Relative Effectiveness of CBT-Components and Sequencing in Indicated Depression Prevention for Adolescents: A Cluster-Randomized Microtrial

Marieke W H van den Heuvel; Denise H M Bodden; Filip Smit; Yvonne Stikkelbroek; John R Weisz; Mirjam Moerbeek; Rutger C M E Engels

doi:10.1080/15374416.2021.1978296

Relative Effectiveness of CBT-Components and Sequencing in Indicated Depression Prevention for Adolescents: A Cluster-Randomized Microtrial

J Clin Child Adolesc Psychol. 2023 Jul 4;52(4):503-518. doi: 10.1080/15374416.2021.1978296. Epub 2021 Oct 13.

Authors

Marieke W H van den Heuvel^{1

2}, Denise H M Bodden^{3

4}, Filip Smit^{2

5

6}, Yvonne Stikkelbroek^{3

7}, John R Weisz⁸, Mirjam Moerbeek⁹, Rutger C M E Engels¹

Affiliations

¹ Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam.
² Department of Mental Health and Prevention, Trimbos Institute, Netherlands Institute of Mental Health and Addiction.
³ Child and Adolescent Studies, Utrecht University.
⁴ Altrecht, Child and Youth Psychiatry.
⁵ Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers.
⁶ Department of Clinical, Neuro and Developmental Psychology, VU University.
⁷ GGZ Oost Brabant, Depression Expertise Center, Youth Psychiatry.
⁸ Department of Psychology, Harvard University.
⁹ Department of Methodology and Statistics, Utrecht University.

PMID: 34644218
DOI: 10.1080/15374416.2021.1978296

Abstract

Objective: Cognitive Behavioral Therapy (CBT) was dismantled into four modules of three sessions each: cognitive restructuring (Think), behavioral activation (Act), problem solving (Solve) and relaxation (Relax). We investigated the modules' relative effectiveness in indicated depression prevention for adolescents and examined variations in sequencing of these modules.

Method: We performed a pragmatic cluster-randomized microtrial with four parallel conditions: (1) Think-Act-Relax-Solve (n = 14 clusters, n = 81 participants); (2) Act-Think-Relax-Solve (n = 13, n = 69); (3) Solve-Act-Think-Relax (n = 13, n = 77); and (4) Relax-Solve-Act-Think (n = 12, n = 55). The sample consisted of 282 Dutch adolescents with elevated depressive symptoms (M_age = 13.8; 55.7% girls, 92.9% Dutch). In total 52 treatment groups were randomized as a cluster. Assessments were conducted at baseline, after each module and at 6-month follow-up with depressive symptoms as primary outcome.

Results: None of the modules (Think, Act, Solve, Relax) was associated with a significant decrease in depressive symptoms after three sessions and no significant differences in effectiveness were found between the modules. All sequences of modules were associated with a significant decrease in depressive symptoms at post-intervention, except the sequence Relax-Solve-Act-Think. At 6-month follow-up, all sequences showed a significant decrease in depressive symptoms. No significant differences in effectiveness were found between the sequences at post-intervention and 6-month follow-up.

Conclusions: Regardless of the CBT technique provided, one module of three sessions may not be sufficient to reduce depressive symptoms. The sequence in which the CBT components cognitive restructuring, behavioral activation, problem solving and relaxation are offered, does not appear to significantly influence outcomes at post- intervention or 6-month follow-up.

Abbreviations: CDI-2:F: Children's Depression Inventory-2 Full-length version; CDI-2:S: Children's Depression Inventory-2 Short version; STARr: Solve, Think, Act, Relax and repeat.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Cognitive Behavioral Therapy* / methods
Depression* / therapy
Ethnicity
Female
Humans
Male
Treatment Outcome