Understanding change – developing a typology of therapy outcomes from the experience of adolescents with depression

Background: Outcome measures mostly focusing on symptom reduction to measure change cannot indicate whether any personally meaningful change has occurred. There is a need to broaden the current understanding of outcomes for adolescent depression and identify whether holistic, interlinked patterns of change may be more clinically meaningful. Objective: To create a typology of therapy outcomes based on the experiences of adolescents with depression. Method: Interview data from 83 participants from a clinical trial of the psychological treatment of adolescent depression was analysed using ideal type analysis. Results: Six ideal types were constructed, reflecting different evaluations of the holistic impact of therapy: “I’ve worked on my relationships”, “With the insight from therapy, and feeling validated, I can cope with life challenges better”, “My mood still goes up and down”, “If I want things to change, I need to help myself”, “Therapy might help, but it hasn’t been enough”, and “I don’t feel therapy has helped me”. Conclusion: Assessing change using outcome measures may not reflect the interconnected experience for adolescents or the contextual meaning of symptom change. The typology developed offers a way of considering the impact of therapy, taking into account how symptom change is experienced within a broader perspective

A MINDFULNESS-BASED INTERVENTION FOR MALTREATED CHILDREN AND ADOLESCENTS IN RESIDENTIAL CARE

Nonostante il maltrattamento all’infanzia costituisca un’esperienza relazionale patogena, alcuni bambini maltrattati mostrano un itinerario di sviluppo resiliente. La tesi si focalizza sul possibile ruolo giocato da meaning-making e mindfulness skills nel funzionamento resiliente. Il primo obiettivo è stato esplorare la relazione tra meaning-making, mindfulness skills e benessere in bambini non maltrattati. Il secondo obiettivo è stato valutare meaning-making e mindfulness skills in minori maltrattati, per determinare se il funzionamento resiliente fosse in relazione con questi costrutti. Il terzo obiettivo è stato creare un intervento per minori maltrattati ospitati in comunità (MBYR), testandone la fattibilità. Lo studio 1 ha esplorato il meaning-making in bambini non maltrattati, non evidenziando alcuna relazione con le loro competenze e difficoltà. Lo studio 2 ha mostrato che le mindfulness skills correlavano negativamente con outcome avversi, ma positivamente con le competenze dei bambini. Lo studio 3 ha esplorato la relazione tra funzionamento resiliente, meaning-making e mindfulness skills in minori maltratti, evidenziando che il meaning-making era legato a livelli più bassi di qualità della vita, mentre le mindfulness skills erano in relazione con il funzionamento resiliente. Questi risultati hanno informato il razionale dell’MBYR, che ha significativamente ridotto i sintomi traumatici, aumentando mindfulness skills e competenze generali (studio 4).Child maltreatment is a pathogenic relational experience representing one of the most difficult challenges to children’s healthy adaptation; nonetheless, some maltreated children develop resiliently. The thesis focuses on the possible role played by meaning-making and mindfulness skills in resilient functioning. The first aim was to investigate the relation between meaning-making, mindfulness skills, and wellbeing in nonmaltreated children. The second aim was to explore meaning-making and mindfulness skills in maltreated children and adolescents, to determine whether resilient functioning was related to these constructs. Finally, the third aim was to design an intervention for maltreated youths in residential care (MBYR) and to test its feasibility. Study 1 explored meaning-making in nonmaltreated children, showing that it was not related to their competencies and difficulties. Study 2 highlighted that mindfulness skills were negatively related to adverse outcomes and positively related to children’s competencies. Study 3 explored the relation between different domains of resilient functioning, meaning-making, and mindfulness skills in maltreated youths, showing that meaning-making was related to lower levels of quality of life, whereas mindfulness skills were related to resilient functioning. These results informed the rationale for the MBYR, which significantly reduced traumatic symptoms while enhancing mindfulness skills and general competencies (study 4)

Understanding change - developing a typology of therapy outcomes from the experience of adolescents with depression

BACKGROUND: Outcome measures mostly focusing on symptom reduction to measure change cannot indicate whether any personally meaningful change has occurred. There is a need to broaden the current understanding of outcomes for adolescent depression and identify whether holistic, interlinked patterns of change may be more clinically meaningful. OBJECTIVE: To create a typology of therapy outcomes based on the experiences of adolescents with depression. METHOD: Interview data from 83 participants from a clinical trial of the psychological treatment of adolescent depression was analysed using ideal type analysis. RESULTS: Six ideal types were constructed, reflecting different evaluations of the holistic impact of therapy: "I've worked on my relationships", "With the insight from therapy, and feeling validated, I can cope with life challenges better", "My mood still goes up and down", "If I want things to change, I need to help myself", "Therapy might help, but it hasn't been enough", and "I don't feel therapy has helped me". CONCLUSION: Assessing change using outcome measures may not reflect the interconnected experience for adolescents or the contextual meaning of symptom change. The typology developed offers a way of considering the impact of therapy, taking into account how symptom change is experienced within a broader perspective