scholarly journals Developing a data-driven algorithm for guiding selection between cognitive behavioral therapy, fluoxetine, and combination treatment for adolescent depression

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Meredith Gunlicks-Stoessel ◽  
Bonnie Klimes-Dougan ◽  
Adrienne VanZomeren ◽  
Sisi Ma
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Combination Treatment ◽  
Adolescent Depression ◽  
Behavioral Therapy ◽  
Individual Characteristics ◽  
Cognitive Behavioral ◽  
Treatment Type ◽  
Children’S Depression ◽  
Starting Point ◽  
Wide Range

Abstract Treating adolescent depression effectively requires providing interventions that are optimally suited to patients’ individual characteristics and needs. Therefore, we aim to develop an algorithm that matches patients with optimal treatment among cognitive-behavioral therapy (CBT), fluoxetine (FLX), and combination treatment (COMB). We leveraged data from a completed clinical trial, the Treatment for adolescents with depression study, where a wide range of demographic, clinical, and psychosocial measures were collected from adolescents diagnosed with major depressive disorder prior to treatment. Machine-learning techniques were employed to derive a model that predicts treatment response (week 12 children’s depression rating scale-revised [CDRS-R]) to CBT, FLX, and COMB. The resulting model successfully identified subgroups of patients that respond preferentially to specific types of treatment. Specifically, our model identified a subgroup of patients (25%) that achieved on average a 16.9 point benefit on the CDRS-R from FLX compared to CBT. The model also identified a subgroup of patients (50%) that achieved an average benefit up to 19.0 points from COMB compared to CBT. Physical illness and disability were identified as overall predictors of response to treatment, regardless of treatment type, whereas baseline CDRS-R, psychosomatic symptoms, school missed, view of self, treatment expectations, and attention problems determined the patients’ response to specific treatments. The model developed in this study provides a critical starting point for personalized treatment planning for adolescent depression.

scholarly journals Trauma informed interventions: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252747
Author(s):  
Hae-Ra Han ◽  
Hailey N. Miller ◽  
Manka Nkimbeng ◽  
Chakra Budhathoki ◽  
Tanya Mikhael ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Health Inequities ◽  
The United States ◽  
Psychological Outcomes ◽  
Cognitive Behavioral ◽  
Health Concern ◽  
Ptsd Symptoms ◽  
Wide Range ◽  
Trauma Informed

Background Health inequities remain a public health concern. Chronic adversity such as discrimination or racism as trauma may perpetuate health inequities in marginalized populations. There is a growing body of the literature on trauma informed and culturally competent care as essential elements of promoting health equity, yet no prior review has systematically addressed trauma informed interventions. The purpose of this study was to appraise the types, setting, scope, and delivery of trauma informed interventions and associated outcomes. Methods We performed database searches— PubMed, Embase, CINAHL, SCOPUS and PsycINFO—to identify quantitative studies published in English before June 2019. Thirty-two unique studies with one companion article met the eligibility criteria. Results More than half of the 32 studies were randomized controlled trials (n = 19). Thirteen studies were conducted in the United States. Child abuse, domestic violence, or sexual assault were the most common types of trauma addressed (n = 16). While the interventions were largely focused on reducing symptoms of post-traumatic stress disorder (PTSD) (n = 23), depression (n = 16), or anxiety (n = 10), trauma informed interventions were mostly delivered in an outpatient setting (n = 20) by medical professionals (n = 21). Two most frequently used interventions were eye movement desensitization and reprocessing (n = 6) and cognitive behavioral therapy (n = 5). Intervention fidelity was addressed in 16 studies. Trauma informed interventions significantly reduced PTSD symptoms in 11 of 23 studies. Fifteen studies found improvements in three main psychological outcomes including PTSD symptoms (11 of 23), depression (9 of 16), and anxiety (5 of 10). Cognitive behavioral therapy consistently improved a wide range of outcomes including depression, anxiety, emotional dysregulation, interpersonal problems, and risky behaviors (n = 5). Conclusions There is inconsistent evidence to support trauma informed interventions as an effective approach for psychological outcomes. Future trauma informed intervention should be expanded in scope to address a wide range of trauma types such as racism and discrimination. Additionally, a wider range of trauma outcomes should be studied.

Cognitive Behavioral Therapy for Insomnia for Caregivers

2019 ◽  
pp. 201-218
Author(s):  
Kelly M. Shaffer ◽  
Patricia Carter ◽  
Sheila N. Garland ◽  
Allison J. Applebaum
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Future Research ◽  
Contributing Factors ◽  
Compensatory Behaviors ◽  
Wide Range ◽  
Cancer Caregivers ◽  
Clinically Significant ◽  
Mental And Physical Health

Between 40% and 76% of cancer caregivers report clinically significant symptoms of insomnia, likely due in part to the unique responsibilities, stressors, and compensatory behaviors endemic to the role. Insomnia negatively affects one’s mental and physical health, is frequently chronic, and may impair the normal grieving process among bereaved caregivers. Cognitive behavioral therapy for insomnia (CBT-I) is a first-line treatment for insomnia and is well suited to address the multifaceted contributing factors unique to caregivers’ sleep disturbance. This chapter addresses the distinct presentation of insomnia among cancer caregivers and describes key modifications to standard CBT-I that address these specific needs to enhance sensitivity and feasibility. A case example demonstrates the implementation of CBT-I tailored to one caregiver’s presentation. Future research must demonstrate effectiveness and acceptability of CBT-I among active caregivers, as well as develop a wide range of effective CBT-I delivery modalities to best serve this vulnerable population.

Suitability for Short-Term Cognitive-Behavioral Therapy

2007 ◽  
Vol 21 (4) ◽  
pp. 334-345 ◽  
Author(s):  
Gail Myhr ◽  
Jeanne Talbot ◽  
Lawrence Annable ◽  
Gilbert Pinard
Keyword(s):  
Anxiety Disorder ◽  
Cognitive Behavioral Therapy ◽  
Rating Scale ◽  
Behavioral Therapy ◽  
Linear Regression Analysis ◽  
Cognitive Behavioral ◽  
Reliable Change Index ◽  
Short Term ◽  
Variable Model ◽  
Wide Range

The Suitability for Short-Term Cognitive Therapy Rating Scale (SRS) defines 10 criteria to assess suitability for short-term cognitive-behavioral therapy (CBT). This study examines the relationships between pretreatment SRS scores and outcome of 113 patients treated with short-term CBT for a wide range of disorders. Using the reliable change index (RCI) as a measure of outcome, 65 individuals (57.5%) of the sample experienced statistically reliable improvement. Married status, employed status, female gender, and anxiety disorder as a primary diagnosis were positively correlated with posttreatment RCI. Awareness of emotion and security operations were the SRS items most strongly correlated with outcome. Also correlated were the two alliance potential items (in-session and out-of-session evidence) and the acceptance of personal responsibility for change. Hierarchical multiple linear regression analysis resulted in a three-variable model where married status, primary anxiety disorder, and mean SRS score accounted for 20% of the variance in RCI scores. We conclude that the SRS adds predictive value to the assessment of potential to succeed in CBT.

Does Homework “Matter” in Cognitive Behavioral Therapy for Adolescent Depression?

2012 ◽  
Vol 26 (4) ◽  
pp. 390-404 ◽  
Author(s):  
Anne D. Simons ◽  
C. Nathan Marti ◽  
Paul Rohde ◽  
Cara C. Lewis ◽  
John Curry ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Cognitive Behavioral Therapy ◽  
Clinical Improvement ◽  
Adolescent Depression ◽  
Behavioral Therapy ◽  
Antidepressant Medication ◽  
Self Report ◽  
Cognitive Behavioral ◽  
Homework Completion ◽  
Over Time

Objective: Examine the degree to which homework completion is associated with various indices of clinical improvement in adolescents with depression treated with cognitive behavioral therapy (CBT) either as a monotherapy and in combination with antidepressant medication. Method: This study used data from the Treatment of Adolescents with Depression Study (TADS), which compared the efficacy of CBT, fluoxetine (FLX), the combination of CBT and FLX (COMB), and a pill placebo (PBO; TADS Team, 2003, 2004, 2005). Current analyses included only TADS participants in the CBT (n = 111) or COMB (n = 107) conditions. Analyses focused on the relations between partial and full homework completion and a dichotomized measure of clinical response, evaluator and self-report ratings of depressive symptoms, hopelessness, and suicidality. Results: Homework completion significantly predicted clinical improvement, decrease in self-reported hopelessness, suicidality, and depression—but not in evaluator-rated depressive symptoms—in adolescents treated with CBT only. These relationships were almost completely absent in the COMB condition. The only significant COMB finding was that partially completed homework was related to decrease in hopelessness over time. Conclusions: These findings suggest that the ability of therapists and clients to collaboratively develop and complete between-session assignments is associated with response to CBT, self-report of severity of depressive symptoms, hopelessness, and suicidality and may be integral to optimizing the effects of CBT when delivered as a monotherapy.

A Comparison of Cognitive-Behavioral Therapy, Sertraline, and Their Combination for Adolescent Depression

2006 ◽  
Vol 45 (10) ◽  
pp. 1151-1161 ◽  
Author(s):  
GLENN A. MELVIN ◽  
BRUCE J. TONGE ◽  
NEVILLE J. KING ◽  
DAVID HEYNE ◽  
MICHAEL S. GORDON ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Adolescent Depression ◽  
Behavioral Therapy ◽  
Cognitive Behavioral
Sign in / Sign up

Export Citation Format

Share Document