Can parent training for parents with high levels of expressed emotion have a positive effect on their child's social anxiety improvement?

The role that parents’ involvement may play in improving their child's social anxiety is still under debate. This paper aimed to investigate whether training parents with high expressed emotion (EE) could improve outcomes for adolescent social anxiety intervention. Fifty-two socially anxious adolescents (aged 13–18 years), whose parents exhibited high levels of expressed emotion, were assigned to either (a) a school-based intervention with an added parent training component, or (b) a school-based program focused solely on intervening with the adolescent (no parental involvement). Post-treatment and 12-month follow-up findings showed that school-based intervention with parent training was superior to the adolescent-specific program, yielding significant reductions in diagnosis remission, social and depressive symptomatology, particularly when the EE status of parents changed. Overall, the findings suggest that high-EE parents of children with social anxiety need to be involved in their child's therapy.     

Group therapy for adolescent depressive disorder: a comparison of social skills and therapeutic support

Two forms of short-term group therapy for depressed adolescents are compared. Adolescents were assigned to either a social skills training or therapeutic support group. Treatment outcome was based on self-report and semistructured clinical interviews for depression, measures of self-concept, and cognitive distortions. After treatment, adolescents in the therapeutic support groups showed significantly greater reductions in clinical depression and significant increases in self-concept compared with those in the social skills training group. These group differences were no longer evident at 9-month follow-up, as adolescents in the therapeutic support groups maintained their improvement, and adolescents in the social skills training groups caught up.     

Multiple behavioral treatment in a sexually aggressive male

Multiple behavioral strategies were used in the treatment of a sexually aggressive male. Self-monitoring reduced obsessive thoughts revolving around poor social relations and sexual aggressiveness. A social skills training program was used to remedy basic skill deficits and improve heterosexual interactions. Compulsive washing and checking rituals were treated with response prevention and flooding in an inpatient setting. Treatment gains were maintained at an 8-month follow-up.     

The Modified Depression Scale (MDS): A Brief, No-Cost Assessment Tool to Estimate the Level of Depressive Symptoms in Students and Schools

Adolescent health researchers and practitioners are frequently interested in assessing depression as part of student screening and for school-wide prevention and intervention planning. However, this task is challenging given the lack of free, brief assessments of depressive symptoms in youth. This study evaluated the psychometric properties of an adapted version of the Modified Depression Scale (MDS). Data came from a school-based survey of 9th-12th graders in Boston (N = 1,657). We assessed internal consistency reliability and known-group validity, in addition to the feasibility of establishing a dichotomous cut-point to classify adolescents as having high versus low depressive symptoms. We also evaluated the validity of the adapted MDS as a school-wide measure. At the student level, the adapted MDS demonstrated acceptable internal consistency. Students engaging in risk behaviors (e.g., substance use) or who were victimized (e.g., bullied) had significantly higher depressive symptom scores. Students who endorsed four or five MDS symptoms often or always had a heightened risk of suicidal ideation, substance use, and failing grades when compared to students who endorsed three or fewer symptoms often or always. At the school level, higher mean levels of depressive symptoms in a school were associated with higher mean levels of suicidal ideation and failing grades. Results of this study suggest that the adapted MDS is a promising measurement tool that could be useful to school-based professionals and researchers to evaluate depressive symptoms in adolescents and ascertain the prevalence of depressive symptoms in schools.     

Cognitive change processes in a group cognitive behavior therapy of depression

The present study attempted to examine the causal relationships among changes in automatic thoughts, dysfunctional attitudes, and depressive symptoms in a 12-week group cognitive behavior therapy (GCBT) program for depression. In all, 35 depressed patients attending the GCBT program were monitored with the Automatic Thoughts Questionnaire, Dysfunctional Attitudes Scale, and Beck Depression Inventory at the pre-treatment, 4th and 8th sessions, and post-treatment. The results were as follows: (1). GCBT reduces negative cognitions; (2). changes in automatic thoughts and dysfunctional attitudes lead to change in depressive symptoms; and (3). automatic thoughts play a mediating role between dysfunctional attitudes and depression. The findings taken as a whole support the Causal Cognition Model of depression.     

A randomized, controlled trial of cognitive behavioral social skills training for middle-aged and older outpatients with chronic schizophrenia

OBJECTIVE: The number of older patients with chronic schizophrenia is increasing. There is a need for empirically validated psychotherapy interventions for these patients. Cognitive behavioral social skills training teaches cognitive and behavioral coping techniques, social functioning skills, problem solving, and compensatory aids for neurocognitive impairments. The authors compared treatment as usual with the combination of treatment as usual plus cognitive behavioral social skills training. METHOD: The randomized, controlled trial included 76 middle-aged and older outpatients with chronic schizophrenia, who were assigned to either treatment as usual or combined treatment. Cognitive behavioral social skills training was administered over 24 weekly group sessions. Blind raters assessed social functioning, psychotic and depressive symptoms, cognitive insight, and skill mastery. RESULTS: After treatment, the patients receiving combined treatment performed social functioning activities significantly more frequently than the patients in treatment as usual, although general skill at social functioning activities did not differ significantly. Patients receiving cognitive behavioral social skills training achieved significantly greater cognitive insight, indicating more objectivity in reappraising psychotic symptoms, and demonstrated greater skill mastery. The overall group effect was not significant for symptoms, but the greater increase in cognitive insight with combined treatment was significantly correlated with greater reduction in positive symptoms. CONCLUSIONS: With cognitive behavioral social skills training, middle-aged and older outpatients with chronic schizophrenia learned coping skills, evaluated anomalous experiences with more objectivity (achieved greater cognitive insight), and improved social functioning. Additional research is needed to determine whether cognitive insight mediates psychotic symptom change in cognitive behavior therapy for psychosis.     

Adapting Dialectical Behaviour Therapy for Children: Towards a New Research Agenda for Paediatric Suicidal and Non-Suicidal Self-Injurious Behaviours

BACKGROUND: Dialectical Behaviour Therapy (DBT) has been used to treat adults and adolescents with suicidal and non-suicidal self-injury. This article describes initial progress in modifying DBT for affected pre-adolescent children. METHOD: Eleven children from regular education classes participated in a 6-week pilot DBT skills training program for children. Self-report measures of children's emotional and behavioural difficulties, social skills and coping strategies were administered at pre- and post-intervention, and indicated that the children had mild to moderate symptoms of depression, anxiety and suicidal ideation at baseline. RESULTS: Subjects were able to understand and utilise DBT skills for children and believed that the skills were important and engaging. Parents also regarded skills as important, child friendly, comprehensible and beneficial. At post-treatment, children reported a significant increase in adaptive coping skills and significant decreases in depressive symptoms, suicidal ideation and problematic internalising behaviours. CONCLUSIONS: These promising preliminary results suggest that continued development of DBT for children with more severe clinical impairment is warranted. Progress on adapting child individual DBT and developing a caregiver training component in behavioural modification and validation techniques is discussed.     

Efficacy of interpersonal psychotherapy for depressed adolescents.

BACKGROUND: Psychotherapy is widely used for depressed adolescents, but evidence supporting its efficacy is sparse. METHODS: In a controlled, 12-week, clinical trial of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), 48 clinic-referred adolescents (aged 12-18 years) who met the criteria for DSM-III-R major depressive disorder were randomly assigned to either weekly IPT-A or clinical monitoring. Patients were seen biweekly by a "blind" independent evaluator to assess their symptoms, social functioning, and social problem-solving skills. Thirty-two of the 48 patients completed the protocol (21 IPT-A-assigned patients and 11 patients in the control group). RESULTS: Patients who received IPT-A reported a notably greater decrease in depressive symptoms and greater improvement in overall social functioning, functioning with friends, and specific problem-solving skills. In the intent-to-treat sample, 18 (75%) of 24 patients who received IPT-A compared with 11 patients (46%) in the control condition met recovery criterion (Hamilton Rating Scale for Depression score < or =6) at week 12. CONCLUSIONS: These preliminary findings support the feasibility, acceptability, and efficacy of 12 weeks of IPT-A in acutely depressed adolescents in reducing depressive symptoms and improving social functioning and interpersonal problem-solving skills. Because it is a small sample consisting largely of Latino, low socioeconomic status adolescents, further studies must be conducted with other adolescent populations to confirm the generalizability of the findings.     

Cognitive Behavioral Therapy for Depressed Adults With Mild Intellectual Disability: A Pilot Study

There is a paucity of research on psychosocial treatments for depression in adults with intellectual disability (ID). In this pilot study, we explored the efficacy of a group CBT treatment that involved a caregiver component in adults with mild ID with a depressive disorder. Sixteen adults with mild ID and a depressive disorder participated in a 10-week group CBT treatment and eight adults with mild ID with a depressive disorder served as a treatment as usual (TAU) control group. Adults with mild ID and caregivers completed measures of depressive symptoms, behavior problems, and social skills at pretreatment, posttreatment, and a 3-month follow-up. Adults with mild ID also completed a series of tasks to measure their understanding of the principles of cognitive therapy pre- and posttreatment. The CBT group demonstrated significant decreases in depressive symptoms and behavior problems from pretreatment to posttreatment and these effects were maintained at a 3-month follow-up. The CBT group demonstrated significant improvements in their ability to infer emotions and thoughts based on various situation-thought-emotion pairings from pretreatment to posttreatment. Findings indicate that adults with mild ID with a depressive disorder benefitted from a group CBT treatment with a caregiver component. Moreover, adults with mild ID appeared to benefit, at least in part, from the cognitive therapy components of the treatment, in addition to the behavior therapy components.     

An exploratory factor analysis of the children's depression rating scale-revised

An exploratory factor analysis was performed in a clinical sample of 314 children and adolescents to investigate the factor structure of the Children's Depression Rating Scale-Revised (CDRS-R; Poznanski et al. 1984). A maximum likelihood method followed by a Promax rotation yielded five factors: observed depressive mood, anhedonia, morbid thoughts, somatic symptoms and reported depressive mood. The age group and gender differences on the factors scores are evaluated. After controlling for gender, the adolescents had more severe depression in terms of observed depressive mood, anhedonia, and somatic symptoms. After controlling for age groups, girls had higher scores for reported depressive mood.     

School-Based Predictors of Early Adolescent Depression

Childhood and adolescent depression is associated with negative outcomes in the school environment. Research demonstrates that childhood and adolescent depression often results in poor schoolwork, reduced academic achievement, impairments on cognitive tasks, and acting out behavior patterns. This longitudinal study sought to determine the extent to which affective, social, and academic variables collected in 3rd, 4th, and 5th grades could predict depressive symptoms in 6th grade (early adolescence). A primary objective was to define conceptual sets of school-based predictor variables that would reliably predict depressive symptoms in early adolescence. Results from cross-validated discriminant function analyses indicated the best group of predictors of depression in early adolescence included teacher rated academic competence, social skills, critical events, self-reported loneliness, self-image, and self-concept. The results suggest that early school-based identifiers of depressive symptoms are found prior to early adolescence.     

Cognitive Behavioral Intervention for Trauma in Schools (CBITS): school-based treatment on a rural American Indian reservation

This study examines a pilot school-based treatment program for American Indian adolescents residing on a reservation who presented with symptoms of Posttraumatic Stress Disorder (PTSD) and symptoms of depression. This is the first study directed at treating American Indian children with trauma; seven case studies demonstrate our findings that a manualized cognitive behavior therapy intervention delivered in group format for 10 weeks has potential for helping some children who experience PTSD symptoms and depression. The findings generally replicate previous research conducted with groups of non-Indian adolescents in urban settings. PTSD and depressive symptoms decreased for three of the four students who completed treatment. Directions for future research include the need to understand and control attrition and to address cultural influences, including making adaptations in the cognitive behavioral formulations and techniques regarding feelings as operant behaviors. Results contribute to knowledge of feasibility and acceptability of cultural adaptations of CBT for trauma in an under-served population.     

A school-based mental health program for traumatized Latino immigrant children

OBJECTIVE: To pilot-test a school mental health program for Latino immigrant students who have been exposed to community violence. METHOD: In this quasi-experimental study conducted from January through June 2000, 198 students in third through eighth grade with trauma-related depression and/or posttraumatic stress disorder symptoms were compared after receiving an intervention or being on a waitlist. The intervention consisted of a manual-based, eight-session, group cognitive-behavioral therapy (CBT) delivered in Spanish by bilingual, bicultural school social workers. Parents and teachers were eligible to receive psychoeducation and support services. RESULTS: Students in the intervention group ( = 152) had significantly greater improvement in posttraumatic stress disorder and depressive symptoms compared with those on the waitlist ( = 47) at 3-month follow-up, adjusting for relevant covariates. CONCLUSIONS: A collaborative research team of school clinicians, educators, and researchers developed this trauma-focused CBT program for Latino immigrant students and their families. This pilot test demonstrated that this program for traumatized youths, designed for delivery on school campuses by school clinicians, can be implemented and evaluated in the school setting and is associated with a modest decline in trauma-related mental health problems.     

Incorporating Well-Adjusted Peers in a Conduct Problems Prevention Program: Evaluation of Acceptability,Fidelity, and Safety of Implementation

In order to prevent iatrogenic effects associated with interventions that aggregate youth with behavior problems and to promote the integration of these youth into normative peer groups, a comprehensive evidence-based prevention program, Early Risers “Skills for Success” (August et al. in Preventing substance abuse: science-based programs for children and adolescents, American Psychological Association, Washington, 2007), was augmented to include well-adjusted children in a strategic peer affiliation component, or buddy system. A total of 190 kindergartners and first graders from five schools in a Midwestern US city were randomly assigned by school to receive the program or serve as controls. In the first summer program component, the children received 72 h of programming in academics, social skills, and creative arts, all within a highly structured social environment. The feasibility of the program was investigated through examination of acceptability, fidelity, and safety of programming, with special attention to acceptability and safety for well-adjusted peer mentors. Results showed that intervention fidelity, as measured by independent observers, was high. Acceptability was high as well, with no differences in attendance between well-adjusted children and children with behavioral problems. There was no evidence of iatrogenic effects or other unsafe outcomes: Peer-reported victimization did not increase, and well-adjusted children did not increase in aggression. In contrast, both well-adjusted children and their peers with behavior problems increased in teacher-rated social skills, and well-adjusted children increased in leadership. The results suggest that the pairing of well-adjusted children with behavior-problem children in a highly structured program such as Early Risers is a feasible program tactic in which the well-adjusted children may also derive some benefit.     

Food Insecurity and Depressive Symptoms in Adolescents Aged 12–15 Years from Low- and Middle-Income Countries

Purpose: Little is known about the role of food insecurity (FIS) on depressive symptoms among adolescents. Thus, this study aimed to explore the association between FIS and depressive symptoms among adolescents aged 12–15 years from low- and middle-income countries across the world. Methods: Data from the Global school-based Student Health Survey were analyzed in 51,702 adolescents [mean (SD) age 13.8 (1.0) years; 49.3% girls). Self-reported measures assessed depressive symptoms during the past 12 months, and food insecurity. Participants reporting yes for depressive symptoms. FIS was categorized into five levels, including ‘never’, ‘rarely’, ‘sometimes’, ‘most of the time’ and ‘always’. Multivariable logistic regression analysis was performed, and a country-wise meta-analysis was undertaken to compare country difference in the associations between FIS and depressive symptoms. Results: The prevalence of depressive symptoms was 30.0%, respectively. Compared with those reporting never for FIS, adolescents with increased severity of FIS were more likely to report depressive symptoms regardless of gender. Country-wise meta-analysis demonstrated that having FIS versus not having FIS was associated with 60% greater odds for depressive symptoms (OR = 1.60; 95% CI: 1.52–1.69) but with a moderate between-country heterogeneity (I² = 12.7%). Conclusion: The current study indicates that alleviating FIS may be an effective prevention against depressive symptoms among adolescents from LMICs. Future studies should adopt improved study design to confirm or negate our research findings, which informs more efficient public mental health interventions.     

An efficacy/effectiveness study of cognitive-behavioral treatment for adolescents with comorbid major depression and conduct disorder

OBJECTIVE: To evaluate effectiveness of the Adolescent Coping With Depression (CWD-A) course, a cognitive-behavioral group intervention for depressed adolescents with comorbid conduct disorder. METHOD: Between 1998 and 2001, 93 nonincarcerated adolescents (ages 13-17 years) meeting criteria for major depressive disorder and conduct disorder were recruited from a county juvenile justice department and randomly assigned to the CWD-A or a life skills/tutoring control condition. Participants were assessed post-treatment and at 6- and 12-month follow-up. Dichotomous outcomes were analyzed with logistic regression; dimensional measures were analyzed using random effects regression. RESULTS: Major depressive disorder recovery rates post-treatment were greater in CWD-A (39%) compared with life skills/tutoring control (19%) (odds ratio 2.66, 95% confidence interval = 1.03-6.85). CWD-A participants reported greater reductions in Beck Depression Inventory-II (r2 = 0.055, p =.033) and Hamilton Depression Rating Scale (r2 = 0.047, p =.039) scores and improved social functioning (r2 = 0.064, p =.019) post-treatment. Group differences in major depressive disorder recovery rates at 6- and 12-month follow-up were nonsignificant, as were differences in conduct disorder both post-treatment and during follow-up. CONCLUSIONS: This is the first randomized, controlled trial of a psychosocial intervention with adolescents with major depressive disorder and conduct disorder. Although the CWD-A appears to be an effective acute treatment for depression in adolescents with multiple disorders, findings emphasize the need to improve long-term outcomes for depressed adolescents with psychiatric comorbidity and imply that interventions for comorbid populations focus directly on each specific disorder.     

Middle school primary prevention program for eating disorders: a controlled study with a twelve-month follow-up

The aim of this pilot study was to evaluate the efficacy of a new school-based eating disorder prevention program designed to reduce dietary restraint and the level of preoccupation with regard to shape and weight. One hundred and six (61 females and 45 males) 11 to 12-year-old students were evaluated, 55 of whom participated in the program (experimental group). An additional 51 students formed the control group. The program met for six sessions, two hours per session. After six months, the experimental group received two booster sessions of two hours in two consecutive weeks. Outcome measures included the Eating Disorder ExaminationQuestionnaire (EDE-Q), the children's version of the Eating Attitudes Test (EAT), the Rosenberg Self-Esteem Scale (RSES), and a Knowledge Questionnaire (KQ) devised by the authors of the program. The questionnaires were administered in both the experimental and control groups, one week before the intervention, one week afterwards, and at six-month and 12-month follow-ups. Unlike a previous school-based eating disorder prevention program, in the experimental group both an increase in knowledge and a decrease in some attitudes were maintained at 12-month follow-up (Eating Concerns EDE-Q scores). Although more intensive interventions seem necessary to modify shape and weight concern and self-esteem, these findings suggest that the intervention had been useful since it led to both an increase in knowledge and a decrease in some dysfunctional eating attitudes.     

Middle School Primary Prevention Program for Eating Disorders: A Controlled Study with a Twelve-Month Follow-Up

The aim of this pilot study was to evaluate the efficacy of a new school-based eating disorder prevention program designed to reduce dietary restraint and the level of preoccupation with regard to shape and weight. One hundred and six (61 females and 45 males) 11 to 12-year-old students were evaluated, 55 of whom participated in the program (experimental group). An additional 51 students formed the control group. The program met for six sessions, two hours per session. After six months, the experimental group received two booster sessions of two hours in two consecutive weeks. Outcome measures included the Eating Disorder ExaminationQuestionnaire (EDE-Q), the children's version of the Eating Attitudes Test (EAT), the Rosenberg Self-Esteem Scale (RSES), and a Knowledge Questionnaire (KQ) devised by the authors of the program. The questionnaires were administered in both the experimental and control groups, one week before the intervention, one week afterwards, and at six-month and 12-month follow-ups. Unlike a previous school-based eating disorder prevention program, in the experimental group both an increase in knowledge and a decrease in some attitudes were maintained at 12-month follow-up (Eating Concerns EDE-Q scores). Although more intensive interventions seem necessary to modify shape and weight concern and self-esteem, these findings suggest that the intervention had been useful since it led to both an increase in knowledge and a decrease in some dysfunctional eating attitudes.     

Self-reported depressive symptoms in first-grade children: developmentally transient phenomena?

The question of whether self-reported depressive symptoms in young children represent more than transient developmental phenomena was examined in an epidemiologically defined sample of 1,313 first graders. Children's reports of depressive symptoms were relatively stable over a 4-month interval. The level of stability was particularly impressive for children initially in the highest quartile of depression, of all whom remained in the highest quartile at retest, 4 months later. In addition, depressive symptoms were significantly related to the negotiation of a number of salient developmental tasks at entrance to first grade, including academic achievement, peer relations, and attention/concentration in the classroom. Moreover, the relationships between depressive symptoms and the various indices of social and academic functioning remained stable over the 4-month test-retest interval.