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1.
Artigo em Inglês | MEDLINE | ID: mdl-32715430

RESUMO

Leonard Bickman's article on the future of artificial intelligence (AI) in psychotherapy research paints an encouraging picture of the progress to be made in this field. We support his perspective, but we also offer some cautionary notes about the boost AI can provide. We suggest that AI is not likely to transform psychotherapy research or practice to the degree seen in pharmacology and medicine because the factors that contribute to treatment response in these realms differ so markedly from one another, and in ways that do not favor advances in psychotherapy. Despite this limitation, it seems likely that AI will have a beneficial impact, improving empirical analysis through data-driven model development, tools for addressing the limitations of traditional regression methods, and novel means of personalizing treatment. In addition, AI has the potential to augment the reach of the researcher and therapist by expanding our ability to gather data and deliver interventions beyond the confines of the lab or clinical office.

2.
Int J Eat Disord ; 2020 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-32691930

RESUMO

OBJECTIVE: It is difficult for individuals with eating disorders (EDs) to build and maintain motivation to recover. This challenge contributes to high rates of treatment dropout and relapse. To date, motivational interventions have been largely ineffective, and there is little research on factors that affect recovery motivation. To better understand recovery motivation and identify potential intervention targets, this study examines factors that affect recovery motivation in individuals with EDs. METHOD: N = 13 participants completed qualitative interviews. All had been recovered from their diagnosed and treated ED for at least 1 year. We applied thematic analysis to interview transcripts in order to identify factors that had influenced recovery motivation and to classify their effects as helpful, harmful, or mixed. RESULTS: Six main themes were identified, with subthemes detailed under each: (a) important people and groups (e.g., social circle, mentor), (b) actions and attitudes of others (e.g., judgmental responses, failure to intervene), (c) treatment-related factors (e.g., therapeutic skills, therapeutic alliance), (d) influential circumstances (e.g., removing triggers, pregnancy/children), (e) personal feelings and beliefs (e.g., obligation to others, hope for the future), and (f) the role of epiphanies (i.e., sudden insights or moments of change). DISCUSSION: In this study, we identified potentially malleable factors that may affect ED recovery motivation (e.g., removing triggers, focusing on obligation to others, getting involved in meaningful causes, securing non-judgmental support, building hope for the future). These factors may be investigated as potential targets or strategies in motivational interventions for EDs.

3.
Behav Ther ; 51(4): 601-615, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32586433

RESUMO

Youth mental health interventions in low-resource communities may benefit from including empirically supported elements, using stigma-free content, and using trained lay-providers. We developed and evaluated such an intervention, targeting adolescent depression and anxiety in Kenya, where mental health care is limited by social stigma and a paucity of providers. Kenyan adolescents (N = 51, ages 14-17, 60.78% female) from a school in an urban slum in Nairobi with self-reported moderate-to-severe symptoms of depression or anxiety were randomized to the 4-week "Shamiri" ("thrive") group intervention or a study skills control intervention of equal duration. The Shamiri intervention included growth mindset, gratitude, and value affirmation exercises. The content was delivered by recent high school graduates (ages 17-21, 60% male) trained as lay-providers. Participants met in school once-a-week in groups of 9-12 youths (average group size 10). Compared to the study-skills control, Shamiri produced greater reductions in adolescent depression symptoms (p = .038; d = .32) and anxiety symptoms (p = .039; d = .54) from baseline to 4-week follow-up, and greater improvements in academic performance (p = .034; d = .32) from the school-term before versus after the intervention. There were no effects on overall social support or perceived control, but the Shamiri group showed larger increases in perceived social support from friends (p = .028, d = .71). This appears to be the first report that a brief, lay-provider delivered, community-based intervention may reduce internalizing symptoms and improve academic outcomes in high-symptom adolescents in Sub-Saharan Africa. Larger replications with extended follow-ups will help gauge the strength and durability of these effects.

4.
Lancet Psychiatry ; 7(7): 581-601, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32563306

RESUMO

BACKGROUND: Depressive disorders are common in children and adolescents. Antidepressants, psychotherapies, and their combination are often used in routine clinical practice; however, available evidence on the comparative efficacy and safety of these interventions is inconclusive. Therefore, we sought to compare and rank all available treatment interventions for the acute treatment of depressive disorders in children and adolescents. METHODS: We did a systematic review and network meta-analysis. We searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, PsycINFO, ProQuest, CINAHL, LiLACS, international trial registries, and the websites of regulatory agencies for published and unpublished randomised controlled trials from database inception until Jan 1, 2019. We included placebo-controlled and head-to-head trials of 16 antidepressants, seven psychotherapies, and five combinations of antidepressant and psychotherapy that are used for the acute treatment of children and adolescents (≤18 years old and of both sexes) with depressive disorder diagnosed according to standard operationalised criteria. Trials recruiting participants with treatment-resistant depression, bipolar disorder, psychotic depression, treatment duration of less than 4 weeks, or an overall sample size of fewer than ten patients were excluded. We extracted data following a predefined hierarchy of outcome measures, and assessed risk of bias and certainty of evidence using validated methods. Primary outcomes were efficacy (change in depressive symptoms) and acceptability (treatment discontinuation due to any cause). We estimated summary standardised mean differences (SMDs) or odds ratios (ORs) with credible intervals (CrIs) using network meta-analysis with random effects. This study was registered with PROSPERO, number CRD42015020841. FINDINGS: From 20 366 publications, we included 71 trials (9510 participants). Depressive disorders in most studies were moderate to severe. In terms of efficacy, fluoxetine plus cognitive behavioural therapy (CBT) was more effective than CBT alone (-0·78, 95% CrI -1·55 to -0·01) and psychodynamic therapy (-1·14, -2·20 to -0·08), but not more effective than fluoxetine alone (-0·22, -0·86 to 0·42). No pharmacotherapy alone was more effective than psychotherapy alone. Only fluoxetine plus CBT and fluoxetine were significantly more effective than pill placebo or psychological controls (SMDs ranged from -1·73 to -0·51); and only interpersonal therapy was more effective than all psychological controls (-1·37 to -0·66). Nortriptyline (SMDs ranged from 1·04 to 2·22) and waiting list (SMDs ranged from 0·67 to 2·08) were less effective than most active interventions. In terms of acceptability, nefazodone and fluoxetine were associated with fewer dropouts than sertraline, imipramine, and desipramine (ORs ranged from 0·17 to 0·50); imipramine was associated with more dropouts than pill placebo, desvenlafaxine, fluoxetine plus CBT, and vilazodone (2·51 to 5·06). Most of the results were rated as "low" to "very low" in terms of confidence of evidence according to Confidence In Network Meta-Analysis. INTERPRETATION: Despite the scarcity of high-quality evidence, fluoxetine (alone or in combination with CBT) seems to be the best choice for the acute treatment of moderate-to-severe depressive disorder in children and adolescents. However, the effects of these interventions might vary between individuals, so patients, carers, and clinicians should carefully balance the risk-benefit profile of efficacy, acceptability, and suicide risk of all active interventions in young patients with depression on a case-by-case basis. FUNDING: National Key Research and Development Program of China.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo/terapia , Psicoterapia/métodos , Adolescente , Antidepressivos/efeitos adversos , Criança , Medicina Baseada em Evidências , Humanos , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como Assunto
5.
J Pediatr Psychol ; 45(6): 633-642, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32386417

RESUMO

OBJECTIVE: In research with community samples, children with chronic physical illnesses have shown elevated anxiety and depressive symptoms, compared to healthy peers. Less is known about whether physical illnesses are associated with elevated internalizing symptoms even among children referred for mental health treatment-a pattern that would indicate distinctive treatment needs among physically ill children receiving mental health care. We investigated the relationship between chronic physical illness and internalizing symptomatology among children enrolling in outpatient mental health treatment. METHOD: A total of 262 treatment-seeking children ages 7-15 and their caregivers completed a demographic questionnaire, Child Behavior Checklist, and Youth Self-Report during a pre-treatment assessment. Physical illnesses were identified through caregiver report. RESULTS: There was no overall association between the presence/absence of chronic physical illness and parent- or child-reported symptoms. However, number of chronic physical illnesses was related to parent- and child-reported affective symptoms. Children with two or more chronic physical illnesses had more severe depressive symptoms than those with fewer physical illnesses. CONCLUSION: Having multiple chronic illnesses may elevate children's risk of depression symptomatology, even in comparison to other children seeking mental health care. This suggests a need to identify factors that may exacerbate depression symptoms in physically ill children who are initiating therapy and to determine whether different or more intensive services may be helpful for this group. The findings suggest the potential utility of screening for depression in youth with chronic physical illnesses, as well as addressing mental and physical health concerns during treatment.

6.
J Consult Clin Psychol ; 88(7): 657-668, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32391709

RESUMO

BACKGROUND: Adolescent depression and anxiety symptoms are prevalent in sub-Saharan African countries, yet treatment options are scarce, and stigma limits help-seeking. Brief, computerized single-session interventions (SSIs) that contain empirically supported stigma-reducing elements may help expand access to treatment. We developed and evaluated such an intervention for Kenyan adolescents. METHOD: High school students (N = 103, age 13-18) were randomized to a digital SSI Shamiri-Digital (Shamiri means "thrive" in Kiswahili) or a study-skills control intervention. Shamiri-Digital consisted of reading and writing activities about 3 concepts: growth mindset, gratitude, and value affirmation. Both Shamiri-Digital and the study-skills control condition were delivered electronically in schools. RESULTS: Compared to the control, Shamiri-Digital produced a greater reduction in adolescent depressive symptoms in both the full sample (p = .028, d = 0.50) and a subsample of youths with moderate to severe depression symptoms (p = .010, d = 0.83) from baseline to 2-week follow-up. The effects exceed the mean effects reported in meta-analyses of full-length, face-to-face psychotherapy for youth depression. There were no significant effects on anxiety symptoms, well-being, or happiness. CONCLUSION: This is the first report that a brief, computerized SSI may reduce depressive symptoms in adolescents in sub-Saharan Africa. Replication trials with extended follow-ups will help gauge the strength and durability of these effects. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

8.
Psychother Res ; : 1-14, 2020 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-32223373

RESUMO

Introduction: Researchers have proposed that predicting who is a likely placebo responder may help guide treatment allocations to treatment regimens that differ in intensity.Methods: We used data from the Treatment of Adolescent Depression Study (TADS) in which adolescents (n = 439) were randomized 1:1:1:1 to placebo, cognitive-behavioral therapy (CBT), medications (MEDs), or their combination (COMB). We developed a prognostic index (PI) in the placebo group to predict self-reported (RADS) and observer-rated (CDRS) depression outcomes using elastic net regularization. We explored whether the PIs moderated outcomes in the treatment conditions.Results: PI-CDRS was predicted by multiple variables but it did not moderate outcomes. PI-RADS was predicted by baseline severity, age, sleep problems, expectations, maternal depression, and the action stage of change. It moderated outcomes such that there were treatment differences for less placebo-responsive patients. For participants prone to placebo response, type of treatment had no statistically significant impact on outcomes. Baseline depression severity accounted for this effect: treatment differences were small and non-significant for patients with milder depression but larger in more severely depressed patients.Discussion: Future work should investigate whether multiple variable explain outcomes beyond severity as well as complex interactions between severity and other variables.

9.
Asian J Psychiatr ; 50: 101980, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32146337

RESUMO

BACKGROUND: Many evidence-based prevention and intervention approaches for youth mental health exist, but most are time-consuming and expensive to deliver. Innovative approaches are needed to develop and disseminate scalable mental health interventions, especially for youth in low- and middle-income countries. Computerized single-session interventions (SSIs) may be able to overcome many of these implementation barriers, especially if deployed in school settings. METHODS: Guided by this logic, we designed three computerized SSIs (based on behavioral activation, gratitude, and growth mindset exercises) for delivery in Indian high schools. Then, we conducted focus groups with Indian adolescents and school officials to inform adaptations of the interventions. Finally, we designed a Hybrid Type 1 effectiveness-implementation study to evaluate the interventions. RESULTS: In this paper, we present the rationale for selecting the interventions, the results of the focus groups, and the design of a Hybrid Type 1 effectiveness-implementation study. Our initial focus group data showed that the interventions were considered acceptable, feasible, and appropriate by both educators and students. We also describe feedback on the interventions which we incorporated to refine the interventions prior to our randomized controlled trial. DISCUSSION: Computerized SSIs may offer innovative, scalable ways to disseminate evidence-based interventions. By identifying which interventions are most acceptable and effective in this highly scalable format, we may understand which SSIs are best suited for continued development, testing, and, ultimately, widespread dissemination.

10.
JAMA Psychiatry ; 2020 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-32186668

RESUMO

Importance: It is not clear whether psychotherapies for depression have comparable effects across the life span. Finding out is important from a clinical and scientific perspective. Objective: To compare the effects of psychotherapies for depression between different age groups. Data Sources: Four major bibliographic databases (PubMed, PsychINFO, Embase, and Cochrane) were searched for trials comparing psychotherapy with control conditions up to January 2019. Study Selection: Randomized trials comparing psychotherapies for depression with control conditions in all age groups were included. Data Extraction and Synthesis: Effect sizes (Hedges g) were calculated for all comparisons and pooled with random-effects models. Differences in effects between age groups were examined with mixed-effects subgroup analyses and in meta-regression analyses. Main Outcomes and Measures: Depressive symptoms were the primary outcome. Results: After removing duplicates, 16 756 records were screened and 2608 full-text articles were screened. Of these, 366 trials (36 702 patients) with 453 comparisons between a therapy and a control condition were included in the qualitative analysis, including 13 (3.6%) in children (13 years and younger), 24 (6.6%) in adolescents (≥13 to 18 years), 19 (5.2%) in young adults (≥18 to 24 years), 242 (66.1%) in middle-aged adults (≥24 to 55 years), 58 (15.8%) in older adults (≥55 to 75 years), and 10 (2.7%) in older old adults (75 years and older). The overall effect size of all comparisons across all age groups was g = 0.75 (95% CI, 0.67-0.82), with very high heterogeneity (I2 = 80%; 95% CI: 78-82). Mean effect sizes for depressive symptoms in children (g = 0.35; 95% CI, 0.15-0.55) and adolescents (g = 0.55; 95% CI, 0.34-0.75) were significantly lower than those in middle-aged adults (g = 0.77; 95% CI, 0.67-0.87). The effect sizes in young adults (g = 0.98; 95% CI, 0.79-1.16) were significantly larger than those in middle-aged adults. No significant difference was found between older adults (g = 0.66; 95% CI, 0.51-0.82) and those in older old adults (g = 0.97; 95% CI, 0.42-1.52). The outcomes should be considered with caution because of the suboptimal quality of most of the studies and the high levels of heterogeneity. However, most primary findings proved robust across sensitivity analyses, addressing risk of bias, target populations included, type of therapy, diagnosis of mood disorder, and method of data analysis. Conclusions and Relevance: Trials included in this meta-analysis reported effect sizes of psychotherapies that were smaller in children than in adults, probably also smaller in adolescents, that the effects may be somewhat larger in young adults, and without meaningful differences between middle-aged adults, older adults, and older old adults.

11.
J Consult Clin Psychol ; 88(3): 255-268, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32068426

RESUMO

OBJECTIVE: To examine the preliminary effectiveness of a modular, transdiagnostic, behavioral/cognitive-behavioral intervention (MATCH) compared with standard manualized treatments (SMT) and usual care (UC) for treating youth with severe irritability. METHOD: We analyzed data from an effectiveness trial in which treatment-referred youths (N = 174; Mage = 10.6 years; 70% boys) were randomized to receive MATCH, SMT, or UC (ns = 53-62). Masked assessments of irritability, diagnoses, impairment, and internalizing, externalizing, total, and top problems were collected from caregivers and youths at pre- and posttreatment, weekly during treatment, and quarterly through 2-year follow-up. Baseline measures of irritability and impairment were used to identify a subsample characterized by severe irritability and mood dysregulation (SIMD; n = 81; Mage = 10.2 years; 69% boys; ns = 24-31 across conditions). Longitudinal multilevel models and ANOVAs were estimated to examine numerous clinical outcomes within and between conditions. RESULTS: Among youth with SIMD, MATCH produced faster improvements than UC and SMT, with medium or large effect sizes in two thirds of all comparisons tested (Mdn ES = 0.60). Although SIMD youths in all conditions showed reductions in DSM diagnoses, only MATCH predicted significantly fewer posttreatment diagnoses than UC (averaging 1.0 fewer; ES = 0.93). Finally, among the entire sample, MATCH and SMT equivalently outperformed UC in reducing irritability (ES = 0.49) and the effects of each treatment condition on other outcomes were not moderated by baseline irritability. CONCLUSIONS: Extant behavioral/cognitive-behavioral psychotherapies-already well-established and widely used-may be helpful for treating youths with severe irritability. A transdiagnostic, modular format showed the most consistently favorable pattern of results across multiple outcomes, informants, and measurement schedules. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

12.
J Am Acad Child Adolesc Psychiatry ; 59(1): 45-63, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31004739

RESUMO

OBJECTIVE: Youth depression is a debilitating condition that constitutes a major public health concern. A 2006 meta-analysis found modest benefits for psychotherapy versus control. Has 13 more years of research improved that picture? We sought to find out. METHOD: We searched PubMed, PsychINFO, and Dissertation Abstracts International for 1960 to 2017, identifying 655 randomized, English-language psychotherapy trials for individuals aged 4 to 18 years. Of these, 55 assessed psychotherapy versus control for youth depression with outcome measures administered to both treatment and control conditions at post (κ = 53) and/or follow-up (κ = 32). Twelve study and outcome characteristics were extracted, and effect sizes were calculated for all psychotherapy versus control comparisons. Using a three-level random-effects model, we obtained an overall estimate of the psychotherapy versus control difference while accounting for the dependency among effect sizes. We then fitted a three-level mixed-effects model to identify moderators that might explain variation in effect size within and between studies. RESULTS: The overall effect size (g) was 0.36 at posttreatment and 0.21 at follow-up (averaging 42 weeks after posttreatment). Three moderator effects were identified: effects were significantly larger for interpersonal therapy than for cognitive behavioral therapy, for youth self-reported outcomes than parent-reports, and for comparisons with inactive control conditions (eg, waitlist) than active controls (eg, usual care). Effects showed specificity, with significantly smaller effects for anxiety and externalizing behavior outcomes than for depression measures. CONCLUSION: Youth depression psychotherapy effects are modest, with no significant change over the past 13 years. The findings highlight the need for treatment development and research to improve both immediate and longer-term benefits.

13.
Assessment ; 27(2): 321-333, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-29716398

RESUMO

Observational measurement of treatment adherence has long been considered the gold standard. However, little is known about either the generalizability of the scores from extant observational instruments or the sampling needed. We conducted generalizability (G) and decision (D) studies on two samples of recordings from two randomized controlled trials testing cognitive-behavioral therapy for youth anxiety in two different contexts: research versus community. Two doctoral students independently coded 543 session recordings from 52 patients treated by 13 therapists. The initial G-study demonstrated that context accounted for a disproportionately large share of variance, so we conducted G- and D-studies for the two contexts separately. Results suggested that reliable cognitive-behavioral therapy adherence studies require at least 10 sessions per patient, assuming 12 patients per therapists and two coders-a challenging threshold even in well-funded research. Implications, including the importance of evaluating alternatives to observational measurement, are discussed.

14.
Dev Psychopathol ; : 1-14, 2019 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-31845636

RESUMO

Exposure to adverse events is prevalent among youths and robustly associated with risk for depression, particularly during adolescence. The Dimensional Model of Adversity and Psychopathology (DMAP) distinguishes between adverse events that expose youths to deprivation versus threat, positing unique mechanisms of risk (cognitive functioning deficits for deprivation, and altered fear and emotion learning for threat) that may require different approaches to intervention. We examined whether deprivation and threat were distinctly associated with behavioral measures of cognitive processes and autonomic nervous system function in relation to depression symptom severity in a community sample of early adolescents (n = 117; mean age 12.73 years; 54.7% male). Consistent with DMAP, associations between threat and depression symptoms, and between economic deprivation and depression symptoms, were distinctly moderated by physiological and cognitive functions, respectively, at baseline but not follow-up. Under conditions of greater cognitive inhibition, less exposure to deprivation was associated with lower symptom severity. Under conditions of blunted resting-state autonomic response (electrodermal activity and respiratory sinus arrhythmia), greater exposure to threat was associated with higher symptom severity. Our findings support the view that understanding risk for youth depression requires parsing adversity: examining distinct roles played by deprivation and threat, and the associated cognitive and biological processes.

15.
Behav Res Ther ; 123: 103498, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31707224

RESUMO

Smartphone applications for the treatment of depression and anxiety have acquired millions of users, yet little is known about whether they include evidence-based therapeutic content. We examined the extent to which popular mental health applications (MH apps) for depression and anxiety contain treatment elements found in empirically supported psychotherapy protocols (i.e., "common elements"). Of the 27 MH apps reviewed, 23 included at least one common element, with a median of three elements. Psychoeducation (in 52% of apps), relaxation (44%), meditation (41%), mindfulness (37%), and assessment (37%) were the most frequent elements, whereas several elements (e.g., problem solving) were not found in any apps. We also identified gaps between app content and empirically supported treatments. Cognitive restructuring was more common in depression protocols than in depression apps (75% of protocols vs. 31% of apps), as was problem solving (34% vs. 0%). For anxiety, exposure (85%, 12%), cognitive restructuring (60%, 12%), and problem solving (25%, 0%) were more common in protocols than apps. Overall, our findings highlight empirically supported treatment elements that are poorly represented in current MH apps. The absence of several core treatment elements underscores the need for future research, including randomized trials testing the effectiveness of popular MH apps.

16.
J Clin Child Adolesc Psychol ; : 1-14, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31517543

RESUMO

A critical task in psychotherapy research is identifying the conditions within which treatment benefits can be replicated and outside of which those benefits are reduced. We tested the robustness of beneficial effects found in two previous trials of the modular Child STEPs treatment program for youth anxiety, depression, trauma, and conduct problems. We conducted a randomized trial, with two significant methodological changes from previous trials: (a) shifting from cluster- to person-level randomization, and (b) shifting from individual to more clinically feasible group-based consultation with STEPs therapists. Fifty community clinicians from multiple outpatient clinics were randomly assigned to receive training and consultation in STEPs (n = 25) or to provide usual care (UC; n = 25). There were 156 referred youths-ages 6-16 (M = 10.52, SD = 2.53); 48.1% male; 79.5% Caucasian, 12.8% multiracial, 4.5% Black, 1.9% Latino, 1.3% Other-who were randomized to STEPs (n = 77) or UC (n = 79). Following previous STEPs trials, outcome measures included parent- and youth-reported internalizing, externalizing, total, and idiographic top problems, with repeated measures collected weekly during treatment and longer term over 2 years. Participants in both groups showed statistically significant improvement on all measures, leading to clinically meaningful problem reductions. However, in contrast to previous trials, STEPs was not superior to UC on any measure. As with virtually all treatments, the benefits of STEPs may depend on the conditions-for example, of study design and implementation support-in which it is tested. Identifying those conditions may help guide appropriate use of STEPs, and other treatments, in the future.

17.
Adm Policy Ment Health ; 46(6): 821-832, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31385107

RESUMO

We examined practitioners' use of the transdiagnostic Modular Approach to Therapy for Children (MATCH) 7 years after learning MATCH for a clinical trial. The practitioners (N = 29; Mage = 52.10, SD = 12.29, 86% women, 97% white) reported using MATCH with 55% of their caseload; use of the various MATCH modules ranged from 39 to 70%. Use was positively associated with amount of MATCH experience in the trial, perceived effectiveness, and ease of implementation. Patterns of specific module use did not consistently match strength of prior evidence (e.g., exposure was least used of the anxiety modules), suggesting challenges for implementation science.

18.
J Clin Child Adolesc Psychol ; : 1-16, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31276433

RESUMO

Research suggests that irritability and defiance are distinct dimensions of youth oppositionality that are differentially associated with internalizing and conduct problems, respectively. Because much of this evidence has emerged with limited psychometric evaluation, we conducted the first multi-informant examination of selected Child Behavior Checklist (CBCL) and Youth Self Report (YSR) items for measuring irritability and defiance in a large clinical sample. Clinically referred youths (N = 1,030; ages 6-15; 43% female, 42% ethnic minority) were assessed prior to treatment using multi-informant rating scales and diagnostic interviews. Analyses examined factor structure, invariance, internal consistency, multi-informant patterns, and convergent, discriminant, and criterion validity with internalizing and externalizing problems/disorders. A correlated 2-factor model of irritability (stubborn/sullen/irritable, mood, temper) and defiance (argues, disobeys-home, disobeys-school) fit well for both informants. Adequate measurement invariance and scale consistency was consistently found for parent-report but not youth-report. With both informants, all hypothesized convergent and discriminant validity associations were supported: irritability and defiance with internalizing and conduct scales, respectively. However, hypothesized criterion validity associations were largely found only by parent-report: irritability with anxiety and depressive disorders, defiance with conduct disorder, and both with oppositional defiant disorder. Results consistently supported the reliability and validity of the CBCL irritability and defiance scales, with somewhat less consistent support for the YSR scales. Thus, CBCL items may provide psychometrically sound assessment of irritability and defiance, whereas further research is needed to advance youth-report and multi-informant strategies. Results also provide further support for a two subdimension model of oppositional defiant disorder symptoms that includes irritability and defiance.

19.
JMIR Res Protoc ; 8(7): e13368, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31290406

RESUMO

BACKGROUND: Depression is the leading cause of disability in youth, with a global economic burden of US >$210 billion annually. However, up to 70% of youth with depression do not receive services. Even among those who do access treatment, 30% to 65% fail to respond and many dropout prematurely, demonstrating a need for more potent, accessible interventions. In a previous trial, a single-session Web-based growth mindset (GM) intervention significantly reduced depressive symptoms in high-symptom adolescents; however, this intervention did not benefit adolescents uniformly. For instance, the intervention reduced depression in adolescents who reported post intervention increases in perceived control, but it did not lead to significant depression reductions in adolescents who reported no significant post intervention increases in perceived control. OBJECTIVE: The goal of this project is to test the acceptability and efficacy of a novel, single-session, virtual reality (VR) depression intervention-the VR Personality Project-teaching GM, the belief that personal attributes are malleable rather than fixed. The VR Personality Project was designed to systematically target and increase adolescents' perceived control by offering a more immersive, engaging, user-directed intervention experience than the Web-based intervention can provide. By targeting an identified predictor of intervention response, the VR Personality Project may lead to larger reductions in depressive symptoms than existing Web-based mindset interventions. METHODS: Adolescents with elevated depressive symptoms or a recent history of depression (N=159; ages 12 to 16 years) will be randomized to one of 3 intervention conditions: the VR Personality Project; the Web-based GM intervention tested previously; or an active, Web-based control. Adolescents and their parents will report on the adolescents' depression symptoms, perceived control, and related domains of functioning at preintervention, postintervention, and at 3- and 9-month follow-up assessments. RESULTS: We predict that the VR and Web-based mindset interventions will both lead to larger reductions in adolescent symptoms than the control intervention. Additionally, we predict that the VR-based single session intervention will lead to larger reductions in depression than the online mindset intervention and that these symptom reductions will be mediated by increases in adolescents' perceived control from pre- to postintervention. CONCLUSIONS: The results may suggest an efficient strategy for reducing adolescent depressive symptoms: One that is mechanism-targeted, relatively affordable (less than US $200 for a commercially available VR headset, a fraction of the cost of long-term psychotherapy) and potentially engaging to adolescents experiencing mood-related distress. TRIAL REGISTRATION: ClinicalTrials.gov NCT0385881; https://clinicaltrials.gov/ct2/show/NCT03858881 (Archived by WebCite at http://www.webcitation.org/78C3roDgA). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/13368.

20.
J Am Acad Child Adolesc Psychiatry ; 58(10): 945-947, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31047993

RESUMO

Adolescent depression is a prevalent disorder that increases risk for significant functional impairment and suicidality.1-3 Several psychotherapies are available, and it has been widely assumed that failure to complete these therapies will undermine benefit. The important study by O'Keeffe et al. raises questions about that assumption.4.

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