Top

Gepubliceerd in:

17-03-2021 | Original Article

Youth Top Problems and Early Treatment Response to the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents

Auteurs: Lauren Milgram, Niza A. Tonarely, Jill Ehrenreich-May

Gepubliceerd in: Child Psychiatry & Human Development | Uitgave 3/2022

Abstract

The Top Problems assessment is an idiographic measure of client concerns that may allow clinicians to identify early treatment response. Few studies have examined early response to evidence-based therapies using Top Problems. We collected weekly Top Problems ratings from 95 youth with emotional disorders who received treatment using the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/UP-A). We assessed Top Problems rating change from session 1 to session 4, the role of pre-treatment variables in early Top Problems rating change, and the role of early Top Problems rating change in post-treatment symptom outcomes. Top Problems ratings decreased significantly from session 1 to session 4. Younger child age and higher parent cognitive flexibility were associated with early Top Problems improvement. Controlling for pre-treatment, early Top Problems rating change did not explain the variance in post-treatment outcomes. Future research should examine Top Problems trajectories over treatment course.

vorige artikel Child Abuse Potential in Young German Parents: Predictors, Associations with Self-reported Maltreatment and Intervention Use

volgende artikel Developmental Changes in the Association Between Cognitive Control and Anxiety

Weisz JR, Chu BC, Polo AJ (2004) Treatment dissemination and evidence-based practice: strengthening intervention through practitioner-researcher collaboration. Clin Psychol Sci Proc 11:300–307CrossRef

Guyatt G, Rennie D (eds) (2002) Users guides: essentials of evidence-based clinical practice. American Medical Association, Chicago

Cook SC, Schwartz AC, Kaslow NJ (2017) Evidence-based psychotherapy: advantages and challenges. Neurotherapeutics 14:537–545PubMedPubMedCentralCrossRef

American Psychological Association (2006) Evidence-based practice in psychology. APA President Task Force Evid Based Pract Psychol 61:271–285

Chorpita BF, Donkervoet C (2005) Implementation of the Felix Consent Decree in Hawaii: the impact of policy and practice development efforts on service delivery. In: Steele RG, Roberts MC (eds) Handbook of mental health services for children, adolescents, and families. Kluwer Academic/Plenum, New York, pp 317–332CrossRef

Jensen-Doss A, Hawley KM, Lopez M, Osterberg LD (2009) Using evidence-based treatments: the experiences of youth providers working under a mandate. Prof Psychol Res 40:417–424CrossRef

Hunsley J, Mash EJ (2007) Evidence-based assessment. Annu Rev Clin Psychol 3:29–51PubMedCrossRef

Jensen-Doss A, Hawley KM (2010) Understanding barriers to evidence-based assessment: clinician attitudes toward standardized assessment tools. J Clin Child Adolesc Psychol 39:885–896PubMedPubMedCentralCrossRef

Achenbach TM (2010) Advancing assessment of children and adolescents: commentary on evidence-based assessment of child and adolescent disorders. J Clin Child Adolesc Psychol 34:541–547CrossRef

10.

Bickman L (2008) A measurement feedback system (MFS) is necessary to improve mental health outcomes. J Am Acad Child Adolesc Psychiatry 47:1114–1119PubMedCrossRef

11.

Bickman L, Kelley SD, Breda C, de Andrade AR, Riemer M (2011) Effects of routine feedback to clinicians on mental health outcomes of youths: results of a randomized trial. Psychiatr Serv 62:1423–1429PubMedCrossRef

12.

Fortney JC, Unützer J, Wrenn G, Pyne JM, Smith GR, Schoenbaum M et al (2017) A tipping point for measurement-based care. Psychiatr Serv 68:179–188PubMedCrossRef

13.

Gondek D, Edbrooke-Childs J, Fink E, Deighton J, Wolpert M (2016) Feedback from outcome measures and treatment effectiveness, treatment efficiency, and collaborative practice: a systematic review. Adm Policy Ment Health 43:325–343PubMedPubMedCentralCrossRef

14.

Lambert MJ, Whipple JL, Hawkins EJ, Vermeersch DA, Nielsen SL, Smart DW (2003) Is it time for clinicians to routinely track patient outcome? A meta-analysis. Clin Psychol Sci Proc 10:288–301CrossRef

15.

Weisz JR, Vaughn-Coaxum RA, Evans SC, Thomassin K, Hersh J, Ng MY et al. (2019) Efficient monitoring of treatment response during youth psychotherapy: the behavior and feelings survey. J Clin Child Adolesc Psychol 49:737–751

16.

Hatfield DR, Ogles BM (2004) The use of outcome measures by psychologists in clinical practice. Prof Psychol Res 35:485–491CrossRef

17.

Phelps R, Eisman EJ, Kohout J (1998) Psychological practice and managed care: results of the CAPP practitioner survey. Prof Psychol Res 29:31–36CrossRef

18.

Garland A, Kruse M, Aarons GA (2003) Clinicians and outcome measurement: what’s the use? J Behav Health Serv Res 30:393–405PubMedCrossRef

19.

Gilbody SM, House AO, Sheldon TA (2002) Psychiatrists in the UK do not use outcomes measures: national survey. Br J Psychiatry 180:101–103PubMedCrossRef

20.

Hatfield DR, Ogles BM (2007) Why some clinicians use outcome measures and others do not. Adm Policy Ment Health 34:283–291PubMedCrossRef

21.

Margison F, Barkham M, Evans C, McGrath G, Clark JM, Audin K, Connell J (2000) Measurement and psychotherapy: evidence-based practice and practice-based evidence. Br J Psychiatry 177:123–130PubMedCrossRef

22.

Sales C, Alves PC (2012) Individualized patient-progress systems: why we need to move towards a personalized evaluation of psychological treatments. Can Psychol 53:115–121CrossRef

23.

Wasil A, Venturo-Conerly K, Gillespie S, Osborn T, Weisz JR (2019) Identifying culturally relevant problems: using the idiographic Top Problems assessment to identify the concerns of resource-poor Kenyan adolescents. PsyArxiv.

24.

Ng MY, Weisz JR (2016) Building a science of personalized intervention for youth mental health. J Child Psychol Psychiatry 57:216–236PubMedCrossRef

25.

Ashworth M, Evans C, Clement S (2008) Measuring psychological outcomes after cognitive behavior therapy in primary care: a comparison between a new patient-generated measure “PSYCHLOPS” (Psychological Outcome Profiles) and “HADS” (Hospital Anxiety and Depression Scale). J Ment Health 18:1–9

26.

Jensen-Doss A, Smith AM, Becker-Haimes EM, Ringle VM, Walsh LM, Nanda M et al (2018) Individualized progress measures are more acceptable to clinicians than standardized measures: results of a national survey. Adm Policy Ment Health 45:392–403PubMedCrossRef

27.

Weisz JR, Chorpita BF, Frye A, Ng MY, Lau N, Bearman SK et al (2011) Youth top problems: using idiographic, consumer-guided assessment to identify treatment needs and to track change during psychotherapy. J Consult Clin Psychol 79:369–380PubMedCrossRef

28.

Nezu AM, Nezu CM (1993) Identifying and selecting target problems for clinical interventions: a problem-solving model. Psychol Assess 5:254–263CrossRef

29.

Dour HJ, Chorpita BF, Lee S, Weisz JR (2013) Sudden gains as a long-term predictor of treatment improvement among children in community mental health organizations. Behav Res Ther 51:564–572PubMedCrossRef

30.

Guan K, Park AL, Chorpita BF (2019) Emergent life events during youth evidence-based treatment: impact on future provider adherence and clinical progress. J Clin Child Adolesc Psychol 48:202–214CrossRef

31.

Weisz JR, Chorpita BF, Palinkas LA, Schoenwald SK, Miranda J, Bearman SK, Daleiden EL et al (2012) Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: a randomized effectiveness trial. Arch Gen Psychiatry 69:274–282PubMedCrossRef

32.

da Conceição Costa DL, Shavitt RG, Cesar RCC, Joaquim MA, Borcato S, Valério C et al (2013) Can early improvement be an indicator of treatment response in obsessive-compulsive disorder? Implications for early-treatment decision-making. J Psychiatr Res 47:1700–1707PubMedCrossRef

33.

Wilson GT (1999) Rapid response to cognitive behavior therapy. Clin Psychol Sci Proc 6:289–292CrossRef

34.

Lambert MJ (2007) Presidential address: what we have learned from a decade of research aimed at improving psychotherapy outcome in routine care? Psychother Res 17:1–14CrossRef

35.

Ilardi SS, Craighead WE (1994) The role of nonspecific factors in cognitive-behavior therapy for depression. Clin Psychol Sci Proc 1:138–156CrossRef

36.

Rush AJ, Kovacs M, Beck AT, Weissenburger J, Hollon SD (1981) Differential effects of cognitive therapy and pharmacotherapy on depressive symptoms. J Affect Disord 3:221–229PubMedCrossRef

37.

Persons JB, Thomas C (2019) Symptom severity at week 4 of cognitive-behavior therapy predicts depression remission. Behav Ther 50:791–802PubMedCrossRef

38.

Bradford A, Cully J, Rhoades H, Kunik M, Kraus-Schuman C, Wilson N et al (2011) Early response to psychotherapy and long-term change in worry symptoms in older adults with generalized anxiety disorder. Am J Geriatr Psychiatry 19:347–356PubMedPubMedCentralCrossRef

39.

Krompinger JW, Monaghan SC, Gironda CM, Garner LE, Crosby JM, Brennan BP et al (2017) Early response is predictive of outcome in intensive behavioral treatment for obsessive compulsive disorder. J Obsess Compul Rel Disord 15:57–63

40.

Torp NC, Skarphedinsson G (2017) Early responders and remitters to exposure based CBT for pediatric OCD. J Obsess Compul Rel Disord 12:71–77

41.

Torp NC, Weidle B, Thomsen PH, Skarphedinsson G, Aalberg M, Nissen JB, et al. (2019) Is it time to rethink standard dosage of exposure-based cognitive behavioral therapy for pediatric obsessive-compulsive disorder? Psychiatry Res 281:11600

42.

Wamser-Nanney R, Scheeringa MS, Weems CF (2016) Early treatment response in children and adolescents receiving CBT for trauma. J Pediatr Psychol 41:128–137PubMedCrossRef

43.

Beard JI, Delgadillo J (2019) Early response to psychological therapy as a predictor of depression and anxiety treatment outcomes: a systematic review and meta-analysis. Depress Anxiety 36:866–878PubMedCrossRef

44.

Crits-Christoph P, Connolly MB, Gallop R, Barber JP, Tu X, Gladis M et al (2001) Early improvement during manual-guided cognitive and dynamic psychotherapies predicts 16-week remission status. J Psychother Pract Res 10:145–154PubMedPubMedCentral

45.

Haas E, Hill RD, Lambert MJ, Morrell B (2002) Do early responders to psychotherapy maintain treatment gains? J Clin Psychol 58:1157–1172PubMedCrossRef

46.

Rech M, Weinzimmer S, Geller D, McGuire JF, Schneider SC, Patyk KC, De Nadai AS, Cepeda SC, Small BJ, Murphy TK, Wilhelm S, Storch EA (2020) Symptom trajectories of early responders and remitters among youth with OCD. J Obsess Compul Rel Disord 27

47.

Schlagert HS, Hiller W (2017) The predictive value of early response in patients with depressive disorders. Psychother Res 27:488–500PubMedCrossRef

48.

Higa CK, Chorpita BF (2008) Evidence-based therapies: translating research into practice. In: Steele RG, Elkin TD, Roberts MC (eds) Handbook of evidence-based therapies for children and adolescents: bridging science and practice. Springer, New York, pp 45–61CrossRef

49.

Riemer M, Rosof-Williams J, Bickman L (2005) Theories related to changing clinician practice. Child Adolesc Psychiatr Clin N Am 14:241–254PubMedCrossRef

50.

Marchette LK, Weisz JR (2017) Practitioner review: empirical evolution of youth psychotherapy toward transdiagnostic approaches. J Child Psychol Psychiatry 58:970–984PubMedCrossRef

51.

Barlow DH, Allen LB, Choate ML (2004) Toward a unified treatment for emotional disorders. Behav Ther 35:205–230CrossRef

52.

Harvey AG, Watkins E, Mansell W, Shafran R (2004) Cognitive behavioural processes across psychological disorders: a transdiagnostic approach to research and treatment. Oxford University Press, OxfordCrossRef

53.

Morris L, Mansell W (2018) A systematic review of the relationship between rigidity/flexibility and transdiagnostic cognitive and behavioral processes that maintain psychopathology. J Exp Psychopathol 9:1–40CrossRef

54.

Sighvatsson MB, Salkovskis PM, Sigurdsson E, Valdimarsdottir HB, Thorsdottir F, Sigurdsson JF (2019) ‘You should always look at the washing machine without actually being in it!’ Thematic framework analysis of patients’ understanding of transdiagnostic cognitive behaviour therapy and its mechanisms. Psychol Psychother 93:258–275PubMedCrossRef

55.

Chasson GS, Bello MS, Luxon AM, Graham TAA, Leventhal AM (2017) Transdiagnostic emotional vulnerabilities linking obsessive-compulsive and depressive symptoms in a community-based sample of adolescents. Depress Anxiety 34:761–769PubMedPubMedCentralCrossRef

56.

McHugh RK, Kertz SJ, Weiss RB, Baskin-Sommers A, Hearon BA, Björgvinsson T (2014) Changes in distress intolerance and treatment outcome in a partial hospital setting. Behav Ther 45:232–240PubMedCrossRef

57.

Barlow DH, Sauer-Zavala S, Carl JR, Bullis JR, Ellard KK (2014) The nature, diagnosis, and treatment of neuroticism: Back to the future. Clin Psychol Sci 2:344–365CrossRef

58.

Tonarely NA, Sherman JA, Grossman R, Shaw AM, Ehrenreich-May J (in press) Neuroticism as an underlying construct in youth emotional disorders. Bull Menninger Clin

59.

Ehrenreich-May J, Kennedy SM, Sherman JA, Bilek EL, Buzzella BA, Bennett SM et al (2018) Unified protocols for transdiagnostic treatment of emotional disorders in children and adolescents: therapist guide. Oxford University Press, New York

60.

Sherman JA, Ehrenreich-May J (in press) An analysis of change processes in the transdiagnostic treatment of emotional disorders in adolescents.

61.

Ehrenreich JT, Goldstein CM, Wright LR, Barlow DH (2009) Development of a unified protocol for the treatment of emotional disorders in youth. Child Fam Behav Ther 31:20–37PubMedPubMedCentralCrossRef

62.

Ehrenreich-May J, Rosenfield D, Queen AH, Kennedy SM, Remmes CS, Barlow DH (2017) An initial waitlist-controlled trial of the unified protocol for the treatment of emotional disorders in adolescents. J Anxiety Disord 46:46–55PubMedCrossRef

63.

Ehrenreich-May J, Queen AH, Bilek EL, Remmes CS, Marciel KK (2014) The unified protocols for the treatment of emotional disorders in children and adolescents. In: Ehrenreich-May J, Chu BC (eds) (2013) Transdiagnostic treatments for children and adolescents: principles and practice. Guilford Press, New York, pp 267–293

64.

Kennedy SM, Bilek EL, Ehrenreich-May J (2019) A randomized controlled pilot trial of the unified protocol for transdiagnostic treatment of emotional disorders in children. Behav Modif 43:330–360PubMedCrossRef

65.

Queen AH, Barlow DH, Ehrenreich-May J (2014) The trajectories of adolescent anxiety and depressive symptoms over the course of a transdiagnostic treatment. J Anxiety Disord 28:511–521PubMedCrossRef

66.

Kennedy SM, Halliday E, Ehrenreich-May J (2020) Trajectories of change and intermediate indicators of non-response to transdiagnostic treatment for children and adolescents. J Clin Child Adolesc Psychol 1–15

67.

Bodden DHM, Bogels SM, Nauta MH, De Haan E, Ringrose J, Appelboom C et al (2008) Child versus family cognitive–behavioral therapy in clinically anxious youth: an efficacy and partial effectiveness study. J Am Acad Child Adolesc Psychiatry 47:1384–1394PubMedCrossRef

68.

Curry J, Rohde P, Simons A, Silva S, Vitiello B, Kratochvil C, Reinecke M, Feeny N, Wells K, Pathak S, Weller E (2006) Predictors and moderators of acute outcome in the treatment for adolescents with depression study (TADS). J Am Acad Child Adolesc Psychiatry 45:1427–1439PubMedCrossRef

69.

Southam-Gerow MA, Kendall PC, Weersing VR (2001) Examining outcome variability: correlates of treatment response in a child and adolescent anxiety clinic. J Clin Child Psychol 30:422–436PubMedCrossRef

70.

Weisz JR, Weiss B, Alicke MD, Klotz ML (1987) Effectiveness of psychotherapy with children and adolescents: a meta-analysis for clinicians. J Consult Clin Psychol 55:542–549PubMedCrossRef

71.

Silverman WK, Albano AM (1996) Anxiety disorders interview schedule for DSM-IV, child and parent versions. Physiological Corporation, San Antonio, TX

72.

Silverman WK, Albano AM (in preparation) Anxiety disorders interview schedule for DSM-5, child and parent versions.

73.

American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders: DSM-IV. Author, Washington DC

74.

American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders: DSM-5. Author, Washington DC

75.

Lyneham HJ, Abbott MJ, Rapee RM (2007) Interrater reliability of the anxiety disorders interview schedule for DSM-IV: child and parent version. J Am Acad Child Adolesc Psychiatry 46:731–736PubMedCrossRef

76.

Silverman WK, Saavedra LM, Pina AA (2001) Test-retest reliability of anxiety symptoms and diagnoses with the anxiety disorders interview schedule for DSM-IV: child and parent versions. J Am Acad Child Adolesc Psychiatry 40:937–944PubMedCrossRef

77.

Wood JJ, Piacentini JC, Bergman RL, McCracken J, Barrios V (2002) Concurrent validity of the anxiety disorders section of the anxiety disorders interview schedule for DSM-IV: child and parent versions. J Clin Child Adolesc Psychol 31:335–342PubMedCrossRef

78.

Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E et al (1998) The mini-international neuropsychiatric interview (M.I.N.I): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59:22–33PubMed

79.

Duncan L, Georgiades K, Wang L, Van Lieshout RJ, MacMillan HL, Ferro MA et al (2018) Psychometric evaluation of the mini international neuropsychiatric interview for children and adolescents (MINI-KID). Psychol Assess 30:916–928PubMedCrossRef

80.

Sheehan DV, Sheehan KH, Shytle RD, Janavs J, Bannon Y, Rogers JE et al (2010) Reliability and validity of the mini international neuropsychiatric interview for children and adolescents (MINI-KID). J Clin Psychiatry 71:313–326PubMedCrossRef

81.

Gross JJ, John OP (2003) Individual differences in two emotion regulation processes: implications for affect, relationships, and wellbeing. J Pers Soc Psychol 85:348–362PubMedCrossRef

82.

Gullone E, Taffe J (2012) The emotion regulation questionnaire for children and adolescents (ERQ–CA): a psychometric evaluation. Psychol Assess 24:409–417PubMedCrossRef

83.

Simons JS, Gaher RM (2005) The distress tolerance scale: development and validation of a self-report measure. Motiv Emot 29:83–102CrossRef

84.

Leyro TM, Bernstein A, Vujanovic AA, McLeish AC, Zvolensky MJ (2011) Distress tolerance scale: a confirmatory factor analysis among daily cigarette smokers. J Psychopathol Behav Assess 33:47–57PubMedPubMedCentralCrossRef

85.

Tonarely NA, Ehrenreich-May J (2019) Confirming the factor structure and validity of the distress tolerance scale (dts) in youth. Child Psychiatry Hum Dev 51:514–526

86.

Chorpita BF, Yim L, Moffitt C, Umemoto LA, Francis SE (2000) Assessment of symptoms of DSM–IV anxiety and depression in children: a revised child anxiety and depression scale. Behav Res Ther 38:835–855PubMedCrossRef

87.

Chorpita BF, Moffitt CE, Gray J (2005) Psychometric properties of the revised child anxiety and depression scale in a clinical sample. Behav Res Ther 43:309–322PubMedCrossRef

88.

Barlow DH, Ellard KK, Fairholme C, Farchione TJ, Boisseau C, Allen L et al (2011) Unified protocol for transdiagnostic treatment of emotional disorders. Oxford University Press, New York

89.

Corp IBM (2017) IBM SPSS statistics for windows, version 2.50. IBM Corp, Armonk

90.

Reynolds S, Wilson C, Austin J, Hooper L (2012) Effects of psychotherapy for anxiety in children and adolescents: a meta-analytic review. Clin Psychol Rev 32:251–262PubMedCrossRef

91.

Weisz JR, McCarty CA, Valeri SM (2006) Effects of psychotherapy for depression in children and adolescents: a meta-analysis. Psychol Bull 132:132–149PubMedPubMedCentralCrossRef

92.

Lewinsohn PM, Clarke GN, Seeley JR, Rohde P (1994) Major depression in community adolescents: age at onset, episode duration, and time to recurrence. J Am Acad Child Adolesc Psychiatry 33:809–818PubMedCrossRef

93.

DiGiuseppe R, Linscott J, Jilton R (1996) Developing the therapeutic alliance in child-adolescent psychotherapy. Appl Prev Psychol 5:85–100CrossRef

94.

Kennedy SM, Tonarely NA, Sherman JA, Ehrenreich-May J (2018) Predictors of treatment outcome for the unified protocol for transdiagnostic treatment of emotional disorders in children (UP-C). J Anxiety Disord 57:66–75PubMedCrossRef

95.

Scott K, Lewis CC, Marti CN (2019) Trajectories of symptom change in the treatment for adolescents with depression study. J Am Acad Child Adolesc Psychiatry 58:319–328PubMedPubMedCentralCrossRef

96.

Skriner LC, Chu BC, Kaplan M, Bodden DH, Bögels SM, Kendall PC, Nauta MH, Silverman WK, Wood JJ, Barker DH, De La Torre J (2019) Trajectories and predictors of response in youth anxiety CBT: integrative data analysis. J Consult Clin Psychol 87:198–211PubMedCrossRef

97.

Hawley KM, Weisz JR (2003) Child, parent, and therapist (dis)agreement on target problems in outpatient therapy: the therapist’s dilemma and its implications. J Consult Clin Psychol 71:62–70PubMedCrossRef

98.

Yeh M, Weisz JR (2001) Why are we here at the clinic? Parent-child (dis)agreement on referral problems at outpatient treatment entry. J Consult Clin Psychol 69:1018–1025PubMedCrossRef

99.

Edelbrock C, Costello AJ, Dulcan MK, Conover NC, Kala R (1986) Parent-child agreement on child psychiatric symptoms assessed via structured interview. J Child Psychol Psychiatry 27:181–190PubMedCrossRef

Titel: Youth Top Problems and Early Treatment Response to the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents
Auteurs: Lauren Milgram
Niza A. Tonarely
Jill Ehrenreich-May
Publicatiedatum: 17-03-2021
Uitgeverij: Springer US
Gepubliceerd in: Child Psychiatry & Human Development / Uitgave 3/2022
Print ISSN: 0009-398X
Elektronisch ISSN: 1573-3327
DOI: https://doi.org/10.1007/s10578-021-01151-4

Bohn Stafleu van Loghum

Deel dit onderdeel of sectie (kopieer de link)

Abstract

Log in om toegang te krijgen

Andere artikelen Uitgave 3/2022

Developmental Changes in the Association Between Cognitive Control and Anxiety

A Preliminary Examination of the Interaction between Maternal Generalized Anxiety Disorder and Offspring Negative Affect in Relation to Maternal Worry about Offspring and Perceptions of Psychological Control

Role of Maternal Depression on Child Development: A Prospective Analysis from Pregnancy to Early Childhood

Interpretation Bias and Anticipated Distress in the Face of Ambiguity: Predictors of Change in Cognitive Behavioral Therapy for Youth Anxiety

Changes in Affective Network Variability Among Youth Treated for Anxiety Disorders

Familial Risk Factors in Relation to Recurrent Depression Among Former Adolescent Psychiatric Inpatients