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Cognitive-Behavioral Therapy for Adolescent Depression: A Meta-Analytic Investigation of Changes in Effect-Size Estimates
Open accessAbstract
Objective To explicate differences between early and recent meta-analytic estimates of the effects of cognitive-behavioral therapy (CBT) for adolescent depression.Method Meta-analytic procedures were used to investigate whether methodological characteristics moderated mean effect sizes among 11 randomized, controlled trials of CBT focusing on adolescents meeting diagnostic criteria for unipolar depression.Results Cumulative meta-analyses indicated that effects of CBT have decreased from large effects in early trials, and confidence intervals have become narrower. Effect sizes were significantly smaller among studies that used intent-to-treat analytic strategies, compared CBT to active treatments, were conducted in clinical settings, and featured greater methodological rigor based on CONSORT (Consolidated Standards of Reporting Trials) criteria. The mean posttreatment effect size of 0.53 was statistically significant.Conclusions Differences in estimates of the efficacy of CBT for depressed adolescents may stem from methodological differences between early and more recent investigations. Overall, results support the effectiveness of CBT for the treatment of adolescent depression.
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“The type of control condition selected in an outcome trial is known to significantly affect the effect size observed (Klein, Jacobs, & Reinecke, 2007).”
From A randomized controlled trial of strong minds: A school-based mental health program combining acceptance and commitment therapy and positive psychology (2016) · cites this paper as Klein, Jacobs, & Reinecke, 2007
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“This magnitude of change compares favorably with those reported in meta–analysis of clinical trials of standard cognitive-behavioral therapy (CBT) or antidepressant drugs (TADS; Kratochvil et al., 2006; ADAPT: Wilkinson et al., 2009), as well as reviews by Klein et al. (2007) and Weisz et al. (2006).”
From A hope intervention for adolescents: a randomized controlled trial delivered by paraprofessionals (2025) · cites this paper as Klein et al., 2007
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Dobson, K. S., Hopkins, J. A., Fata, L., Scherrer, M. C., & Allan, L. C. (2010) · Canadian Journal of School Psychology · doi:10.1177/0829573510386449 · Cited by 35
van den Brink, G., Stapersma, L., Marroun, H. E., Henrichs, J., Szigethy, E., Utens, E. M. W. J., & Escher, J. C. (2016) · BMJ Open Gastroenterology · doi:10.1136/bmjgast-2015-000071 · Cited by 34
Durgam, S., Chen, C., Migliore, R., Prakash, C., Edwards, J. G., & Findling, R. L. (2018) · Pediatric Drugs · doi:10.1007/s40272-018-0290-4 · Cited by 34
Is Treatment Working? Detecting Real Change in the Treatment of Child and Adolescent Depression
Liu, F. F., & Adrian, M. C. (2019) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2019.02.011 · Cited by 34
Ede, M. O., Igbo, J. N., Eseadi, C., Ede, K. R., Ezegbe, B. N., Ede, A. O., Ezurike, C. A., Onwuka, G. T., & Ali, R. B. (2019) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-019-00327-1 · Cited by 38
Rasing, S. P. A., Stikkelbroek, Y. A. J., & Bodden, D. H. M. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17010153 · Cited by 35
“80) [12,13], and only 50% of the treated youth show symptom improvement after psychotherapy [14].”
BackgroundA review of psychotherapy outcome research: Considerations for school‐based mental health providers
Zirkelback, E. H., & Reese, R. J. (2010) · Psychology in the Schools · doi:10.1002/pits.20526 · Cited by 35
Charkhandeh, M., Talib, M. A., & Hunt, C. J. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.03.044 · Cited by 34
“Our results support earlier findings of the use of CBT intervention on depression treatment both in Iran and elsewhere in the world (Klein et al., 2007; March et al., 2007; Michael and Crowley, 2002; Qin et al., 2015; Weisz et al., 2006).”
BackgroundResultPsychotherapy of Mood Disorders
Picardi, A., & Gaetano, P. (2014) · Clinical Practice and Epidemiology in Mental Health · doi:10.2174/1745017901410010140 · Cited by 38
“While initial meta-analyses conducted throughout the late 1990s may have overestimated the effect size of CBT, the effectiveness of IPT and CBT for the treatment of depression among adolescents is nevertheless supported by recent reviews, meta-analyses, and clinical trials [58-60].”
Result16 Cognitieve interventies bij kinderen en jongeren
Nauta, M. H., Braet, C., & Scholing, A. (2011) · Bohn Stafleu van Loghum eBooks · doi:10.1007/978-90-313-8310-8_16 · Cited by 32
Stikkelbroek, Y. A. J., Bodden, D. H. M., Deković, M., & van Baar, A. L. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-314 · Cited by 35
“Based on previous research [16] an effect size (Cohen’s d) of 0.”
MethodKeleş, S., Munthe, E., & Ruud, E. (2021) · International Journal of Inclusive Education · doi:10.1080/13603116.2021.1979670 · Cited by 31
“We only included studies published in peer-reviewed journals, since the peer review process is one way of attempting to ensure methodological rigour (Klein, Jacobs, and Reinecke 2007).”
MethodThe unfulfilled promise of the antidepressant medications
Davey, C. G., & Chanen, A. M. (2016) · The Medical Journal of Australia · doi:10.5694/mja16.00194 · Cited by 33
Shafran, R., Bennett, S. D., Coughtrey, A. E., Welch, A., Walji, F., Cross, J. H., Heyman, I., Sibelli, A., Smith, J. S., Ross, J., et al. (2020) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-019-00310-3 · Cited by 30
Simmons, M. B., Hetrick, S. E., & Jorm, A. F. (2013) · BMC Psychiatry · doi:10.1186/1471-244x-13-335 · Cited by 31
“A recent meta-analysis of CBT for adolescent depression demonstrated a decrease in effect size over time [14].”
MethodGipson, P. Y., & King, C. A. (2011) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2010.11.005 · Cited by 28
Jacob, M. K., Keeley, M. L., Ritschel, L. A., & Craighead, W. E. (2011) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.774 · Cited by 28
COPE for the Treatment of Depressed Adolescents
Lusk, P., & Melnyk, B. M. (2011) · Journal of the American Psychiatric Nurses Association · doi:10.1177/1078390311416117 · Cited by 28
Psychological treatment for adolescent depression: perspectives on the past, present, and future
Hayes, L., Bach, P. A., & Boyd, C. P. (2010) · Behaviour Change · doi:10.1375/bech.27.1.1 · Cited by 28
“Klein, Jacobs, and Reinecke (2007) also used effect size analysis but restricted their comparison to adolescents with a diagnosis of depression.”
BackgroundMethodFamily-Based Crisis Intervention in the Emergency Department: A New Model of Care
Ginnis, K. B., White, E. M., Ross, A. M., & Wharff, E. A. (2013) · Journal of Child and Family Studies · doi:10.1007/s10826-013-9823-1 · Cited by 27
“There is a strong body of literature that supports their use in decreasing depressive symptoms (Klein et al. 2007; Spirito et al. 2011).”
BackgroundHyde, A. J., May, B. H., Xue, C. C., & Zhang, A. L. (2017) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2017.02.022 · Cited by 27
Liang, J., Li, J., Wu, R.-K., Li, J., Qian, S., Jia, R., Ying-quan, W., Qian, Y., & Xu, Y. (2020) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-020-01492-w · Cited by 32
Reinecke, M. A., Curry, J. F., & March, J. S. (2009) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374410903258991 · Cited by 27
“The results of TADS are congruent with other research in suggesting that CBT may be efficacious for treating depression among adolescents (for reviews, see Curry, 2001 ; David-Ferdon & Kaslow, 2008 ; Fonagy, Target, Cottrell, Phillips, & Kurtz, 2002; Klein, Jacobs, & Reinecke, 2007 ; Weisz, McCarty, & Valeri, 2006), a…”
ResultSelf-citationHoppen, T. H., & Nexhmedin Morina, B. (2020) · Clinical Psychology Review · doi:10.1016/j.cpr.2020.101855 · Cited by 27
A Multi‐Family Group Intervention for Adolescent Depression: The BEST MOOD Program
Poole, L. A., Lewis, A. J., Toumbourou, J. W., Knight, T., Bertino, M. D., & Pryor, R. (2016) · Family Process · doi:10.1111/famp.12218 · Cited by 25
Psychological management of unipolar depression
Lampe, L. A., Coulston, C. M., & Berk, L. (2013) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12123 · Cited by 26
“In a meta-analysis of 20 studies (106), the mean weighted post-treatment effect size of CBT was 0.”
Metadata
- Authors
- KLEIN, J. B., JACOBS, R. H., & REINECKE, M. A.
- Affiliations
- Northwestern University (US)
- Corresponding author
- KLEIN, JESSE B.
- ORCID
- JACOBS, RACHEL H.
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2007-11
- Volume
- 46
- Issue
- 11
- Pages
- 1403-1413
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC2270481
- OpenAlex
- W2074331965
- Cited by
- 254
- References
- 43
- Citations by year
- 2026: 4 · 2025: 13 · 2024: 6 · 2023: 10 · 2022: 13 · 2021: 13 · 2020: 25 · 2019: 18 · 2018: 16 · 2017: 9 · 2016: 20 · 2015: 19 · 2014: 13 · 2013: 22 · 2012: 10
- FWCI
- 1.59
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (F31MH075308)
- 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 › Psychological Treatments and Assessments
- Keywords
- cognitive behavioral therapy, adolescent depression, major depressive disorder, treatment efficacy, effect size heterogeneity, methodological quality, intention-to-treat analysis, clinical trial design
- MeSH terms
- Adolescent, Major Depressive Disorder, Humans, Cognitive Behavioral Therapy, Treatment Outcome
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