Matthijs Oud1, Lars de Winter2, Evelien Vermeulen-Smit3, Denise Bodden4, Maaike Nauta5, Lisanne Stone6, Marieke van den Heuvel7, Reham Al Taher8, Ireen de Graaf9, Tim Kendall10, Rutger Engels11, Yvonne Stikkelbroek12. 1. Department of Reintegration, Trimbos-Institute, Da Costakade 45, 3521 VS Utrecht, the Netherlands. Electronic address: matthijsoud@gmail.com. 2. Phrenos Center of Expertise, Da Costakade 45, 3521 VS Utrecht, the Netherlands. Electronic address: ldewinter@kcphrenos.nl. 3. Christian University of Applied Sciences Ede, P.O. Box 80, 6710 BB, Ede, the Netherlands. Electronic address: evermeulen@che.nl. 4. Child and Adolescent Studies, University of Utrecht, P.O. Box 80.140, 3508 TC Utrecht, the Netherlands. Electronic address: D.Bodden@uu.nl. 5. Department of Clinical Psychology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands. Electronic address: m.h.nauta@rug.nl. 6. Karakter kinder- en jeugdpsychiatrie, Reinier Postlaan 12, 6525 GC Nijmegen, the Netherlands. Electronic address: l.stone@karakter.com. 7. Department of Public Mental Health, Trimbos-Institute, Da Costakade 45, 3521 VS Utrecht, the Netherlands. Electronic address: mheuvel@trimbos.nl. 8. Psychologist for Jung Institute for Free Analysis for Children and Adolescence, 8 St. Mary's Road, Crumlin, Dublin 12, Ireland. Electronic address: r.altaher@hotmail.com. 9. Department of Public Mental Health, Trimbos-Institute, Postbus 725, 3500 AS Utrecht, the Netherlands. Electronic address: igraaf@trimbos.nl. 10. National Clinical Director for Mental Health, NHS England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, United Kingdom. Electronic address: tim2.kendall@virgin.net. 11. Rector Magnificus, Erasmus Universiteit Rotterdam, Postbus 1738, 3000 DR Rotterdam, the Netherlands. Electronic address: rutger.engels@eur.nl. 12. Child and Adolescent Studies, University of Utrecht, P.O. Box 80.140, 3508 TC Utrecht, the Netherlands. Electronic address: Y.Stikkelbroek@uu.nl.
Abstract
BACKGROUND: Cognitive-behavioral therapy (CBT) is first choice of treatment for depressive symptoms and disorders in adolescents, however improvements are necessary because overall efficacy is low. Insights on CBT components and contextual and structural characteristics might increase the efficacy. The aim of our approach is to evaluate the efficacy of CBT for youth with depression and investigate the influence of specific components, contextual and structural factors that could improve effects. METHODS: A systematic review of randomized controlled trials was conducted, searches were undertaken in CINAHL, CENTRAL, EMBASE, MEDLINE/PubMed and PsycINFO. Outcomes were meta-analyzed and confidence in results was assessed using the GRADE-method. Meta-regression was used to pinpoint components or other factors that were associated with an in- or decrease of effects of CBT. RESULTS: We included 31 trials with 4335 participants. Moderate-quality evidence was found for CBT reducing depressive symptoms at the end of treatment and at follow-up, and CBT as indicated prevention resulted in 63% less risk of being depressed at follow-up. CBT containing a combination of behavioral activation and challenging thoughts component (as part of cognitive restructuring) or the involvement of caregiver(s) in intervention were associated with better outcomes for youth on the long term. CONCLUSIONS: There is evidence that CBT is effective for youth with a (subclinical) depression. Our analyses show that effects might improve when CBT contains the components behavioral activation and challenging thoughts and also when the caregiver(s) are involved. However, the influential effects of these three moderators should be further tested in RCTs.
BACKGROUND: Cognitive-behavioral therapy (CBT) is first choice of treatment for depressive symptoms and disorders in adolescents, however improvements are necessary because overall efficacy is low. Insights on CBT components and contextual and structural characteristics might increase the efficacy. The aim of our approach is to evaluate the efficacy of CBT for youth with depression and investigate the influence of specific components, contextual and structural factors that could improve effects. METHODS: A systematic review of randomized controlled trials was conducted, searches were undertaken in CINAHL, CENTRAL, EMBASE, MEDLINE/PubMed and PsycINFO. Outcomes were meta-analyzed and confidence in results was assessed using the GRADE-method. Meta-regression was used to pinpoint components or other factors that were associated with an in- or decrease of effects of CBT. RESULTS: We included 31 trials with 4335 participants. Moderate-quality evidence was found for CBT reducing depressive symptoms at the end of treatment and at follow-up, and CBT as indicated prevention resulted in 63% less risk of being depressed at follow-up. CBT containing a combination of behavioral activation and challenging thoughts component (as part of cognitive restructuring) or the involvement of caregiver(s) in intervention were associated with better outcomes for youth on the long term. CONCLUSIONS: There is evidence that CBT is effective for youth with a (subclinical) depression. Our analyses show that effects might improve when CBT contains the components behavioral activation and challenging thoughts and also when the caregiver(s) are involved. However, the influential effects of these three moderators should be further tested in RCTs.
Authors: Greg Clarke; Christina R Sheppler; Alison J Firemark; Andreea M Rawlings; John F Dickerson; Michael C Leo Journal: Contemp Clin Trials Date: 2020-02-28 Impact factor: 2.226
Authors: Tomas Lindegaard; Elisabet Wasteson; Youstina Demetry; Gerhard Andersson; Derek Richards; Shervin Shahnavaz Journal: Internet Interv Date: 2022-04-01