Elsevier

Behavior Therapy

Volume 37, Issue 1, March 2006, Pages 36-48
Behavior Therapy

Effectiveness of Cognitive-Behavioral Therapy for Adolescent Depression: A Benchmarking Investigation☆

https://doi.org/10.1016/j.beth.2005.03.003Get rights and content

Abstract

In this study, we examined the effectiveness of cognitive-behavioral therapy (CBT) for adolescent depression. Outcomes of 80 youth treated with CBT in an outpatient depression specialty clinic, the Services for Teens at Risk Center (STAR), were compared to a “gold standard” CBT research benchmark. On average, youths treated with CBT in STAR experienced significantly slower symptom improvement than youths in the CBT benchmark. However, outcomes for STAR teens were more similar to the research benchmark when accounting for differences in referral source (clinical versus advertisement) between the datasets. Results support further efforts to test the effectiveness of CBT in clinically representative community practice settings and samples.

Section snippets

Participants

Participants for this investigation were drawn from two sources: (a) the patient database and medical records system of the STAR Center, an outpatient clinic providing treatment to depressed and suicidal adolescents, and (b) the research data file of the Brent et al. (1997) clinical trial of CBT for adolescent depression.

Comparison of samples

As can be seen in Table 1, the sample of youth receiving treatment in STAR was similar in many respects to the youth included in the Brent clinical trial. Youth demographic characteristics were virtually identical, with no significant differences between STAR and the RCT in terms of age, gender, or inclusion of minority youth (all p > .22). At intake, the level of depression symptoms endorsed on the BDI also was equivalent, although there was a trend toward higher rates of “double depression”

Discussion

In this investigation, we sought to address a basic, but unanswered, question about the treatment of depressed adolescents: Can CBT, the research standard of care for youth depression, produce positive effects in the samples and settings of real-world clinical service? We examined the outcomes of 80 depressed adolescents treated with CBT in an outpatient depression specialty clinic, the STAR Center. To anchor our evaluation of youth outcomes, we then compared the effects of treatment in STAR to

References (54)

  • M.E. Addis et al.

    A national survey of practicing psychologists’ attitudes toward psychotherapy treatment manuals

    Journal of Consulting and Clinical Psychology

    (2000)

  • Diagnostic and statistical manual of mental disorders

    (1987)

  • Diagnostic and statistical manual of mental disorders

    (2000)
  • R. Barbe et al.

    Suicidality and its relationship to treatment outcome in depressed adolescents

    Suicide and Life-Threatening Behavior

    (2004)
  • A.T. Beck et al.

    Cognitive therapy of depression

    (1979)
  • A.T. Beck et al.

    Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation

    Clinical Psychology Review

    (1988)
  • B. Birmaher et al.

    Practice parameters for the assessment and treatment of children and adolescents with depressive disorders

    Journal of the American Academy of Child and Adolescent Psychiatry

    (1998)
  • D.A. Brent et al.

    Psychiatric risk factors of adolescent suicide: A case control study

    Journal of the American Academy of Child and Adolescent Psychiatry

    (1993)
  • D.A. Brent et al.

    A psychoeducational program for families of affectively ill children and adolescents

    Journal of the American Academy of Child and Adolescent Psychiatry

    (1993)
  • D.A. Brent et al.

    Psychosocial interventions for treating adolescent suicidal depression: A comparison of three psychosocial interventions

  • D.A. Brent et al.

    A clinical psychotherapy trial for adolescent depression comparing cognitive, family, and supportive treatments

    Archives of General Psychiatry

    (1997)
  • D.A. Brent et al.

    Predictors of treatment efficacy in a clinical trial of three psychosocial treatments for adolescent depression

    Journal of the American Academy of Child and Adolescent Psychiatry

    (1998)
  • D.A. Brent et al.

    Cognitive-behavioral approaches to the treatment of depression and anxiety

  • A.S. Bryk et al.

    Hierarchical linear models: Applications and data analysis methods

    (1992)
  • W.J. Chambers 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

    Archives of General Psychiatry

    (1985)
  • G. Clarke et al.

    Cognitive-behavioral group treatment of adolescent depression: Prediction of outcome

    Behavior Therapy

    (1992)
  • G.N. Clarke et al.

    Cognitive-behavioral group treatment of adolescent depression: Efficacy of acute group treatment and booster sessions

    Journal of the American Academy of Child and Adolescent Psychiatry

    (1999)
  • G.N. Clarke et al.

    Group cognitive-behavioral treatment for depressed adolescent offspring of depressed parents in a health maintenance organization

    Journal of the American Academy of Child and Adolescent Psychiatry

    (2002)
  • M. Franklin et al.

    Effectiveness of exposure and ritual prevention for obsessive-compulsive disorder: Randomized compared with nonrandomized samples

    Journal of Consulting and Clinical Psychology

    (2000)
  • M.S. Gould et al.

    Psychopathology associated with suicidal ideation and attempts among children and adolescents

    Journal of the American Academy of Child and Adolescent Psychiatry

    (1998)
  • C. Hammen et al.

    The context of depression in clinic-referred youth: Neglected areas in treatment

    Journal of the American Academy of Child and Adolescent Psychiatry

    (1999)
  • K. Hoagwood et al.

    Outcomes of mental health care for children and adolescents: I. A comprehensive conceptual model

    Journal of the American Academy of Child and Adolescent Psychiatry

    (1996)
  • C.W. Hughes et al.

    The Texas children’s medication algorithm project: Report of the Texas consensus conference panel on medication treatment of childhood major depressive disorder

    Journal of the American Academy of Child and Adolescent Psychiatry

    (1999)
  • J. Kaufman et al.

    Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): Initial reliability and validity data

    Journal of the American Academy of Child and Adolescent Psychiatry

    (1997)
  • A.E. Kazdin et al.

    Drawing on clinical practice to inform research on child and adolescent psychotherapy: Survey of practitioners

    Professional Psychology: Research and Practice

    (1990)
  • P.C. Kendall et al.

    Normative comparisons in therapy outcome

    Behavioral Assessment

    (1988)
  • P.C. Kendall et al.

    Issues in the transportability of treatment: The case of anxiety disorders for youth

    Journal of Consulting and Clinical Psychology

    (1995)

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    ☆

    Data collection and manuscript preparation were facilitated by support from the National Institute of Mental Health, the Klingenstein Third Generation Foundation, and the William T. Grant Foundation. We gratefully acknowledge the following colleagues who aided in the conduct of this study and the preparation of this report: Laurel Beery-Chiappetta, Jeff Bridge, Richelle Cerrone, Henry Chan, Diane DeCecco, Colleen Grimm, Jeanie Knox-Houtsinger, Alissa Mohammed, Beverly Sughrue, and Jay Thornton. Thanks also to Teresa Treat, Alan Kazdin, David Armor, and David Axelson for their helpful comments on earlier drafts of the manuscript.

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