Reward-Related Neural Predictors and Mechanisms of Symptom Change in Cognitive Behavioral Therapy for Depressed Adolescent Girls

Background: The therapeutic alliance is considered an important causal agent of psychotherapy efficacy. However, studies in cognitive behavioral therapy (CBT) for depression have suggested that alliance might be more of a consequence rather than a cause of depressive symptom change, while adherence to CBT specific techniques was found to be associated with subsequent depression change. We aimed to add to this body of literature by assessing the temporal associations of both therapeutic alliance and manual adherence with depressive symptom change in a relatively large sample of depressed adult outpatients over the full course of CBT.Methods: Adults with a major depressive episode (n = 98) participating in a randomized clinical trial were offered 22 weeks of CBT and rated the Penn Helping Alliance Questionnaire (HAq-I) at weeks 5 and 22. Therapists rated their adherence to the CBT manual after each session and observers assessed the Hamilton Depression Rating Scale scores at weeks 0, 5, 10, and 22. Linear mixed model analyses were used to assess the associations of alliance and adherence with prior and subsequent depression change.Results: HAq-I Relationship and manual adherence ratings were not significantly associated with prior nor with subsequent depression change (p > 0.14). Prior depression change was associated with the HAq-I subscale Perceived helpfulness at the end of treatment (r = 0.30, CI = 0.03–0.56, p = 0.03).Conclusion: We were not able to replicate prior depression change in CBT for depression to be associated with improved quality of the therapeutic alliance when using a more “pure” measure of the therapeutic relationship. Limitations of this study include the subjective alliance and adherence assessments. Our findings indicate the need to appropriately distinguish between the perceived helpfulness and the relationship factors when examining therapeutic alliance.

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The Effectiveness of Adolescent-centered Mindfulness Training and Cognitive Behavioral Therapy on Depression and Suicidal Ideation in Adolescent Girls With Bipolar II Disorder

Caspian Journal of Neurological Sciences ◽

10.32598/cjns.5.19.175 ◽

2019 ◽

Vol 5 (4) ◽

pp. 175-184

Author(s):

Bahar Shayegh Borojeni ◽

◽

Gholamreza Manshaee ◽

Ilnaz Sajjadian ◽

◽

...

Keyword(s):

Suicidal Ideation ◽

Cognitive Behavioral Therapy ◽

Adolescent Girls ◽

Behavioral Therapy ◽

Mindfulness Training ◽

Cognitive Behavioral ◽

Bipolar Ii Disorder ◽

Bipolar Ii ◽

Post Test

Background: Cognitive behavioral therapy has provided the most empirical evidence concerning the treatment of mood disorders, especially depression. However, the findings have not confirmed the definitive efficacy of this treatment so far. Objectives: This study aimed to compare the effectiveness of adolescent-centered mindfulness training with cognitive behavioral therapy on depression and suicidal ideation in adolescent girls with bipolar II disorder. Materials & Methods: This was a quasi-experimental with pre-test, post-test design, a control group, and a 45-day follow-up. The study population consisted of all adolescent girls with bipolar II disorder referred to Al-Zahra Hospital in Isfahan. Using a convenience sampling method, we recruited 45 female patients with depression based on inclusion and exclusion criteria and then randomly divided into one control and two experimental groups (15 patients in each group). The subjects answered the research questionnaires, including depression and suicidal ideation of Beck version II before and after the intervention and 45 days later. One experimental group received Bourdick-based mindfulness training and one experimental group received, and another experimental group received cognitive behavioral therapy. Results: The results of covariance analysis showed that adolescent-centered mindfulness training and cognitive behavioral therapy were effective in reducing depression tested at post-test (F=64.94; P<0.001) and follow-up (F=28.35; P<0.001). Also, there was a significant effect on suicidal ideation reduction in the post-test (F=84.72; P<0.001) and follow-up (F=45.54; P<0.001). Cognitive-behavioral therapy results have been more effective in reducing both depression and suicidal ideation than adolescent-centered mindfulness training. Conclusion: Cognitive behavioral therapy has reduced depression and suicidal ideation by challenging negative self-thoughts and dysfunctional core beliefs, as well as changing patterns, and lifestyle.

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