Program

Dec 12, 2012

OVERVIEW

Interpersonal psychotherapy for adolescents (IPT-A) is a type of psychotherapy designed to lower rates of depression and improve social functioning among depressed adolescents, by promoting positive interpersonal relationships.  IPT-A has been found to be effective in reducing depression symptoms among adolescents as well as improving some, but not all, aspects of social functioning and social problem-solving.

DESCRIPTION OF PROGRAM

Target population: Adolescents who are depressed or at risk for depression

Interpersonal psychotherapy for adolescents (IPT-A) is a form of psychotherapy that focuses on interpersonal relationships.  It has been adapted from interpersonal psychotherapy, which was originally designed for adults, to be appropriate for adolescents. IPT-A is a short therapy, generally lasting 12 sessions.  The first four sessions serve as an introduction to the topic of depression and IPT-A, and are used to evaluate interpersonal relationships, to identify problems, and to establish a treatment plan.  The next four sessions focus on working on the identified problems, monitoring depression, and facilitating positive relationships.  The final four sessions focus on ending the treatment, addressing any separation issues the patient might have, and recognizing the patient’s interpersonal competence.  The adaptation for adolescents includes a focus on common adolescent development issues, such as parental separation, authority and autonomy, development of relationships, experience with peer pressure and death, and experience with single-parent families.

EVALUATION(S) OF PROGRAM

Rossello, J. & Bernal, G. (1999). The efficacy of cognitive-behavioral and interpersonal treatments for depression in Puerto Rican adolescents. Journal of Consulting and Clinical Psychology, 67, 734-745.

Evaluated population: Seventy-one Puerto-Rican adolescents and youth (13- to 17-years-old) diagnosed with major depressive disorder, dysthymia, or both disorders were evaluated.  Participants were recruited from a university psychological services center.  Fifty-four percent of the sample was female.  All participants were enrolled in school and ranged in grade level from 5th through 12th grades.

Approach: Participants were randomly assigned to one of three groups: cognitive-behavioral therapy (CBT; N=25), IPT-A (N=23), or a wait-list control group (N=23).  Both treatments involved 12 weekly, one-hour sessions conducted by clinical psychology Ph.D. candidates.  More information on the CBT intervention can be found here [ADD LINK].  Wait-list participants were told that they would receive treatment in 12 weeks.

Data were collected from participants at baseline, post-treatment, and 3-month follow-up on depressive symptoms, self-concept, self-esteem, social adjustment, family emotional involvement, social abilities, and behavior problems.  Data on parent involvement was collected from the parents of participants.

Results: The researchers found that IPT-A significantly reduced depressive symptoms at post-test compared with the control group.  IPT-A had an effect size (Cohen’s d) of 0.73 on depressive symptoms.

Self-esteem and social adaptation scores also significantly increased at post-test for participants in the IPT-A group when compared with the control group.  IPT-A did not have a significant impact on family emotional involvement or on behavioral problems at post-test.

At the 3-month follow-up, attrition for the IPT-A group was high (53 percent) and the wait-list group could no longer serve as a control because they became eligible for treatment at 12-weeks; as such, no follow-up analyses were conducted.

Mufson, L., Weissman, M. M., Moreau, D., & Garfinkel, R. (1999).  Efficacy of interpersonal psychotherapy for depressed adolescents. Archives of General Psychiatry, 56, 573-579.

Evaluated population:  Forty-eight English-speaking adolescents and youth (12- to 18-years-old) in New York City who qualified as having major depressive disorder according to the DSM-III were evaluated.  Participants were clinic-referred and were excluded if they were suicidal, were in another treatment for the same condition, had a chronic mental illness, or who met the criteria for psychosis, bipolar I or II, conduct disorder, substance abuse disorder, eating disorder, or obsessive compulsive disorder.  The sample was largely composed of low socioeconomic status Latino youth.

Approach: Participants were randomly assigned to IPT-A (N=24) or clinical monitoring (N=24), which served as the control group. Participants in IPT-A received weekly sessions for 12 weeks.  Participants were also allowed one phone call per week with their therapist during the first four weeks of treatment.  Participants in the control group received monthly 30-minute sessions with a therapist who was instructed to refrain from giving advice or engaging in skills training.

Outcome data, including diagnosis, symptoms, global and social functioning, and social problem-solving skills were collected at baseline and at week 12 (post-treatment).

Results:

Depression

The group receiving IPT-A had lower levels of depressive symptoms post-treatment than the control group. In addition, significantly more patients receiving IPT-A recovered from their depression than patients in the control group (75 percent versus 46). Treatment group members were also rated as less depressed by the treating clinicians than control group members post-treatment, and more treatment group members were reported as improved by the clinicians.  IPT-A did not have an impact on suicidality or global functioning.

Social Adjustment

Participants receiving IPT-A scored significantly higher on overall social adjustment functioning, functioning with their friends, and functioning in dating relationships than the control group.  The treatment and control group scores did not differ for school functioning or family functioning.

Social Problem-Solving

The group receiving IPT-A scored significantly higher on positive problem-solving orientation and rational problem-solving than the control group.  Looking at the subscales of the rational problem-solving scale, IPTA-A participants also scored higher on functioning in generation of alternatives, and solution and verification.  Meanwhile, no differences existed between the two groups on the subscales of negative problem-solving orientation, impulsivity/carelessness, and avoidance style.

Mufson, L., Pollack Dorta, K., Wickramaratne, P., Nomura, Y., Olfson, M., & Weissman, M. M. (2004). A randomized effectiveness trial of interpersonal psychotherapy for depressed adolescents. Archives of General Psychiatry, 61, 577-584.

Evaluated population: Sixty-three English-speaking adolescents and youth (12- to 18-years-old, mean age 15 years) who qualified as having major depressive disorder, dysthymia, depression disorder not otherwise specified, or adjustment disorder with depressed mood (according to the DSM-IV) were evaluated.  Exclusion criteria included: suicidality, mental retardation, life-threatening medical illness, substance abuse disorder, psychosis, schizophrenia, or currently being in treatment or taking medication for depression.  The sample was largely composed of Hispanic (77 percent), female (91 percent), low socioeconomic status (34 percent) youth in New York City.  The evaluated sample were all drawn from urban, school-based clinics (three in middle schools, two in high schools).

Approach: Randomization occurred at both the clinic/clinician level and the participant level.  Participants were randomly assigned to IPT-A or treatment as usual, which served as the control group.  Participants in the IPT-A group received 35-minute weekly sessions for eight consecutive weeks.  Participants then received four sessions at any time during the next eight weeks. Participants in the “treatment as usual” (control) group received whatever treatment they would have received if the program had not been in place.

Outcome data, including depression symptoms, global functioning, and social functioning were collected at baseline and at weeks 4, 8, 12, and 16 throughout treatment in clinician-rated and self-reported formats.  An additional phone follow-up occurred at week 16 and assessed depression and general functioning.  This article focuses on data from week 12.

Results:

Depression

At week 12, the group receiving IPT-A had lower levels of clinician-rated depressive symptoms post-treatment than the control group.  The treatment had a medium effect size (Cohen’s d) of 0.50.  The self-reported measure of depression did not significantly differ between the treatment and control groups. In addition, more patients receiving IPT-A recovered from their depression than patients in the control group (50 percent versus 34 on one measure and 74 percent versus 52 on another).

General Functioning

Participants receiving IPT-A had more clinician-reported improvement in overall functioning than control group members, with an effect size of 0.54. In addition, treatment members were rated by clinicians as significantly less ill, with an effect size of 0.48. Participants receiving IPT-A also had significantly higher clinician-reported levels of improvement in their symptoms, with an effect size of 0.59.

Social Functioning

At week 12, the treatment group self-reported significantly greater improvement in dating and overall social functioning, and marginally greater improvement in family functioning The effect sizes were 0.43, 0.55 and 0.32, respectively. There were no significant differences in functioning with friends or school.

The study findings remained consistent at week 16 for depression and general functioning.

SOURCES FOR MORE INFORMATION

References:

Mufson, L., Pollack Dorta, K., Wickramaratne, P., Nomura, Y., Olfson, M.,  Weissman, M. M. (2004). A randomized effectiveness trial of interpersonal psychotherapy for depressed adolescents. Archives of General Psychiatry, 61, 577-584.

Mufson, L., Weissman, M. M., Moreau, D., & Garfinkel, R. (1999).  Efficacy of interpersonal psychotherapy for depressed adolescents. Archives of General Psychiatry, 56, 573-579.

Rossello, J. & Bernal, G. (1999).  The efficacy of cognitive-behavioral and interpersonal treatments for depression in Puerto Rican adolescents.  Journal of Consulting and Clinical Psychology, 67, 734-745.

Treatment Manuals

Klerman, G. L., Weissman, M. M., Rounsaville, B. J., & Chevron, E. S. (1984). Interpersonal Psychotherapy of Depression. New York: Basic Books.

Weissman, M. M., Markowitz, J. C., & Klernman, G. L. (2000). Comprehensive Guide to

Interpersonal Psychotherapy. New York: Basic Books.

KEYWORDS: Adolescents (12-17), Youth (16+), Young Adults, Males and Females (Co-ed), High-Risk, Hispanic/Latino, Clinic/Provider-based, Manual is Available, Counseling/Therapy, Depression/Mood Disorders, Social Skills/Life Skills, Self-Esteem/Self-Concept, Urban

Program information last updated 12/12/12.