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School-Based Cognitive-Behavioral Therapy for Adolescent Depression S.R. Shirk, H. Kaplinski & G. Gudmundsen (2009)
Shawna Sjoquist
APSY 674
OUTLINE
Introduction Design Method (Sample, Measures, Treatment, Procedure) Results (Preliminary Analysis, Predictors of Outcomes) Strengths/ Limitations
Further Implications
DEPRESSION
Emotional/ Affective Symptoms
Cognitive Symptoms Motivational Symptoms Physical Symptoms
Dysphonic mood Inability to experience enjoyment
DEPRESSION
15% to 20% of adolescents will experience major depression, with annual incidence rate of 7.7%
Randomized control trials have revealed moderate to large treatment effects for adolescent depression.
Advancing as a promising evidence-based treatment for adolescent depression (Kazdin & Weisz, 2003)
Comparable results for CBT under clinically representative conditions (i.e. School mental health services).
CURRENT
STUDY
DESIGN
Benchmarking Strategy
Magnitude Predictors
Naturalistic Design
Evaluation
Treatment Response
METHOD: SAMPLE
50 adolescents Selected from 4 high schools in the Rocky Mountain West region.
Diversity
Gender
Male 32%
Female 68%
14
Comorbid Disorders
3+ Disorders
11%
20% 40% GAD CD Social Phobia ADHD
29%
METHOD: MEASURES
C-DISC-IV (Mood, Anxiety, Disruptive Behavior Disorder Modules) (Shaffer et al., 2000).
Good psychometric properties and Research supports use with adolescents. Pre, mid and post-treatment
METHOD: MEASURES
Evaluated exposure to stress and pre-treatment perception of stress Internal reliability set at .82
Trauma History
Self reported item added to the LEQ Indicated presence or absence of exposure to traumatic event.
Demographic Information
Gender, Age, Grade, Race-ethnicity Number of sessions attended.
12 Session Manual Based CBT Culturally sensitive protocol was selected Slight cultural modifications made Delivered by 8 doctoral level psychologists Three Components:
Treatment Fidelity
METHOD: PROCEDURES
Identification Informed Consent Pre-treatment intake sessions Treatment occurred in school-based clinics C-DISC-IV and BDI at 2 weeks post completion or 14 weeks after treatment start date were termination occurred prior to week 12.
Overall
Avg. of 8.8 sessions completed; 58% full completion Significant reduction in depressive symptoms on BDI pre and post-treatment No significant therapist or school effects of outcomes.
2. 5 times as large
STUDY STRENGTHS
STUDY LIMITATIONS
Address long-term outcomes for CBT in school settings Impact of CBT on academic outcomes Potential impact of therapist training and supervision outcomes Evaluate outcomes of school based CBT delivered by school-based clinicians.
IMPLICATIONS: PRACTICE
Potential treatment approach for school based services Associated treatment costs
FINAL THOUGHTS
REFERENCES
Kazdin, A., & Weisz, J. (Eds.). (2003). Evidence-based psychotherapies for children and adolescents. New York: Guilford.
Shirk, S. R., Kaplinski, H., & Gudmundsen, G. (2009). School-Based CognitiveBehavioral Therapy for Adolescent Depression: A Benchmarking Study. Journal Of Emotional & Behavioral Disorders, 17(2), 106-117.
Rice, K & McLaughlin, T. F. (2001). Childhood and Adolescent Depression: A Review with Suggestions for Special Educators. International Journal of Special Education, 16(2), 85-96 Shaffer, D., Fisher, P., Lucas, C., Dulcan, M., & Schwab-Stone, M. (2000). NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): Description, differences from pre-vious versions, and reliability of some common diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 2838.
Newcomb, M., Huba, G., & Bentler, P. (1981). A multidimensional assessment of stressful life events among adolescents: Derivation and correlates. Journal of Health and Social Behavior, 22, 400415.