Review Of Efficacy Research

Brent and colleagues (1997) compared individual CT to systems behavioral family therapy (SBFT) and nondirective supportive therapy (NST) with 107 adolescents with MDD. Treatment was weekly for 12-16 weeks. "Remission" was defined as at least 3 consecutive weeks of normal scores on self-reported depression and absence of MDD. Remission was higher for CT (60%) than for SBFT (38%) or NST (39%). Parents also perceived CT as more credible than the other treatments.

The results of two controlled outcome studies suggest that Lewinsohn and Clarke's CWD course is efficacious in the treatment of clinically depressed adolescents. Lewinsohn et al. (1990) treated 40 teens with MDD or dysthymia in a 7-week, 14-session program, with 19 adolescents serving as a waiting-list control group. Almost half of the treated adolescents, but only one of the waiting-list adolescents, were below diagnostic threshold after treatment. Parents of one-half of the treated adolescents participated in a psychoeducational group intervention, but parent intervention did not significantly affect outcome. In a subsequent trial, Clarke, Rohde, Lewinsohn, Hops, and Seeley (1999) randomly assigned 123 depressed adolescents to group CWD or a waiting-list control, with treatment extending to 8 weeks. Improvement rates were higher in this study (65% and 69%, respectively, in the treated conditions). Almost half of those in the wait-list control group also improved. Booster sessions in the 4 months following treatment improved recovery for adolescents who remained depressed after the acute intervention.

More recently, TADS CBT was compared to fluoxetine (FLX), the combination of CBT and fluoxetine (COMB), and clinical management with pill placebo (PBO) over 12 weeks of acute treatment in a 13-site trial with 439 adolescents with MDD. Acute treatment was followed by continuation treatment for 6 more weeks, then maintenance treatment for 18 additional weeks. "Acute treatment response" was defined as an independent evaluator's rating of 1 (Very much improved) or 2 (Much improved) on the 7-point Clinical Global Impressions—Improvement scale (CGI-I; TADS Team, 2004). At the 12-week assessment point, response rates were 35% (PBO), 43% (CBT), 61% (FLX), and 71% (COMB). CBT did not separate statistically from PBO, but COMB achieved the highest response rate to date for acute intervention with adolescent MDD. COMB also reduced suicidal ideation more than the other interventions. It appears, then, that 12 weeks of individual CBT may be insufficient for moderately to severely depressed youth. CBT appears, however, to be as effective as fluoxetine alone if treatment is continued for a longer period of time. Results of the TADs study indicate that gains were maintained during the continuation and maintenance phases of treatment. At week 36 the remission rates were 60% for adolescents receiving a continuation of CBT and medication, 55% for adolescents receiving fluoxetine alone, and 64% for those receiving CBT alone. Paired comparisons indicate that, by week 24, all three active treatments have equivalent remission rates (The TADS Team, 2007).

This pattern of findings, in which a combination of CBT and medications is superior to CBT alone for the acute treatment of depression (TADS Team, 2004), is similar to that observed in a recent study of the treatment of chronic depression among adults (Keller et al., 2000).

Combining data across studies to date, at least 14 randomized, controlled trials of CBT have been completed with depressed youth. Reviews and initial meta-analyses indicated that the effect sizes obtained are moderate to large and therapeutic gains are maintained over time (Reinecke et al., 1998). The results of a recent meta-analysis by Weisz, McCarty, and Valeri (2006), however, brought into question the strength of the effects observed. They reported a mean acute treatment for CBT effect size of 0.34, which was markedly lower than that found in earlier reviews. This difference appears to stem from several factors, including increasing severity of depression among youth participating in more recent studies, increasingly stringent control groups, and differences in analytic models employed in the meta-analyses (Klein, Jacobs, & Reinecke, 2007).

Letting Go, Moving On

Letting Go, Moving On

Learning About Letting Go, Moving On Can Have Amazing Benefits For Your Life And Success! Don't be held back by the past - face your guilt and fears and move on! Letting go is merely arriving at a decision, no more allowing something from the past tense to influence your life today or to cut down your inner sense of peace and welfare.

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