Impact of comorbidity in prevention of adolescent depressive symptoms.

Despite the well-known relevance of comorbidity, few studies have examined the impact of comorbid anxiety or externalizing symptoms on the prevention of depressive symptoms in adolescents. To replicate earlier positive effects of a cognitive-behavioral prevention program of depressive symptoms and to test the hypothesis that the prevention program would be less effective in adolescents with comorbid anxiety and externalizing symptoms, a study was conducted involving 301 8th-grade students, randomly divided into an intervention group and a non-intervention control group. The randomized design included baseline, post-intervention, and 6-month follow-up. The prevention program included 10 sessions held in a regular school setting. The prevention program showed positive effects on depressive symptoms, independent of comorbid symptoms. These effects were found mainly with girls independent of their depressive symptoms at baseline, and in part with boys with less severe depressive symptoms at baseline. Surprisingly, negative effects of the prevention program on depressive symptoms were found on the depression of boys with more severe depressive symptoms at baseline. The prevention program’s low rate of attrition and high recruitment rate support the generalizability of the results

A randomized controlled trial of a cognitive-behavioral program for the prevention of depression in adolescents compared to nonspecific and no-intervention control conditions.

Adolescent depression is a common and recurrent disorder associated with significant impairment and other forms of psychopathology. Finding an effective intervention that prevents depression in adolescents is an important public health priority. Participants were 518 high school students (mean age = 15.09; SD = 0.76) from the mid-south of the United States. Participants were randomly assigned to one of three conditions: a cognitive-behavioral program (CB; n = 166), nonspecific control (NSp; n = 175), or a no-intervention control condition (NIC; n = 177). Both the CB and NSp conditions consisted of 90-minute sessions administered once a week over a 10-week period during regular school hours. Depressive symptoms were assessed with the Children’s Depression Inventory (CDI) at baseline, post-intervention, and at 4-, 8-, and 12-month follow-ups. The time by condition interaction was significant [F(8, 478.57) = 3.32, p = .001] indicating that at the 4-month follow-up, youth in the CB condition had significantly lower CDI scores compared to those in the NSp (p = 0.047, g = 0.29; CI: 0.06-0.52) and the NIC conditions (p = 0.003, g = 0.30; CI: 0.07-0.53). Future studies need to examine the importance of theory-driven change mechanisms, interpersonal relationships, and structural circumstances in schools as factors impacting the long-term effects of CB prevention programs

A randomized trial to evaluate the course of effects of a program to prevent adolescent depressive symptoms over 12 months.

Although few prevention studies have been designed to investigate the course of prevention effects over time, it seems that the effects on depressive symptoms increase from post-intervention to 6-month follow-up but then decrease with longer lags to follow-up. Furthermore, previous prevention studies have found differential intervention effects for boys and girls without testing possible explanations for this effect. The present randomized control group study with 301 8th-grade students examined the effects of a depression prevention program from baseline until 12-month follow-up. As expected, while positive intervention effects were found on girls’ depressive symptoms, no such effects were found on boys’ depressive symptoms. Further, the positive intervention effects on girls’ depressive symptoms increased to the 6-month follow-up and remained stable through the 12-month follow-up, while depression symptoms in control-group girls increased from 6-month to 12-month follow-up. Further exploratory analyses revealed that neither baseline conduct problems nor cognitive or social knowledge of the prevention program at 12-month follow-up alone explained the sex effect. However, some limited evidence was found indicating that total knowledge (cognitive and social) might partially explain the effect but there was significant variability remaining to be explained

17 Tipps wie man Kinder erzieht - Welche Erziehungsstrategien setzen Eltern ein?

Untersucht wird, welche der im Triple P-Gruppentraining vermittelten Erziehungsstrategien von den Eltern im Alltag umgesetzt werden. Die Daten stammen aus dem Projekt "Zukunft Familie", in dem die längerfristige Wirksamkeit des Elterntrainings in einer kontrollierten Studie an 280 Familien untersucht wurde. Insgesamt nahmen 144 Eltern am Gruppentraining teil und füllten vor, direkt nach der Intervention und bei der Ein-Jahres-Katamnese Kursbeurteilungs- bzw. Fragebogen zu den Erziehungsstrategien aus. Die Ergebnisse zeigten, dass die positiven Erziehungsstrategien zur Förderung der kindlichen Entwicklung bereits vor dem Training weiter verbreitet waren als die Tipps zum Umgang mit kindlichem Problemverhalten. Über 90 Prozent der Eltern praktizierten die positiven Erziehungsstrategien auch bei der Ein-Jahres-Nachuntersuchung. Darüber hinaus gab es eine signifikante Abnahme bei der Verwendung der "Auszeit"-Strategie. (ZPID

Testing the causal mediation component of Dodge’s social information processing model of social competence and depression.

In Dodge’s model of “social information processing” depression is the result of a linear sequence of five stages of information processing (Dodge, 1993). These stages follow a person’s reaction to situational stimuli, such that each stage of information processing mediates the relationship between earlier and later stages. Because support for the social information processing model of depression has mainly come from retrospective examination of the literature (Dodge, 1993), we conducted a three wave prospective study including 92 adolescents without lifetime or current depression. Depressive symptoms and information processing were assessed by using well established measures employed in previous studies. The social information processing model was supported by cross-sectional results of our study. Based on prospective data we could only partially support the mediation hypotheses of the model. We discuss our unexpected results in light of limitation, including applied measures and sample characteristics

Are Treatment Preferences Relevant in Response to Serotonergic Antidepressants and Cognitive-Behavioral Therapy in Depressed Primary Care Patients? Results from a Randomized Controlled Trial Including a Patients' Choice Arm

Background Little is known about the influence of depressed patients' preferences and expectations about treatments upon treatment outcome We investigated whether better clinical outcome in depressed primary care patients is associated with receiving their preferred treatment Methods Within a randomized placebo-controlled single-centre 10-week trial with 5 arms (sertraline, placebo, cognitive-behavioral group therapy, CBT-G, moderated self-help group control, treatment with sertraline or CBT-G according to patients' choice), outcomes for 145 primary care patients with mild-to-moderate depressive disorders according to DSM-IV criteria were investigated Preference for medication versus psychotherapy was assessed at screening using a single item Post-baseline difference scores for the Hamilton Depression Rating Scale (HAMD-17) were used to assess treatment outcome (mixed-model repeated-measures regression analysis) Results Depressed patients receiving their preferred treatment (n = 63), whether sertraline or CBT-G, responded significantly better than those who did not receive their preferred therapy (n = 54, p = 0 001) The difference in outcome between both groups was 8 0 points on the HAMD-17 for psychotherapy and 2 9 points on the HAMD-17 for treatment with antidepressants Results were not explained by differences in depression severity or dropout rates Conclusions Patients' relative preference for medication versus psychotherapy should be considered when offering a treatment because receiving the preferred treatment conveys an additional and clinically relevant benefit (HAMD-17 +2 9 points for drugs, +8 0 points for CBT-G) in outcome Copyright (C) 2010 S Karger AG Base

Spinnen-Angst-Fragebogen (SAF) Validierung der deutschen Version des Fear of Spiders Questionnaire (FSQ).

Bislang fehlte im deutschen Sprachraum ein Instrument, das erlaubt, differenzierte Daten zum Thema Spinnenphobie zu erheben. Aus diesem Grund wurde der „Fear of Spiders Questionnaire“ (FSQ) von Szymanski und O´Donohue (1995) als ein Screening-Instrument für solche Zwecke übersetzt. Die interne Konsistenz beträgt für den Spinnen-Angst-Fragebogen (SAF) r = .94, und die Retest-Reliabilität über einen Monat ist r = .75. Bei der Faktorenanalyse zeigten sich die Faktoren Vermeidungs- und Hilfesuchverhalten und Furcht vor Verletzung (aufgeklärte Varianz 58.9 % und 8.6 %). Diese Faktorenstruktur ist weitgehend identisch mit der für die englischsprachige Version. Erwartungsgemäß traten hohe Korrelationen mit dem Spider-Phobia-Questionnaire (SPQ), geringere aber signifikante Korrelationen mit dem „Beck-Angstinventar“ (BAI), und keine signifikante Korrelationen mit dem „Beck-Depressions-Inventar“ (BDI) auf. Mit dem Spinnen-Angst-Fragebogen liegt ein Instrument vor, das die ökonomische und genaue Erfassung von Angst vor Spinnen im Selbsturteil erlaubt. The Fear of Spiders Questionnaire” (FSQ) of Szymanski and O´Donohue (1995) was translated into German because a well validated tool to screen for spider phobia has been missing. The resulting Spinnen-Angst-Fragebogen (SAF) shows an internal consistency of r = .94 and a test-retest reliability of r = .75. The factors avoidance/ help seeking and fear of harm (accounted variance 58.9 % and 8.6 %) were extracted, which are most similar to the English version. As expected, high correlations were found with the Spider-Phobia-Questionnaire (SPQ). Significant correlations appeared with the “Beck Anxiety Inventory” (BAI) and no correlations with the “Beck Depression Inventory” (BDI). Altogether the Spinnen-Angst-Fragebogen seems to be a economic and reliable instrument to assess the anxiety with spiders at the selfrating

Verhaltensdiagnostik aus der Perspektive der Kognitiven Therapie Analyse automatischer Gedanken und Grundüberzeugungen (Behavioral diagnostics from the view of the cognitive therapy : identification of automatic thoughts and attitudes).

Die Veränderung von mit psychischen Problemen verbundenen negativen automatischen Gedanken und Grundüberzeugungen ist zentraler Bestandteil jeder Kognitiven Verhaltenstherapie. Daher ist die Aufdeckung dieser dem Bewusstsein oft nur wenig zugänglichen kognitiven Prozessen von entscheidender Bedeutung für den Erfolg einer Psychotherapie. Im vorliegenden Artikel werden neben dem ABCDE-Protokoll, welches die Standardmethode zur Identifikation und Veränderung negativer automatischer Gedanken ist, unterschiedliche Methoden zur Exploration von Grundüberzeugungen (Beispielsituationen sammeln, Imaginationsmethode, Pfeil-abwärts-Technik) detailliert dargestellt. Hierbei wird das eher induktive Vorgehen zur Aufdeckung von Grundüberzeugungen von Albert Ellis mit den mehr deduktiven Strategien von Aaron Beck und den Weiterentwicklungen von Judith Beck verglichen. The modification of negative automatic thoughts and attitudes that are associated with psychological problems is a core element of every cognitive-behavioral therapy. As these cognitions are only partially accessible for the conscious, it is of prominent importance for the success of a cognitive-behavioral therapy to identify them. This article presents the ABCDE-protocol, which is the standard tool to identify and change negative automatic thoughts, and different methods to explore negative attitudes (collection of example situations, imagination technique, downward-arrow-technique) in detail. Here, Ellis’ the rather inductive procedure to identify attitudes is compared with Aaron Beck’s more deductive strategies and further developments by Judith Beck

Psychoanalytic and cognitive-behavior therapy of chronic depression : study protocol for a randomized controlled trial

Background: Despite limited effectiveness of short-term psychotherapy for chronic depression, there is a lack of trials of long-term psychotherapy. Our study is the first to determine the effectiveness of controlled long-term psychodynamic and cognitive-behavioral (CBT) treatments and to assess the effects of preferential vs. randomized assessment. Methods/design: Patients are assigned to treatment according to their preference or randomized (if they have no clear preference). Up to 80 sessions of psychodynamic or psychoanalytically oriented treatments (PAT) or up to 60 sessions of CBT are offered during the first year in the study. After the first year, PAT can be continued according to the ‘naturalistic’ usual method of treating such patients within the system of German health care (normally from 240 up to 300 sessions over two to three years). CBT therapists may extend their treatment up to 80 sessions, but focus mainly maintenance and relapse prevention. We plan to recruit a total of 240 patients (60 per arm). A total of 11 assessments are conducted throughout treatment and up to three years after initiation of treatment. The primary outcome measures are the Quick Inventory of Depressive Symptoms (QIDS, independent clinician rating) and the Beck Depression Inventory (BDI) after the first year. Discussion: We combine a naturalistic approach with randomized controlled trials(RCTs)to investigate how effectively chronic depression can be treated on an outpatient basis by the two forms of treatment reimbursed in the German healthcare system and we will determine the effects of treatment preference vs. randomization