The Impact of Self-Criticism and Dependency on Adolescent Depression, Treatment Outcome, and Therapeutic Process in Brief Psychotherapies for Depression

Abstract

BACKGROUND: Studies in adults have suggested that personality dimensions of self-criticism and dependency convey vulnerability to depression and negatively influence treatment response. Yet, there is a dearth of studies on these personality dimensions in adolescents. This PhD research, therefore, adopts a mixed-method approach to investigate the relationship between self-criticism, dependency, depression and its treatment in youths with clinical depression. METHODS: Data from a pre-existing clinical trial were used, in which 465 depressed adolescents diagnosed with depression who received either cognitive behaviour therapy, short-term psychoanalytic psychotherapy, or brief psychosocial intervention were assessed at baseline, 6-, 12-, 36-week treatment end, 52-, and 86-week post-randomisation. Participants’ self-criticism and dependency were measured at baseline, and the therapeutic alliance as rated by both youths and therapists was collected during the treatment. The young people were also interviewed about their expectations and experiences of the therapy after treatment. For this PhD, multiple regression, multilevel modelling, and interpretative phenomenological analysis were the major analytical approaches. RESULTS: Greater self-criticism in the adolescents was associated with maladaptive pre-treatment functioning (e.g., depression) and difficulties in engaging with the therapy (e.g., having poor ratings on the alliance and expressing mistrust in therapists during interviews), which, in turn, were associated with poorer outcomes over time. Findings for dependency were more mixed, as dependency was associated with improvements in general and social functioning during the treatment, but also with a tendency to relapse after treatment. There was some evidence for gender-incongruency, as self-criticism in girls and dependency in boys tended to associate with poorer functioning and poorer alliance as rated by therapists. DISCUSSION: Overall, findings reported in this thesis provide further evidence for the role of both self- criticism and dependency in adolescent depression, and how these personality dimensions may interact with the therapeutic process. The implications and limitations of these findings are discussed