TY - JOUR
T1 - Relative Effectiveness of CBT-Components and Sequencing in Indicated Depression Prevention for Adolescents
T2 - A Cluster-Randomized Microtrial
AU - van den Heuvel, Marieke W.H.
AU - Bodden, Denise H.M.
AU - Smit, Filip
AU - Stikkelbroek, Yvonne
AU - Weisz, John R.
AU - Moerbeek, Mirjam
AU - Engels, Rutger C.M.E.
N1 - Funding Information:
Dutch Organization for Health research and Development (ZonMw), Grant number 729300012. We acknowledge the Consortium Anxiety and Depression in Youth within which the study was embedded. We thank the therapists and student- and research assistants for their contribution to the project. We are also grateful to the schools that collaborated, and all participating adolescents and parents. Lastly, we thank the two anonymous peer reviewers for their constructive comments.
Publisher Copyright:
© 2021 The Author(s). Published with license by Taylor & Francis Group, LLC.
PY - 2023
Y1 - 2023
N2 - Objective: Cognitive Behavioral Therapy (CBT) was dismantled into four modules of three sessions each: cognitive restructuring (Think), behavioral activation (Act), problem solving (Solve) and relaxation (Relax). We investigated the modules’ relative effectiveness in indicated depression prevention for adolescents and examined variations in sequencing of these modules. Method: We performed a pragmatic cluster-randomized microtrial with four parallel conditions: (1) Think-Act-Relax-Solve (n = 14 clusters, n = 81 participants); (2) Act-Think-Relax-Solve (n = 13, n = 69); (3) Solve-Act-Think-Relax (n = 13, n = 77); and (4) Relax-Solve-Act-Think (n = 12, n = 55). The sample consisted of 282 Dutch adolescents with elevated depressive symptoms (Mage = 13.8; 55.7% girls, 92.9% Dutch). In total 52 treatment groups were randomized as a cluster. Assessments were conducted at baseline, after each module and at 6-month follow-up with depressive symptoms as primary outcome. Results: None of the modules (Think, Act, Solve, Relax) was associated with a significant decrease in depressive symptoms after three sessions and no significant differences in effectiveness were found between the modules. All sequences of modules were associated with a significant decrease in depressive symptoms at post-intervention, except the sequence Relax-Solve-Act-Think. At 6-month follow-up, all sequences showed a significant decrease in depressive symptoms. No significant differences in effectiveness were found between the sequences at post-intervention and 6-month follow-up. Conclusions: Regardless of the CBT technique provided, one module of three sessions may not be sufficient to reduce depressive symptoms. The sequence in which the CBT components cognitive restructuring, behavioral activation, problem solving and relaxation are offered, does not appear to significantly influence outcomes at post- intervention or 6-month follow-up. Abbreviations: CDI-2:F: Children’s Depression Inventory-2 Full-length version; CDI-2:S: Children’s Depression Inventory-2 Short version; STARr: Solve, Think, Act, Relax and repeat.
AB - Objective: Cognitive Behavioral Therapy (CBT) was dismantled into four modules of three sessions each: cognitive restructuring (Think), behavioral activation (Act), problem solving (Solve) and relaxation (Relax). We investigated the modules’ relative effectiveness in indicated depression prevention for adolescents and examined variations in sequencing of these modules. Method: We performed a pragmatic cluster-randomized microtrial with four parallel conditions: (1) Think-Act-Relax-Solve (n = 14 clusters, n = 81 participants); (2) Act-Think-Relax-Solve (n = 13, n = 69); (3) Solve-Act-Think-Relax (n = 13, n = 77); and (4) Relax-Solve-Act-Think (n = 12, n = 55). The sample consisted of 282 Dutch adolescents with elevated depressive symptoms (Mage = 13.8; 55.7% girls, 92.9% Dutch). In total 52 treatment groups were randomized as a cluster. Assessments were conducted at baseline, after each module and at 6-month follow-up with depressive symptoms as primary outcome. Results: None of the modules (Think, Act, Solve, Relax) was associated with a significant decrease in depressive symptoms after three sessions and no significant differences in effectiveness were found between the modules. All sequences of modules were associated with a significant decrease in depressive symptoms at post-intervention, except the sequence Relax-Solve-Act-Think. At 6-month follow-up, all sequences showed a significant decrease in depressive symptoms. No significant differences in effectiveness were found between the sequences at post-intervention and 6-month follow-up. Conclusions: Regardless of the CBT technique provided, one module of three sessions may not be sufficient to reduce depressive symptoms. The sequence in which the CBT components cognitive restructuring, behavioral activation, problem solving and relaxation are offered, does not appear to significantly influence outcomes at post- intervention or 6-month follow-up. Abbreviations: CDI-2:F: Children’s Depression Inventory-2 Full-length version; CDI-2:S: Children’s Depression Inventory-2 Short version; STARr: Solve, Think, Act, Relax and repeat.
KW - Child steps
KW - Cognitive-behavioral therapy
KW - Conduct problems
KW - Effectiveness trial
KW - Efficacy
KW - Interventions
KW - Metaanalysis
KW - Psychotherapy
KW - Standard
KW - Youth
UR - http://www.scopus.com/inward/record.url?scp=85117240520&partnerID=8YFLogxK
U2 - 10.1080/15374416.2021.1978296
DO - 10.1080/15374416.2021.1978296
M3 - Article
AN - SCOPUS:85117240520
SN - 1537-4416
VL - 52
SP - 503
EP - 518
JO - Journal of Clinical Child and Adolescent Psychology
JF - Journal of Clinical Child and Adolescent Psychology
IS - 4
ER -