Multiple randomized control-group studies have supported the effectiveness of cognitive-behavioral therapy for treating depression and anxiety. More specifically, there is substantial evidence that cognitive-behavioral therapy is significantly more effective than no treatment. However, it is not as clear whether cognitive-behavioral therapy is more effective than alternative forms of psychotherapy such as family therapy or non-directive psychotherapy. Brent, Holder, Kolko, Birmaher, Baugher, Roth, Iyengar & Johnson (1997) randomly assigned 107 adolescents (13 to 18 years old) with major depressive disorder to one of three groups: cognitive-behavioral therapy, systemic behavior family therapy and a wait-list control group. The majority of the sample was Caucasian American (85%) and female (75%). The researchers found that adolescents in the cognitive-behavioral therapy treatment showed lower rates of major depressive symptoms than either the family therapy or wait-list groups. Somewhat similar results were found by Reynolds and Coats (1986) in their comparison of cognitive-behavioral therapy, relaxation training and no treatment. The researchers randomly assigned 30 moderately depressed high school students to one of the three experimental groups. They found that the cognitive-behavioral therapy and relaxation training groups were functioning at a superior state compared to the wait-list control group at the five-week follow-up. A comparable randomized study conducted with 68 6th, 7th and 8th graders, who were moderately to severely depressed, again showed that cognitive-behavioral therapy and relaxation therapy results in significant clinical improvements, compared to a wait-list control group. Lewinsohn, Clarke, Hopes & Andrews (1990) compared cognitive-behavioral therapy to cognitive-behavioral therapy plus parent training (i.e., instructing the parents on what the youth learn in order to promote acceptance and understanding) and a wait-list control. The 59 depressed youth (mean age was approximately 16 years old) were randomly assigned to one of the three groups. Results show that both treatment groups were significantly better than the wait-list control group, though no differences were found between the two treatments. Clarke, Rohde, Lewinsoh, Hops and Seeley (1999) conducted a replication study and found the same results. The researchers randomly assigned 123 youth (14 to 18 years old) to a cognitive-behavioral therapy, cognitive-behavioral therapy plus parent training or a wait-list control group. Immediately after treatment, both treatment groups showed significant improvement over the control group, with two-thirds of the treatment groups no longer meeting criteria for major depression compared to 48% of the wait-list control group. Furthermore, only 25% of youth across the study experienced a relapse at the two-year follow-up. Preliminary evidence for the cross-cultural effectiveness of psychotherapy on the reduction of depressive symptoms is provided by Rossello and Bernal (1999) who randomly assigned 71 Puerto-Rican adolescents (13 to 18 years old) to either a cognitive-behavior therapy, an interpersonal therapy or a wait-list control group. The adolescents had been diagnosed with major depressive disorder, dysthymia or both disorders. The researchers found that cognitive-behavior therapy and interpersonal therapy both significantly reduced depressive symptoms compared to the control group. In fact, adolescents who received one of the therapies were functioning better than 72% of the control group.