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

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.

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Effectiveness of group CBT in treating adolescents with depression symptoms: a critical review

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2015-0080 ◽

2016 ◽

Vol 29 (3) ◽

Cited By ~ 2

Author(s):

Bernardo Nardi ◽

Micaela Massei ◽

Emidio Arimatea ◽

Andrés Moltedo-Perfetti

Keyword(s):

Depressive Symptoms ◽

Cognitive Behavioral Therapy ◽

Adolescent Depression ◽

Behavioral Therapy ◽

Therapy Group ◽

Cognitive Behavioral ◽

Control Group ◽

Depression Symptoms ◽

Self Awareness ◽

Pubmed Search

Abstract Depression is among the most common psychological disorders of adolescents. Its management is based on pharmacological treatment, psychological therapy, or a combination thereof. Cognitive behavioral therapy (CBT) is the most extensively tested intervention for adolescent depression. A PubMed search was conducted for randomized controlled trials (RCT) of the efficacy of CBT in treating adolescents with depressive symptoms published in 2005–2015. Keywords were “cognitive behavioral therapy”, “group therapy”, “depression” and “adolescent”. Of the 23 papers that were retrieved, only six met all inclusion criteria. Three of them reported a significant reduction in depressive symptom severity after either individual or group (G)-CBT compared with the control group, even with a small number of CBT sessions (six rather than 10–12), with a medium or medium-to-large effect size. One study reported improved self-awareness and a significantly greater increase in perceived friend social support compared with bibliotherapy and check with brochure. Two studies reported clinical symptom reduction without significant differences compared with the control group (activity contrast). This review highlighted primarily that very few RCT have applied CBT in adolescents; moreover, it confirmed the effectiveness of G-CBT, especially as psychotherapy, although it was not always superior to other interventions (e.g. other activities in prevention programs). Comparison showed that G-CBT and group interpersonal psychotherapy were both effective in reducing depressive symptoms. Successful G-CBT outcomes were related to the presence of peers, who were an important source of feedback and support to observe, learn, and practice new skills to manage depressive symptoms and improve social-relational skills.

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Comparing Cognitive Behavioral Therapy, Antidepressant Medication, and Combined Treatment in Individuals With Hypochondriasis

PsycEXTRA Dataset ◽

10.1037/e537002011-001 ◽

2011 ◽

Author(s):

Arthur J. Barsky ◽

Brian Fallon

Keyword(s):

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Combined Treatment ◽

Antidepressant Medication ◽

Cognitive Behavioral

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Adding cognitive behavioral therapy to treatment plans reduces depressive symptoms among adolescents

PsycEXTRA Dataset ◽

10.1037/e556142006-014 ◽

2006 ◽

Keyword(s):

Depressive Symptoms ◽

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Treatment Plans

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Cognitive Behavioral Therapy, Ketamine, and Combination Treatment for Depression: Impressions of Credibility in Participants with Self-Reported Depressive Symptoms

Journal of Psychoactive Drugs ◽

10.1080/02791072.2021.1912863 ◽

2021 ◽

pp. 1-11

Author(s):

Mitch Earleywine ◽

Brianna R. Altman ◽

Joseph De Leo

Keyword(s):

Depressive Symptoms ◽

Cognitive Behavioral Therapy ◽

Combination Treatment ◽

Behavioral Therapy ◽

Cognitive Behavioral

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Barriers to Cognitive Behavioral Therapy Homework Completion Scale–Depression Version: Development and Psychometric Evaluation

International Journal of Cognitive Therapy ◽

10.1521/ijct.2012.5.2.219 ◽

2012 ◽

Vol 5 (2) ◽

pp. 219-235 ◽

Cited By ~ 4

Author(s):

Judith A. Callan ◽

Jacqueline Dunbar-Jacob ◽

Susan M. Sereika ◽

Clement Stone ◽

Amy Fasiczka ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Psychometric Evaluation ◽

Cognitive Behavioral ◽

Homework Completion

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The impact of depressive symptoms on response to integrated cognitive behavioral therapy for substance use disorders and intimate partner violence

Advances in Dual Diagnosis ◽

10.1108/add-09-2020-0020 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Lourah M. Kelly ◽

Cory A. Crane ◽

Kristyn Zajac ◽

Caroline J. Easton

Keyword(s):

Intimate Partner Violence ◽

Substance Use ◽

Depressive Symptoms ◽

Cognitive Behavioral Therapy ◽

Treatment Response ◽

Partner Violence ◽

Behavioral Therapy ◽

Intimate Partner ◽

Cognitive Behavioral ◽

Content Type

Purpose Past studies demonstrated the efficacy of integrated cognitive-behavioral therapy (CBT) for substance use disorder (SUD) and intimate partner violence (IPV) as well as high rates of depressive symptoms in this population. However, little is known about how depressive symptoms impact treatment outcomes. The authors hypothesized that integrated CBT, but not standard drug counseling (DC), would buffer the negative effects of depressive symptoms on treatment response. Design/methodology/approach A secondary analysis of a randomized trial compared men assigned to 12 weeks of integrated CBT for SUD and IPV (n = 29) to those in DC (n = 34). Findings Most (60%) of the sample reported any depressive symptoms. Controlling for baseline IPV, reporting any depressive symptoms was associated with more positive cocaine screens during treatment. Among men with depressive symptoms, integrated CBT but not DC was associated with fewer positive cocaine screens. Controlling for baseline alcohol variables, integrated CBT and depressive symptoms were each associated with less aggression outside of intimate relationships (family, strangers, etc.) during treatment. For men without depressive symptoms, integrated CBT was associated with less non-IPV aggression compared to DC. Effects were not significant for other substances, IPV, or at follow-up. Research limitations/implications This study found some evidence for differential response to CBT by depressive symptoms on cocaine and aggression at end of treatment, which did not persist three months later. Future studies should explore mechanisms of integrated CBT for SUD and IPV, including mood regulation, on depressive symptoms in real-world samples. Practical implications Integrated CBT buffered depressive symptoms’ impact on cocaine use, yet only improved non-IPV aggression in men without depressive symptoms. Originality/value Although integrated CBT’s efficacy for improving SUD and IPV has been established, moderators of treatment response have not been investigated.

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Blended Care-Cognitive Behavioral Therapy for Depression and Anxiety in Real-World Settings: Pragmatic Retrospective Study (Preprint)

10.2196/preprints.18723 ◽

2020 ◽

Author(s):

Anita Lungu ◽

Janie Jihee Jun ◽

Okhtay Azarmanesh ◽

Yan Leykin ◽

Connie E-Jean Chen

Keyword(s):

Cognitive Behavioral Therapy ◽

Real World ◽

Behavioral Therapy ◽

Anxiety Symptoms ◽

Cognitive Behavioral ◽

Depression And Anxiety ◽

Symptoms Of Depression ◽

Care Intervention ◽

Blended Care ◽

Over Time

BACKGROUND The past few decades saw considerable advances in research and dissemination of evidence-based psychotherapies, yet available treatment resources are not able to meet the high need for care for individuals suffering from depression or anxiety. Blended care psychotherapy, which combines the strengths of therapist-led and internet interventions, can narrow this gap and be clinically effective and efficient, but has rarely been evaluated outside of controlled research settings. OBJECTIVE This study evaluated the effectiveness of a blended care intervention (video-based cognitive behavior therapy and internet intervention) under real-world conditions. METHODS This is a pragmatic retrospective cohort analysis of 385 participants with clinical range depression and/or anxiety symptoms at baseline, measured using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), who enrolled in blended care psychotherapy treatment. Participants resided in the United States and had access to the blended care intervention as a mental health benefit offered through their employers. Levels of depression and anxiety were tracked throughout treatment. Hierarchical linear modeling was used to examine the change in symptoms over time. The effects of age, gender, and providers on participants’ symptom change trajectories were also evaluated. Paired sample t-tests were also conducted, and rates of positive clinical change and clinically significant improvement were calculated. RESULTS The average depression and anxiety symptoms at 6 weeks after the start of treatment were 5.94 and 6.57, respectively. There were significant linear effects of time on both symptoms of depression and anxiety (β=–.49, <i>P</i><.001 and β=–.64, <i>P</i><.001). The quadratic effect was also significant for both symptoms of depression and anxiety (β=.04, P<.001 for both), suggesting a decelerated decrease in symptoms over time. Approximately 73% (n=283) of all 385 participants demonstrated reliable improvement, and 83% (n=319) recovered on either the PHQ-9 or GAD-7 measures. Large effect sizes were observed on both symptoms of depression (Cohen d=1.08) and of anxiety (d=1.33). CONCLUSIONS Video blended care cognitive behavioral therapy interventions can be effective and efficient in treating symptoms of depression and anxiety in real-world conditions. Future research should investigate the differential and interactive contribution of the therapist-led and digital components of care to patient outcomes to optimize care.

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