.

[36]  Response of depressed adolescents to cognitive-behavioral treatment: do differences in initial severity clarify the comparison of treatments? , 1994 .

[37]  J. Weisz,et al.  Identifying and developing empirically supported child and adolescent treatments. , 1998, Journal of consulting and clinical psychology.

[38]  P. Kendall,et al.  Therapy outcome research methods. , 1999 .

[39]  J. Szapocznik,et al.  Structural family versus psychodynamic child therapy for problematic Hispanic boys. , 1989, Journal of consulting and clinical psychology.

[40]  M. Weissman,et al.  The course of major depression in the offspring of depressed parents. Incidence, recurrence, and recovery. , 1992, Archives of general psychiatry.

[41]  J. Weisz,et al.  Cognitive Mediators of the Outcome of Psychotherapy with Children , 1989 .

[42]  R. Harrington,et al.  Controlled trial of a brief cognitive-behavioural intervention in adolescent patients with depressive disorders. , 1996, Journal of child psychology and psychiatry, and allied disciplines.

[43]  M. Drake.  Diagnostic and Statistical Manual of Mental Disorders (3rd ed. rev.) , 1988 .

[44]  M. Davies,et al.  The assessment of affective disorders in children and adolescents by semistructured interview. Test-retest reliability of the schedule for affective disorders and schizophrenia for school-age children, present episode version. , 1985, Archives of general psychiatry.

[45]  Gerard Egan,et al.  The skilled helper : a systematic approach to effective helping , 1990 .

[46]  L. Greenberg,et al.  The psychotherapeutic process: A research handbook. , 1986 .

[47]  J. F. Alexander,et al.  Functional family therapy , 1982 .

[48]  G. Holmbeck.  Toward terminological, conceptual, and statistical clarity in the study of mediators and moderators: examples from the child-clinical and pediatric psychology literatures. , 1997, Journal of consulting and clinical psychology.

[49]  S Iyengar,et al.  Clinical outcome after short-term psychotherapy for adolescents with major depressive disorder. , 2000, Archives of general psychiatry.

[50]  C B Begg,et al.  A treatment allocation procedure for sequential clinical trials. , 1980, Biometrics.

[51]  R. Sheppard,et al.  RECENT DEVELOPMENTS IN THE , 1966 .

[52]  Michel Boivin,et al.  The roles of social withdrawal, peer rejection, and victimization by peers in predicting loneliness and depressed mood in childhood , 1995, Development and Psychopathology.

[53]  G. Keitner,et al.  THE McMASTER FAMILY ASSESSMENT DEVICE: RELIABILITY AND VALIDITY* , 1985 .

[54]  P. Kendall,et al.  Comorbidity of anxiety and depression in youth: treatment implications. , 1992, Journal of consulting and clinical psychology.

[55]  P. Kendall.  Treating anxiety disorders in children: results of a randomized clinical trial. , 1994, Journal of consulting and clinical psychology.

[56]  G. Keitner,et al.  Cognitive therapy with depressed inpatients: specific effects on dysfunctional cognitions. , 1991, Journal of consulting and clinical psychology.

[57]  D Lester,et al.  The measurement of pessimism: the hopelessness scale. , 1974, Journal of consulting and clinical psychology.

[58]  G. S. Pettit,et al.  Mechanisms in the cycle of violence. , 1990, Science.

[59]  G. Fava,et al.  Cognitive-behavioral management of drug-resistant major depressive disorder. , 1997, The Journal of clinical psychiatry.

[60]  B. Birmaher,et al.  Psychosocial interventions for treating adolescent suicidal depression: A comparison of three psychosocial interventions. , 1996 .

[61]  J. Weisz,et al.  Effects of psychotherapy with children and adolescents revisited: a meta-analysis of treatment outcome studies. , 1995, Psychological bulletin.

[62]  P. Kendall,et al.  Therapy for youths with anxiety disorders: a second randomized clinical trial. , 1997, Journal of consulting and clinical psychology.

[63]  A. Beck,et al.  Hopelessness and eventual suicide: a 10-year prospective study of patients hospitalized with suicidal ideation. , 1985, The American journal of psychiatry.

[64]  R. A. Laird,et al.  A FAMILY THERAPIST RATING SCALE , 1983 .

[65]  Self-talk in youth with anxiety disorders: states of mind, content specificity, and treatment outcome. , 1996, Journal of consulting and clinical psychology.

[66]  A. Robin,et al.  Negotiating Parent-Adolescent Conflict: A Behavioral-Family Systems Approach , 1989 .

[67]  W. Reynolds,et al.  A comparison of cognitive-behavioral therapy and relaxation training for the treatment of depression in adolescents. , 1986, Journal of consulting and clinical psychology.

[68]  K. Stark,et al.  A comparison of the relative efficacy of self-control therapy and a behavioral problem-solving therapy for depression in children , 1987, Journal of abnormal child psychology.

[69]  J. Weisz,et al.  Brief treatment of mild-to-moderate child depression using primary and secondary control enhancement training. , 1997, Journal of consulting and clinical psychology.

[70]  D. Brent,et al.  A psychoeducational program for families of affectively ill children and adolescents. , 1993, Journal of the American Academy of Child and Adolescent Psychiatry.

[71]  B. Birmaher,et al.  Predictors of treatment efficacy in a clinical trial of three psychosocial treatments for adolescent depression. , 1998, Journal of the American Academy of Child and Adolescent Psychiatry.

[72]  Lawrence M. Baldwin,et al.  THE McMASTER FAMILY ASSESSMENT DEVICE , 1983 .

[73]  H. Strupp,et al.  Effects of training in time-limited dynamic psychotherapy: changes in therapist behavior. , 1993, Journal of consulting and clinical psychology.

[74]  M. Thase,et al.  The role of psychotherapy in the treatment of depression: review of two practice guidelines. , 1996, Archives of general psychiatry.

[75]  B. Leadbeater,et al.  The development of problem behavior syndromes in at-risk adolescents , 1994, Development and Psychopathology.

[76]  P. Knapp,et al.  Consultation-liaison in child psychiatry: a review of the past 10 years. Part I: Clinical findings. , 1998, Journal of the American Academy of Child and Adolescent Psychiatry.

[77]  P. Kendall,et al.  Normative comparisons for the evaluation of clinical significance. , 1999, Journal of consulting and clinical psychology.

[78]  S. Nolen-Hoeksema,et al.  Therapeutic empathy and recovery from depression in cognitive-behavioral therapy: a structural equation model. , 1992, Journal of consulting and clinical psychology.

[79]  J. Durlak,et al.  Effectiveness of cognitive-behavior therapy for maladapting children: a meta-analysis. , 1991, Psychological bulletin.

[80]  S D Imber,et al.  Some conceptual and statistical issues in analysis of longitudinal psychiatric data. Application to the NIMH treatment of Depression Collaborative Research Program dataset. , 1993, Archives of general psychiatry.

[81]  J. Lochman,et al.  The Moderating Effects of Children's Fear and Activity Level on Relations Between Parenting Practices and Childhood Symptomatology , 1997, Journal of abnormal child psychology.

[82]  H. Strupp,et al.  The Vanderbilt process measures: The Psychotherapy Process Scale (VPPS) and the Negative Indicators Scale (VNIS). , 1986 .

[83]  R. Rapee,et al.  Family treatment of childhood anxiety: a controlled trial. , 1996, Journal of consulting and clinical psychology.

[84]  P. Lewinsohn,et al.  Nonspecific improvement effects in depression using interpersonal skills training, pleasant activity schedules, or cognitive training. , 1979, Journal of Consulting and Clinical Psychology.

[85]  A. B. Hollingshead,et al.  Four factor index of social status , 1975 .

[86]  A T McLellan,et al.  Therapist success and its determinants. , 1985, Archives of general psychiatry.

[87]  W. Bickerton,et al.  Treatment for Children and Adolescents with Depression: Lessons from a Controlled Trial , 1996 .