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BMC Psychiatry
Published in: BMC Psychiatry 1/2019

Open Access 01-12-2019 | Affective Disorder | Study protocol

Dismantling the relative effectiveness of core components of cognitive behavioural therapy in preventing depression in adolescents: protocol of a cluster randomized microtrial

Authors: Marieke W. H. van den Heuvel, Denise H. M. Bodden, Mirjam Moerbeek, Filip Smit, Rutger C. M. E. Engels

Published in: BMC Psychiatry | Issue 1/2019

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Abstract

Background

Both depressive disorder and subclinical depressive symptoms during adolescence are a major public health concern. Therefore, it is important that depression is detected at an early stage and is treated preventively. Prevention based on the principles of Cognitive Behavioural Therapy (CBT) has proven to be the most effective, however research has mainly focused on the effectiveness of “prevention packages” consisting of multiple CBT-components, rather than on the distinct CBT-components. This study will evaluate the relative effectiveness of four core components of CBT (cognitive restructuring (CR), behavioural activation (BA), problem solving (PS) and relaxation (RE)). In addition the relative (cost-)effectiveness of four different sequences of these components will be evaluated: (1) CR – BA – RE – PS, (2) BA – CR – RE – PS, (3) PS – GA – CR – RE and (4) RE – PS – BA – CR.

Methods

We will perform a non-blinded multisite cluster randomized prevention microtrial with four parallel conditions consisting of the four sequences. The four sequences of components will be offered in groups of high school students with elevated depressive symptoms. For each CBT-component a module of three sessions is developed. Assessments will be conducted at baseline, after each CBT-component, prior to each session, at post-intervention and at 6-month follow-up. Potential moderators and mediators will be evaluated exploratively to shed light on for whom the (sequences of) CBT-components are most effective and how effects are mediated.

Discussion

The potential value of the study is insight in the relative effectiveness of the four most commonly used CBT-components and four different sequences, and possible moderators and mediators in the prevention of depression among adolescents. This knowledge can be used to optimize and personalize CBT-programs.

Trial registration

The study is registered in the Dutch Trial Register (Trial NL5584 / NTR6176) on October 13, 2016.
Literature
1.
Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen HU. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res. 2012;21:169–84.PubMedPubMedCentralCrossRef
2.
Merikangas KR, He J, Burstein M, et al. Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Study-Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010;49:980–9.PubMedPubMedCentralCrossRef
3.
Verboom CE, Sijtsema JJ, Verhulst FC, Penninx BWJH. Longitudinal associations between depressive problems, academic performance, and social functioning in adolescent boys and girls. Dev Psychol. 2014;50:247–57.PubMedCrossRef
4.
5.
Keenan-Miller D, Hammen CL, Brennan PA. Health outcomes related to early adolescent depression. J Adolescent Health. 2007;41:256–62.CrossRef
6.
Portzky G, van Heeringen C. Suïcide bij jongeren. Psychische Gezondheid. 2009;37:75–89.CrossRef
7.
Goodyer I, Cooper PJ. A community study of depression in adolescent girls. II: the clinical features of identified disorder. Br J Psychiatry. 1993;163:374–80.PubMedCrossRef
8.
Herbert J, Goodyer IM, Altham PME, Pearson J, Secher SM, Shiers HM. Adrenal secretion and major depression in 8- to 16-year-olds II. Influence of co-morbidity at presentation. Psychol Med. 1996;26:257–63.PubMedCrossRef
9.
Bodden DHM, Stikkelbroek Y, Dirksen CD. Societal burden of adolescent depression, an overview and cost-of-illness study. J Affect Disord. 2018;241:256–62.PubMedCrossRef
10.
Gotlib IH, Lewinsohn PM, Seeley JR. Symptoms versus a diagnosis of depression - differences in psychosocial functioning. J Consult Clinic Psychol. 1995;63:90–100.CrossRef
11.
Jaycox LH, Stein BD, Paddock S, et al. Impact of teen depression on academic, social, and physical functioning. Pediatrics. 2009;124:596–605.CrossRef
12.
Pine DS, Cohen E, Cohen P, Brook J. Adolescent depressive symptoms as predictors of adult depression: moodiness or mood disorder? Am J Psychiatry. 1999;156:133–5.PubMedCrossRef
13.
Cuijpers P, Muñoz RF, Clarke GN, Lewinsohn PM. Psychoeducational treatment and prevention of depression: the “coping with depression” course thirty years later. Clin Psychol Rev. 2009;29:449–58.PubMedCrossRef
14.
Kennard BD, Clarke GN, Weersing VR, et al. Effective components of TORDIA cognitive-behavioral therapy for adolescent depression: preliminary findings. J Consult Clin Psychol. 2009;77:1033–41.PubMedPubMedCentralCrossRef
15.
McCarty CA, Weisz JR. Effects of psychotherapy for depression in children and adolescents: what we can (and can't) learn from meta-analysis and component profiling. J Am Acad Child Adolesc Psychiatry. 2007;46:879–86.PubMedPubMedCentralCrossRef
16.
Weersing VR, Rozenman MS, Maher-Bridge M, Campo JV. Anxiety, depression, and somatic distress: developing a transdiagnostic internalizing toolbox for pediatric practice. Cogn Behav Pract. 2012;19:68–82.PubMedPubMedCentralCrossRef
17.
Horowitz JL, Garber J. The prevention of depressive symptoms in children and adolescents: a meta-analytic review. J Consult Clin Psychol. 2006;74:401–15.PubMedCrossRef
18.
Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive therapy of depression. New York: Guilford Press; 1979.
19.
Dobson KS. Cognitive Therapy for depression In: Whisman MA, editor. Adapting cognitive therapy for depression. Managing complexity and comorbidity. New York: Guilford Publications; 2008. p. 3–35.
20.
Leder G. Know thyself? Questioning the theoretical foundations of cognitive behavioral therapy. Rev Phil Psych. 2017;8:391–410.CrossRef
21.
Longmore RJ, Worrell M. Do we need to challenge thoughts in cognitive behavior therapy? Clin Psychol Rev. 2007;2:173–87.CrossRef
22.
Oud M, de Winter L, Vermeulen-Smit E, et al. Effectiveness of CBT for children and adolescents with depression: a systematic review and meta-regression analysis. Eur Psychiatry. 2019;57:33–45.PubMedCrossRef
23.
Weisz JR, McCarty CA, Valeri SM. Effects of psychotherapy for depression in children and adolescents: a meta-analysis. Psychol Bull. 2006;132:132–49.PubMedPubMedCentralCrossRef
24.
25.
Lewinsohn PM. A behavioral approach to the treatment of depression. In: Freidman RM, Katz MM, editors. The psychology of depression: contemporary theory and research. New York: Wiley; 1974. p. 157–85.
26.
Dimidjian S, Barrera M, Martell C, Muñoz RF, Lewinsohn PM. The origins and current status of behavioral activation treatments for depression. Annu Rev Clin Psychol. 2011;7:1–38.PubMedCrossRef
27.
Hetrick SE, Cox GR, Fisher CA, et al. Back to basics: could behavioural therapy be a good treatment option for youth depression? A critical review. Early Interv Psychiatry. 2014;9:1–7.
28.
McCauley E, Gudmundsen G, Schloredt K, et al. The adolescent behavioral activation program: adapting behavioral activation as a treatment for depression in adolescence. J Clin Child Adolesc Psychol. 2016;45:291–304.PubMedCrossRef
29.
Ritschel LA, Ramirez CL, Cooley JL, Craighead WE. Behavioral activation for major depression in adolescents: results from a pilot study. Clin Psychol-Sci Pr. 2016;23:39–57.CrossRef
30.
Takagaki K, Okamoto Y, Jinnin R, et al. Behavioral activation for late adolescents with subthreshold depression: a randomized controlled trial. Eur Child Adolesc Psychiatry. 2016;25:1171–82.PubMedCrossRef
31.
Tindall L, Mikocka-Walus A, McMillan D, Wright B, Hewitt C, Gascoyne S. Is behavioural activation effective in the treatment of depression in young people? A systematic review and meta-analysis. Psychol Psychother. 2017;90:770–96.PubMedPubMedCentralCrossRef
32.
D’Zurilla TJ, Nezu AM, Maydeu-Olivares A. Social problem solving: theory and assessment. In: Chang EC, D’Zurilla TJ, Sanna LJ, editors. Social problem solving: theory, research and training. Washington DC: American Psychological Association; 2004. p. 11–27.CrossRef
33.
D’Zurilla TJ, Goldfried MR. Problem solving and behavior modification. J Abn Psychol. 1971;78:107–26.CrossRef
34.
Anderson RJ, Goddard L, Powell JH. Social problem-solving and depressive symptom vulnerability: the importance of real-life problem-solving performance. Cogn Ther Res. 2011;35:48–56.CrossRef
35.
Hasegawa A, Kunisato Y, Morimoto H, Nishimura H, Matsuda Y. How do rumination and social problem solving intensify depression? A longitudinal study. J Rat-Emo Cognitive-Behav Ther. 2018;36:28–46.
36.
Hoek W, Schuurmans J, Koot HM, Cuijpers P. Effects of internet-based guided self-help problem-solving therapy for adolescents with depression and anxiety: a randomized controlled trial. PLoS One. 2012;7:e43485.PubMedPubMedCentralCrossRef
37.
Hoek W, Schuurmans J, Koot HM, Cuijpers P. Prevention of depression and anxiety in adolescents: a randomized controlled trial testing the efficacy and mechanisms of internet-based self-help problem-solving therapy. Trial. 2009;10:93.CrossRef
38.
Hankin BL, Abela JRZ. Development of psychopathology: a vulnerability-stress perspective. Thousand Oaks: Sage Publications, Inc; 2005.
39.
Reynolds WM, Coats KIA. Comparison of cognitive-behavioral therapy and relaxation training for the treatment of depression in adolescents. J Consult Clin Psychol. 1986;54:653–60.PubMedCrossRef
40.
Clarke GN, Lewinsohn PM, Hops H. Adolescent coping with depression course. Eugene: Castalia Publishing; 1990.
41.
Stikkelbroek Y, Bouman H, Cuijpers P. De Doepressiecursus. Dordrecht: Eigen Beheer; 2005.
42.
Braet C, Stark K. Pak Aan. Cognitieve gedragstherapie bij kinderen met depressie (tweedelig): Therapeutenboek en Werkboek om je sombere buien te overwinnen. Amsterdam: Boom; 2011.
43.
Tak YR, van Zundert RMP, Kuijpers RCWM, van Vlokhoven BS, Rensink HFW, Engels RCME. A randomized controlled trial testing the effectiveness of a universal school-based depression prevention program Op Volle Kracht in the Netherlands. BMC Public Health. 2012. https://​doi.​org/​10.​1186/​1471-2458-12-21.
44.
Albertz N, Bergsma A, de Gijsel S, et al. Head Up. Draaiboek voor begeleiders. 2007.
45.
Chorpita BF, Daleiden E, Weisz JR. Modularity in the design and application of therapeutic interventions. Appl Prev Psychol. 2005;11:141–56.CrossRef
46.
Chorpita BF, Weisz JR. Modular approach to therapy for children with anxiety, depression, trauma, or conduct problems (MATCH-ADTC). Satellite Beach: PracticeWise; 2009.
47.
Blase K, Fixsen D. Core intervention components: identifying and operationalizing what makes programs work. ASPE research brief. Washington, DC: US Department of Health and Human Services; 2013.
48.
49.
Campbell MK, Piaggio G, Elbourne DR, Altman DG, For the CONSORT Group. Consort 2010 statement: extension to cluster randomised trials. BMJ. 2012;345:e5661.PubMedCrossRef
50.
Bodden D, Braet C, Stikkelbroek Y. CDI-2 Screeningsvragenlijst voor depressie bij kinderen en jongeren. Handleiding. Amsterdam: Hogrefe Uitgevers BV; 2016.
51.
Huisman A, Smits N, Kerkhof AJFM. Signaleren van suïcidaliteit bij jongeren met de VOZZ-vragenlijst. Tijdschrift Jeugdgezondheidszorg. 2015;47:118–20.CrossRef
52.
53.
Stice E, Shaw H, Bohon C, Marti CN, Rohde P. A meta-analytic review of depression prevention programs for children and adolescents: factors that predict magnitude of intervention effects. J Consul Clin Psychol. 2009;77:486–503.CrossRef
54.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: American Psychiatric Association; 2000.
55.
Kaufman J, Birmaher B, Brent D, et al. Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry. 1997;36:980–8.PubMedCrossRef
56.
Reichart CG, Wals M, Hillegers M. K-SADS. Utrecht: H.C. Rümke Groep; 2000.
57.
Lauth B, Arnkelsson GB, Magnusson P, Skarphedinsson G, Ferrari P, Petursson H. Validity of K-SADS-PL (schedule for affective disorders and schizophrenia for school-age children-present and lifetime version) depression diagnoses in an adolescent clinical population. Nord J Psychiatry. 2010;64:409–20.PubMedCrossRef
58.
Weisz JR, Chorpita BF, Frye A, et al. Youth top problems: using idiographic, consumer-guided assessment to identify treatment needs and to track change during psychotherapy. J Consult Clin Psychol. 2011;79:369–80.PubMedCrossRef
59.
60.
Ravens-Sieberer U, Wille N, Badia X, et al. Feasibility, reliability, and validity of the EQ-5D-Y: results from a multinational study. Qual Life Res. 2010;19:887–97.PubMedPubMedCentralCrossRef
61.
Bodden DHM, Dirksen CD, Bögels SM, Appelboom C, Appelboom-Geerts KCMMJ, Brinkman AG, et al. Costs and cost-effectiveness of family CBT versus individual CBT in clinically anxious children. Clin Child Psychol Psychiatry. 2008;13:395–416.CrossRef
62.
Stikkelbroek Y, Bodden DHM, Deković M, van Baar AL. Effectiveness and cost effectiveness of cognitive behavioral therapy (CBT) in clinically depressed adolescents: individual CBT versus treatment as usual (TAU). BMC Psychiatry. 2013;13:314.PubMedPubMedCentralCrossRef
63.
64.
Achenbach TM, McConaughy SH, Ivanova MY Rescorla LA. Manual for the ASEBA brief problem monitor (BPM). Burlington: ASEBA; 2011.
65.
Piper BJ, Gray HM, Raber J, Birkett MA. Reliability and validity of brief problem monitor, an abbreviated form of the child behavior checklist. Psychiatry Clin Neurosci. 2014;68:759–67.PubMedPubMedCentralCrossRef
66.
Maric M, Heyne DA, van Widenfelt BM, Westenberg P. Distorted cognitive processing in youth: the structure of negative cognitive errors and their associations with anxiety. Cogn Ther Res. 2011;35:11–20.CrossRef
67.
Kanter JW, Mulick PS, Busch AM, Berlin KS, Martell CR. Behavioral activation for depression scale (BADS) (long and short form). Measurement instrument database for the social science. 2012. www.​midss.​org.
68.
Kanter JW, Mulick PS, Busch AM, Berlin KS, Martell CR. The behavioral activation for depression scale (BADS): psychometric properties and factor structure. J Psychopathol Behav Assess. 2006;29:191–202.CrossRef
69.
Manos RC, Kanter JW, Wen L. The behavioral activation for depression scale-short form: development and validation. Behav Ther. 2011;42:726–39.PubMedCrossRef
70.
D’Zurilla TJ, Nezu AM, Maydeu-Olivares A. Social Problem-Solving Inventory - Revised (SPSI-R): Technical manual. North Tonawanda: Multi-Health Systems; 2002.
71.
Dreer LE, Berry J, Rivera P, et al. Efficient assessment of social problem-solving abilities in medical and rehabilitation settings: a Rasch analysis of the social problem-solving inventory-revised. J Clin Psychol. 2009;65:653–69.PubMedPubMedCentralCrossRef
72.
Cohen S, Williamson G. Perceived stress in a probability sample of the United States. In: Spacapan S, Oskamp S, editors. The social psychology of health. Newbury Park: Sage; 1988. p. 31–67.
73.
Lee EH. Review of the psychometric evidence of the perceived stress scale. Asian Nurs Res. 2012;6:121–7.CrossRef
74.
Bodden D, Stikkelbroek Y. Vragenlijst Eerdere Hulp en Interventies. Utrecht: Utrecht University; 2010.
75.
StataCorp. Stata Statistical Software: Release 14. College Station: StataCorp LP; 2015.
76.
Muthén LK, Muthén BO. Mplus User's guide. Sixth edition. Los Angeles: Muthén & Muthén; 1998-2010.
77.
Hox J, Moerbeek M, van de Schoot R. Multilevel analysis: techniques and applications, third edition (quantitative methodology series). New York: Routledge; 2018.
78.
Husereau D, Drummond M, Petrou S, et al. Consolidated health economic evaluation reporting standards (CHEERS) - explanation and elaboration: a report of the ISPOR health economic evaluations publication guidelines good reporting practices task force. Value Health. 2013;16:231–50.PubMedCrossRef
79.
Briggs AH, Wonderling DE, Mooney CZ. Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation. Health Econ. 1997;6:327–40.PubMedCrossRef
80.
Efron B, Tibshirani RJ. An introduction to the bootstrap. New York: Chapman and Hall; 1993.CrossRef
81.
Hetrick SE, Cox GR, Witt KG, Bir JJ, Merry SN. Cognitive Behavioural therapy (CBT), third-wave CBT and interpersonal therapy (IPT) based interventions for preventing depression in children and adolescents. Cochrane Database Syst Rev. 2016.
82.
Klein JB, Jacobs RH, Reinecke MA. Cognitive-behavioral therapy for adolescent depression: a meta-analytic investigation of changes in effect-size estimates. J Am Acad Child Adolesc Psychiatry. 2007;46:1403–13.PubMedPubMedCentralCrossRef
83.
Reinecke MA, Ryan NE, DuBois DL. Cognitive-behavioral therapy of depression and depressive symptoms during adolescence: a review and meta-analysis. J Am Acad Child Adolesc Psychiatry. 1998;37:26–34.PubMedCrossRef
84.
Taljaard M, Grimshaw JM. Concept, characteristics and implications of cluster randomization. Clin Invest. 2014;4:1–4.CrossRef
85.
Rasing SPA, Creemers DHM, Stikkelbroek YAJ, Kuijpers RCWM, Engels RCME. Adolescent depression prevention growing up: challenges and future directions. Int Soc Stud Behav Dev. 2016;2:20–2.
Metadata
Title
Dismantling the relative effectiveness of core components of cognitive behavioural therapy in preventing depression in adolescents: protocol of a cluster randomized microtrial
Authors
Marieke W. H. van den Heuvel
Denise H. M. Bodden
Mirjam Moerbeek
Filip Smit
Rutger C. M. E. Engels
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2019
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-019-2168-6

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