Program

Apr 08, 2013

 OVERVIEW

Coping with Stress is a cognitive-behavioral therapy program that was developed to prevent depression among adolescents who are at-risk for depression. It teaches strategies to identify and overcome negative, pessimistic, and irrational thoughts that may lead to depression. The intervention has been evaluated with youth who had a past depressive episode, symptoms of depression, or a parent with depression. There were positive impacts on episodes of depression and depressive symptoms.

DESCRIPTION OF PROGRAM

Target population: Adolescents at-risk for depressive episodes

The Coping with Stress depression prevention program consists of 15 one-hour sessions for groups of three to ten adolescents. These sessions are led by a trained therapist and are intended to teach adolescents specific techniques to help them identify and overcome negative and unrealistic thoughts that may lead to depression. Adolescents, regardless of their randomization condition in the study, are permitted to continue any mental health services or their usual care. The intervention may also involve information sessions for parents to discuss the skills that the adolescents are taught in the sessions. The Coping with Stress intervention is adapted from Coping with Depression, which is used to treat depression in adolescents.

EVALUATION(S) OF PROGRAM

Clarke, G. N., Hawkins, W., Murphy, M., Sheeber, L. B., Lewinsohn, P. M., & Seeley, J. R. (1995).  Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: A randomized trial of a group cognitive intervention.  Journal of the American Academy of Child and Adolescent Psychiatry, 34(3), 312-321.

Evaluated population: A total of 150 “demoralized” adolescents (9th- and 10th-graders) from three suburban high schools were evaluated. “Demoralized” adolescents met a certain threshold of depressive symptoms, but did not have major depression or dysthymia. The sample was 70 percent female and 93 percent white. The average age was 15.3 years.

Approach: Adolescents were randomly assigned to the Coping with Stress intervention or a usual care control group. In this study, the sessions were 45-minutes long, and the 15 sessions were completed over the course of 5 weeks. Data were collected at baseline, post-intervention, 6-month follow-up, and 12-month follow-up on depressive symptoms, psychiatric diagnoses, and functioning. There were significantly more females in the intervention condition, but otherwise the two groups were equivalent.

Results: The researchers found at the 12-month follow-up that significantly fewer youth in the intervention group had depression or dysthymia compared with the control group, but there was no difference between the groups on other types of psychiatric diagnoses. The intervention group also had decreased their depressive symptoms on one measure significantly more than the control group between baseline and post-intervention. However, there was no difference between groups in the decrease from baseline to 12-month follow-up or on a different measure of depressive symptoms. Similarly, the intervention group increased functioning from baseline to post-intervention significantly more than the control group, but there was no difference between the groups in functioning from baseline to 12-month follow-up.

Clarke, G. N., Hornbrook, M. C., Lynch, F., Polen, M., Gale, J., Beardslee, W., . . . Seeley, J. (2001). A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents. Archives of General Psychiatry, 58, 1127-1134.

Evaluated population: Ninety-four adolescents aged 13 to 18 who had depressive symptoms, but did not have major depression or dsythymia and had at least one parent who was recently or being treated for depression served as the subjects for this study. The majority of the sample was white, and the sample was 60 percent female with an average age of 14.6 years.

Approach: Adolescents were randomly assigned to the intervention of a usual care control condition. In this study, there was a focus on identifying and challenging negative or irrational thoughts specifically related to the depressed parent. There were also three parent information sessions, which were conducted at the beginning, middle, and end of the intervention. There were no differences between the two groups at baseline. Data were collected at baseline, post-treatment, 12-month follow-up, and 24-month follow-up on psychiatric diagnoses, depressive symptoms, functioning, and parent-rated depression, internalizing behavior, and externalizing behavior.

Results: Adolescents in the intervention were less likely than those in the control group to have diagnoses of depression, depressive symptoms, and depressed days, but there was no difference between the groups on parent-rated depression. In addition, the intervention group had fewer incidences of depression over the follow-up period than the control group, although this lessened over time. Adolescents in the treatments had lower suicidality compared with those in the control group. There was also a positive impact on functioning for adolescents in the treatment group. There was no impact on psychiatric diagnoses other than depression, internalizing behavior, or externalizing behavior.

Garber, J., Clarke, G. N., Weersing, V. R., Beardslee, W. R., Brent, D. A., Gladstone, T. R. G., . . . & Iyengar, S. (2009).  Prevention of depression in at-risk adolescents: A randomized control trial. Journal of the American Medical Association, 301, 2215-2224.

Evaluated population: A total of 316 adolescents (13 to 17 years of age) from sites in Nashville, TN; Pittsburgh, PA; Portland, OR; and Boston, MA were evaluated. Adolescents had a past history of depression and/or current depressive symptoms and parent(s) or caretaker(s) with current or past depressive disorder. More than one-half of adolescents (59%) were female; 80 percent were white; and approximately 7 percent were Latino. The average age was 14.8 years. More than three-quarters of adolescents’ parents (77%) had a high school education or below.

Approach: Participants were randomly assigned to the Coping with Stress intervention (n=159) or the usual care control group (n=157). In this modified version of Coping with Stress there was an acute phase of treatment, which involved 8 weekly 90-minute sessions and a continuation phase of treatment, which involved 6 monthly sessions. There were also two parent information meetings: one at the beginning and one at the end of treatment. Adolescents were taught problem solving in addition to techniques for identifying and overcoming negative or irrational thoughts. The two groups were equivalent at baseline. Data were collected at baseline, after the acute phase of the intervention, and after the continuation phase on episodes of depression, depressive symptoms, and use of mental health services.

Results: Through the 9-month follow-up, the incidence of depressive episodes was significantly lower for those in the prevention program compared with those in usual care. Additionally, participants in the prevention program showed significantly greater improvement in self-reported depressive symptoms compared with usual care. However, while the prevention program was more effective than usual care in preventing the onset of depression among participants whose parents were currently depressed, the authors found that the prevention program was not significantly more effective than usual care among participants whose parents were currently depressed at study entry. There was no difference in effectiveness based on participants’ baseline levels of depression of history of depression. There was no impact on use of mental health services.

SOURCES FOR MORE INFORMATION

References

Clarke, G. N., Hawkins, W., Murphy, M., Sheeber, L. B., Lewinsohn, P. M., & Seeley, J. R. (1995).  Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: A randomized trial of a group cognitive intervention.  Journal of the American Academy of Child and Adolescent Psychiatry, 34(3), 312-321.

Clarke, G. N., Hornbrook, M. C., Lynch, F., Polen, M., Gale, J., Beardslee, W., . . . Seeley, J. (2001). A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents. Archives of General Psychiatry, 58, 1127-1134.

Garber, J., Clarke, G. N., Weersing, V. R., Beardslee, W. R., Brent, D. A., Gladstone, T. R. G., . . . Iyengar, S. (2009).  Prevention of depression in at-risk adolescents: A randomized control trial. Journal of the American Medical Association, 301, 2215-2224.

Website: http://www.kpchr.org/research/public/acwd/acwd.html

The manual is available on their website.

Contact Information

Gregory N. Clarke, Ph.D.
Kaiser Permanente Center for Health Research
3800 N. Kaiser Center Dr.
Portland, OR 97227
phone: (503) 335-6673
greg.clarke@kpchr.org

KEYWORDS: Adolescence (12-17), Youth (16+), Males and Females, High-Risk, White or Caucasian, Urban, Suburban, Clinic-based, Cost, Manual, Counseling/Therapy, Skills Training, Parent or Family Component, Depression, Other Mental Health, Other Behavioral Problems

Program information last updated on 4/8/2013.