Madara Hall - Marinela

New ways of preventing and treating depression in youth

Marieke van den Heuvel (1) Sanne Rasing (2 + 3) Denise Bodden (2) Keith Dobson (discussant) (4) Speaker

CBT has repeatedly found to be effective in preventing and treating depression. However, studies mainly focused on effectiveness of CBT “treatment packages” so little is known about which CBT elements are essential for its’ effectiveness. In the first presentation, a prevention study will be presented in which we evaluate the effectiveness of the four most commonly used CBT-elements (i.e., cognitive restructuring, behavioral activation, relaxation and problem solving skills). A RCT was conducted in which adolescents (n=240, ages 12-18) with elevated levels of depression were randomly assigned to four conditions which each started with a different 3-session CBT-element. Results from this RCT will be presented. Also, not all depressed adolescents profit from CBT, the drop-out rate is high and the motivation of adolescents is low. So perhaps, we should look into other, innovative ways of treating depressed adolescents. The second presentation will present data on blended CBT in which online CBT treatment is combined with therapist sessions to treat clinically depressed adolescents (12 to 21 years old). The aim of this study is to evaluate the (cost-)effectiveness of D(o)epression Blended by comparing D(o)epression blended (still including participants) with D(o)epression face-to-face (n=44) and CAU (n=44). Results will be presented. The third presentation focusses on the effectiveness of Acceptance and Commitment Therapy in the treatment of adolescent depression. This intervention is aimed at increasing psychological flexibility and taking action towards values, instead of reduction of symptoms. Preliminary results of the effects of ACT in clinically depressed youth (12-21 years old) will be presented.

Marieke van den Heuvel (1), Sanne Rasing (2 + 3), Denise Bodden (2), Keith Dobson (discussant) (4)

1. Netherlands Institute of Mental Health and Addiction (Trimbos instute), Utrecht, the Netherlands
2. Utrecht University, Utrecht, the Netherlands,
3. GGZ Oost Brabant, Oss, the Netherlands
4. University of Calgary, Calgary, Canada

1.Core elements of Cognitive Behavioral Therapy in preventing depression in youth: Does the type and sequence of elements matter?

Presenter: Marieke van den Heuvel MSc

Co-authors: Denise Bodden & Rutger Engels

Affiliations: Trimbos-institute & Utrecht University, The Netherlands

Depression during adolescence is a major public health concern, because of its high prevalence, association with suicide, comorbid psychiatric diagnoses and high treatment costs. Even sub-clinical levels of depressive symptoms put adolescents at risk for several negative outcomes. Therefore, it is important that depression is detected at an early stage and is treated preventively. Prevention programs based on the principles of Cognitive Behavioral Therapy (CBT) have proven to be the most effective and most applied in preventing depression among adolescents. Thus far, research has mainly focused on effectiveness of “prevention packages” consisting of multiple CBT-elements. Little research has been done on the specific elements of these protocols. Most common CBT-elements in existing programs are cognitive restructuring, behavioral activation, relaxation and problem solving skills. It is unclear which of these elements contribute to the positive outcomes of CBT-programs and how these elements should be offered (i.e., what their optimal sequencing is). A Randomized Controlled Trial has been conducted to evaluate the differential effectiveness of different types and sequences of CBT-elements in the prevention of depression among 220 adolescents. Preliminary results will be presented.


2. Blended CBT as treatment for depressive disorders in adolescents in psychiatric care

Presenter: Denise Bodden

Co-authors: Sanne Rasing & Yvonne Stikkelbroek

Affiliations: Utrecht University, The Netherlands

CBT is an effective intervention to treat depressive disorders. However, research has shown that up to 57% of patients drop out of treatment and that 50% of the adolescents still has depressive symptoms after treatment. Alternative interventions, such as Interpersonal Psychotherapy and Problem-Solving Therapy, are comparable to CBT in terms of effectiveness, but also in terms of drop-out and remission-rate. So, offering different treatments does not seem to be the solution to improve effectiveness. Offering CBT as a blended intervention might be.

Earlier research has shown that online CBT and face-to-face CBT have similar effects in treating depressive disorders in adults. It is known that online interventions increase motivation, treatment expectancies, independence, accessibility, and decrease resistance and drop-out because it can be easily tailored to the needs of patients. Furthermore, adolescents seem to prefer self-help. Combining online treatment with therapist guidance through email, online chat and face-to-face sessions (hence a blended treatment) is associated with higher completion of treatment.  Moreover, therapeutic guidance in treatment of depression is strongly advised to monitor  the suicide risk.

In this presentation, an overview of the literature on treatment of depressive disorders in adolescents , the design of a pragmatic quasi-experimental controlled trial on the effectiveness of blended cognitive behavioural therapy as treatment for clinically depressed adolescents and preliminary results will be shown.


 3. ACT your way: Acceptance & Commitment Therapy (ACT) for depressed youth

Presenter: Denise Bodden

Co-authors: Denise Matthijssen & Jacquelijne Schraven

Affiliations: Utrecht University, The Netherlands

Recently, Acceptance and Commitment therapy (ACT) has been receiving more attention in clinical practice. Acceptance and Commitment Therapy (ACT) is a so called third generation behavior therapy. The goal of ACT is not to reduce depressive symptoms but to increase one’s Psychological flexibility; an individual’s acceptance of negative feelings, thoughts and physical sensations and the ability to choose an adaptive response based on the values of that individual.

ACT is an effective treatment for adults with a depressive disorder (A-Tjak et al., 2015). There are only a few studies that have investigated ACT in youth and they often are directed at prevention of depressive symptoms (Hayes, Boyd & Sewell, 2011; Livheim et al., 2015). More research on the effectiveness of ACT in clinically depressed adolescents is needed.

ACT your way is an intervention based on ACT which focusses on youth (15 to 25 years old) with problems concerning their identity, autonomy or psychopathology.  ACT your way consists of a workbook fort the adolescent and a therapist guide. In this study, the quality of the manual as well as the efficacy of ACT your way was investigated in youth with chronic depression or recidivism. The goal of this study was to investigate whether ACT your way leads to changes in psychological flexibility, quality of life, depressive symptoms, etc. The design consisted of a pre-, post – and 6-month follow-up analyses. Adolescents’ self-reports were employed. Preliminary results will be presented.