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A Clinical Psychotherapy Trial for Adolescent Depression Comparing Cognitive, Family, and Supportive Therapy
Abstract
BACKGROUND: Previous studies in nonclinical samples have shown psychosocial treatments to be efficacious in the treatment of adolescent depression, but few psychotherapy treatment studies have been conducted in clinically referred, depressed adolescents. METHODS: One hundred seven adolescent patients with DSM-III-R major depressive disorder (MDD) were randomly assigned to 1 of 3 treatments: individual cognitive behavior therapy, systemic behavior family therapy (SBFT), or individual nondirective supportive therapy (NST). Treatments were 12 to 16 sessions provided in as many weeks. Intent-to-treat analyses were conducted using all follow-up data. RESULTS: Of the 107 patients enrolled in the study, 78 (72.9%) completed the study, 4 (3.7%) never initiated treatment, 10 (9.3%) had exclusionary criteria that were undetected at entry, 8 (7.5%) dropped out, and 7 (6.5%) were removed for clinical reasons. Cognitive behavior therapy showed a lower rate of MDD at the end of treatment compared with NST (17.1% vs 42.4%; P = .02), and resulted in a higher rate of remission (64.7%, defined as absence of MDD and at least 3 consecutive Beck Depression Inventory scores < 9) than SBFT (37.9%; P = .03) or NST (39.4%; p = .04). Cognitive behavior therapy resulted in more rapid relief in interviewer-rated (vs both treatments, P = .03) and self-reported depression (vs SBFT, P = .02). All 3 treatments showed significant and similar reductions in suicidality and functional impairment. Parents' views of the credibility of cognitive behavior therapy improved compared with parents' views of both SBFT (P = .01) and NST (P = .05). CONCLUSIONS: Cognitive behavior therapy is more efficacious than SBFT or NST for adolescent MDD in clinical settings, resulting in more rapid and complete treatment response.
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“Trials comparing CBT to either family therapy or supportive psychotherapy show that it is better at both improving mood and achieving remission.9”
From Computerised cognitive behaviour therapy for depression in adolescents: Study protocol for a feasibility randomised controlled trial (2014) · cites this paper as [9]
In the citing paper
“Other bias | High risk | Authors state that an ITT analysis was carried out on all 107 participants in the Brent 1997 publication, however in the Renaud 1998 publication it states that analysis was carried out on 100 randomised participants (see ITT analysis de- tails above)”
From Interventions for preventing relapse and recurrence of a depressive disorder in children and adolescents (2012) · cites this paper as Brent 1997 publication
In the citing paper
“Random sequence genera- tion (selection bias) | Low risk |”
From Interventions for preventing relapse and recurrence of a depressive disorder in children and adolescents (2012) · cites this paper as Brent 1997 publication
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“There were few comparative psychotherapy trials with only three studies (Brent et al., 1997; Eggert et al., 2002; Spirito et al., 2015) comparing a psychological intervention to another or even to a different form of the same type of intervention (e.g. CBT for adolescents only, or adolescents and…”
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InfluentialTrajectories of Functioning Into Emerging Adulthood Following Treatment for Adolescent Depression
Peters, A. T., Jacobs, R. H., Feldhaus, C. G., Henry, D. B., Albano, A. M., Langenecker, S. A., Reinecke, M. A., Silva, S. G., & Curry, J. F. (2015) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2015.09.022 · Cited by 31
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BackgroundMethodResultInfluentialGlad for What TADS Adds, but Many TADS Grads Still Sad
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“With respect to methodology, half of the studies used an experimental design (Brent et al., 1997; Cotgrove et al., 1995; Greenfield et al., 2002; Harrington et al., 1998; Wood et al., 2001).”
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“Results from recent clinical trials (Brent et al., 1997; Kazdin, Esveldt-Dawson, French, & Unis, 1987; Weisz et al., 1995) suggest that even when therapies demonstrate efficacy, treatment failure for some youth is likely and should be of concern to mental health professionals.”
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“Treatment of major psychiatric disorders does not appear to necessarily reduce suicidal behavior or the number of suicide attempts (Brent et al., 1997; Khan et al., 2000).”
BackgroundA guide to what works for depression
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“There is now reasonable evidence for the efficacy of interpersonal psychotherapy and cognitive behavioral therapy without medication for the treatment of depressed adolescents (Mufson et al., 2004; Brent et al., 1997).”
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“Brent and colleagues [31] specified a number of predictors of poor response to CBT (defined as lack of recovery and high recurrence rates) that included severe baseline depression, recruitment from the clinic versus an advertisement, parent-child conflict, comorbid anxiety, and high levels of hopelessness.”
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“The intensity and focus of such sessions varied widely, from brief psychoeducation efforts (e.g., Brent et al. 1997) to parent sessions (generally between two and six sessions) in parallel to youth-only sessions (e.g., Garber et al. 2009; Shochet et al. 2001) to more directly family-focused…”
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“Clinicians serving Hispanic women have found similar psychological characteristics, including problems in the regulation of emotions and impulsivity that are known to be related to suicidality (Brent et al., 1997; Corruble, Damy, & Guelfi, 1999; Mann, Oquendo, Underwood, & Arango, 1999).”
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“Further, iterations of BFST (18) and other family-based interventions (19) have yielded positive outcomes in the broader youth depression literature.”
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“…of 13 to 18 involved parents, for example, family treatment that focused on learning the children’s treatment skills and on BPT components like family communication and problem solving (Brent et al., 1997; Clarke, Rohde, Lewinsohn, Hops, & Seeley, 1999; Lewinsohn, Clarke, Hops, & Andrews, 1990).”
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Letting the Story Unfold: A Case Study of Client-Centered Therapy for Childhood Traumatic Grief
Goodman, R. F., Morgan, A. V., Juriga, S., & Brown, E. J. (2004) · Harvard Review of Psychiatry · doi:10.1080/10673220490509534 · Cited by 21
Qin, B., Zhou, X., Michael, K. D., Liu, Y., Whittington, C. J., Cohen, D., Zhang, Y., & Xie, P. (2015) · BMJ Open · doi:10.1136/bmjopen-2014-005918 · Cited by 22
Psychosocial Treatment of Depression and Suicidality in Adolescents
Klomek, A., & Stanley, B. (2007) · CNS Spectrums · doi:10.1017/s1092852900020654 · Cited by 22
“CBT resulted in lower rates of major depressive disorder (MDD) at the end of treatment and more rapid relief.(27)”
BackgroundCurry, J. F., & Wells, K. C. (2005) · Cognitive and Behavioral Practice · doi:10.1016/s1077-7229(05)80023-9 · Cited by 21
Adolescent Depression: Challenges and Opportunities
Jackson, B., & Lurie, S. (2006) · Advances in Pediatrics · doi:10.1016/j.yapd.2006.04.008 · Cited by 21
Major Depressive Disorder in Adolescence: A Brief Review of the Recent Treatment Literature
Milin, R., Walker, S., & Chow, J. (2003) · The Canadian Journal of Psychiatry · doi:10.1177/070674370304800906 · Cited by 21
“A large controlled study of MDD in adolescents (n = 107, completers n = 78), comparing 12 weeks to 16 weeks of individual CBT, nondirective supportive psychotherapy, and systemic behavioural family therapy (70), showed a significant improvement over the study duration for each of the 3 treatments .”
MethodDepressive Disorders in Children and Adolescents
Martínez, W., Zychinski, K. E., & Polo, A. J. (2012) · Wiley eBooks · doi:10.1002/9781118156391.ebcp001022 · Cited by 21
Prevention of Childhood Anxiety and Depression
Barrett, P. M., & Turner, C. M. (2004) · Wiley eBooks · doi:10.1002/9780470753385.ch18 · Cited by 21
Treatment of Depression in Children and Adolescents
Seligman, L. D., Goza, A. B., & Ollendick, T. H. (2004) · doi:10.1002/9780470753385.ch13 · Cited by 21
Hu, H., Yang, X., Mo, P. K. H., Zhao, C., Kuang, B., Zhang, G., & Lin, G. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.1001280 · Cited by 23
“Social support can be improved by traditional interventions such as nondirective supportive therapy and new interventions such as promoting social networks and support, which have proven to be successful in decreasing suicidal ideation and depression (Brent et al., 1997; Martin et al., 2011).”
BackgroundDaniels, S., McCurdy, M., Whitsitt, L., Skinner, C. H., Schwartz‐Micheaux, J., & White, J. (2019) · Reading & Writing Quarterly · doi:10.1080/10573569.2019.1618226 · Cited by 20
Psicoterapia baseada em evidências em crianças e adolescentes
Pheula, G. F., & Isolan, L. (2007) · Archives of Clinical Psychiatry (São Paulo) · doi:10.1590/s0101-60832007000200003 · Cited by 20
The acceptability of treatments for depression to a community sample of adolescent girls
Caporino, N. E., & Karver, M. S. (2012) · Journal of Adolescence · doi:10.1016/j.adolescence.2012.04.007 · Cited by 20
“Treatment descriptions were developed based on empirically supported treatment manuals specific to adolescent depression (Brent et al., 1997; Clarke, Lewinsohn, & Hops, 1990; Diamond, Siqueland, & Diamond, 2003; Mufson, Dorta, Moreau, & Weissman, 2004) as well as treatment descriptions used in…”
MethodMargraf, J. (2009) · Springer eBooks · doi:10.1007/978-3-540-79541-4_1 · Cited by 14
Early onset major depressive disorder
Fleisher, W. P., & Katz, L. Y. (2001) · Paediatrics & Child Health · doi:10.1093/pch/6.7.444 · Cited by 19
“In another study (37) that compared CBT, systemic behaviour family therapy and nondirective supportive therapy, all three treatments showed significant reductions in suicidality and func-”
BackgroundGálvez‐Lara, M., Corpas, J., Moreno, E. M., Martínez, J. F. V., Sánchez-Raya, A., & Moriana, J. A. (2018) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-018-0257-6 · Cited by 20
(2006) · Psychotherapeut · doi:10.1007/s00278-006-0480-3 · Cited by 20
Wright, B., Tindall, L., Littlewood, E., Adamson, J., Allgar, V., Bennett, S., Gilbody, S., Verduyn, C., Alderson-Day, B., Dyson, L., et al. (2014) · BMJ Open · doi:10.1136/bmjopen-2014-006488 · Cited by 18
“Data will be managed in Atlas/ ti or NVivo 9 and will be analysed according to the constant comparison method through thematic coding of the data.”
MethodWilliams, R. M., Ehde, D. M., Day, M., Turner, A. P., Hakimian, S., Gertz, K., Ciol, M., McCall, A., Kincaid, C., Pettet, M. W., et al. (2020) · Contemporary Clinical Trials · doi:10.1016/j.cct.2020.105935 · Cited by 19
Metadata
- Authors
- Brent, D. A.
- Corresponding author
- Brent, David A.
- ORCID
- Brent, David A.
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 1997-09-01
- Volume
- 54
- Issue
- 9
- Pages
- 877
- ISSN
- 0003-990X (ISSN-L)
- OpenAlex
- W1993925129
- Cited by
- 753
- References
- 58
- Citations by year
- 2025: 4 · 2024: 12 · 2023: 12 · 2022: 12 · 2021: 24 · 2020: 12 · 2019: 9 · 2018: 17 · 2017: 11 · 2016: 16 · 2015: 32 · 2014: 31 · 2013: 22 · 2012: 35
- FWCI
- 35.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01mh046500-07)
- National Institute of Mental Health (MH 46500)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- adolescent depression, major depressive disorder, cognitive behavioral therapy, supportive therapy, family therapy, treatment efficacy, remission, suicidality, functional disability, parental attitudes
- MeSH terms
- Adolescent, Age Factors, Attitude to Health, Depressive Disorder, Family Therapy, Female, Humans, Male, Person-Centered Psychotherapy, Parents, Patient Dropouts, Social Class, Suicide, Comorbidity, Cognitive Behavioral Therapy, Treatment Outcome
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