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Childhood depression is a widespread disorder, with Latina girls experiencing higher rates of depression. Cognitive-Behavioral therapy is an empirically supported intervention for the treatment of depression. Group processes occurring during therapy, such as group cohesion, have been proposed as mechanisms through which positive change occurs, though their effectiveness have only begun to be explored. The proposed study will examine the effects of group cohesion in the context of a group CBT treatment on changes in depressive symptoms in biethnic youth. Specifically, this study will analyze self-reports of group cohesion and pre- and post-treatment depression scores of 8- to 14-year old Latina and European-American girls undergoing a CBT treatment for depression. It is hoped that this study will lead to an increased discernment in cultural sensitivity with regards to the delivery of interventions for the treatment of depression. / text

Prior work has provided support that women with breast cancer are hyper-responsive to stressful challenges and that Cognitive-Behavioral Stress Management (CBSM) interventions can lead to reductions in cortisol, a measure of physiological stress. It may follow that breast cancer patients would show decreases in cortisol levels if they are taught stress management techniques. The purpose of this study was to investigate post-intervention psychosocial processes (i.e., participants' perceptions of achieved specific skills targeted by CBSM and non-specific changes associated with the group experience) that may explain intervention-related changes in cortisol among a sample of women as they moved through medical treatment for non-metastatic breast cancer. It was hypothesized that (a) women receiving a 10-week, group-based stress management intervention during ongoing medical treatment for breast cancer would show reductions in late afternoon serum cortisol levels and (b) perceived ability to implement stress management skills or other experiences gained in the supportive group environment may explain changes in cortisol. Participants (N = 128) were women recruited 4-8 weeks post-surgery for non-metastatic breast cancer. Women were randomly assigned to receive either the 10-week CBSM intervention (N = 63) or a one-day psychoeducational seminar (n = 65). The intervention aimed to teach relaxation, cognitive restructuring, and interpersonal skills. Participants were assessed at study entry, 6 month follow-up (i.e., 3 months post-intervention) and 12 month follow-up (i.e., 6 months post-intervention). Latent Growth Curve Modeling (LGM) was used to test for differential effects of study condition on change over time in cortisol and the effects of specific and non-specific group processes on change in cortisol. Results indicated there was a significant effect of study condition on change over time in cortisol, relaxation skills, and assertiveness skills. There were not significant relationships between changes in cortisol and any of the components analyzed and mediation was not established using LGM. There was, however, a significant association between changes in an item that assessed cognitive restructuring and cortisol. Exploratory analyses of lagged (Time 2 controlling for Time 1) psychosocial processes mediating (Time 3 controlling for Time 2) cortisol changes were then conducted. Results indicated that condition's effect on cortisol approached significance and condition had a significant effect on the muscle relaxation component and cognitive restructuring item. Furthermore, there was evidence that intervention-related changes in confidence about using muscle relaxation and cognitive restructuring may help explain decreases in cortisol levels among this sample of women. Overall, this study demonstrated that a 10-week, CBSM intervention was associated with decreased cortisol levels and increased relaxation and assertiveness skills. Furthermore, there was a strong relationship between changes in cognitive restructuring and cortisol. Future research should investigate how changes in cortisol may be related to health behaviors and health outcomes among breast cancer patients.

Childhood depression is a widespread, stable disorder, and recurring disorder (Kovacs, Feinberg, Crouse-Novak, Paulauskas, & Finkelstein, 1984). Cognitive-Behavioral therapy is an empirically supported intervention for the treatment of depression (Weersing & Weisz, 2002; Weisz, McCarty, & Valeri, 2006). CBT for depression is often comprised of cognitive, behavioral, problem-solving, and relational interventions (McCarty & Weisz, 2007). While it is evident that CBT as a whole is efficacious, there exists a dearth of knowledge concerning the specific components within CBT, which contribute to symptom reduction in youth (Kazdin & Weisz, 1998; Kennard et al., 2009). Therefore, the manner in which CBT accomplishes change is not well understood (Shirk & Karver, 2006). Specifically, while cognitive theories assert that interventions targeted at modifying negative cognitions reduce depression (Beck, 1967), few studies, particularly with regards to depressed youth, have addressed this (Stice, Rohde, Seeley, & Gau, 2010). As such, this hypothesis concerning the role of depressogenic cognitions as mediators between certain CBT interventions and symptom reduction remains unsubstantiated (Weersing, Rozenman, & Gonzales, 2009). The current study assessed whether higher levels of cognitive, behavioral, problem solving, and relational components were associated with lower levels of post-treatment depression, as well as whether they were mediated through changes in the cognitive triad, a measure of depressogenic thinking. No studies have assessed the effectiveness of discrete interventions incorporated in CBT treatments for depression in youth, further examining whether noted changes in depression are mediated through cognitions, specifically the cognitive triad. Participants included 40 depressed females, aged 9 to 14, assessed using self-report measures and a diagnostic interview for depression, who engaged in treatment using a manualized group CBT treatment protocol. Results from hierarchical linear models indicated that higher participant cognitive triad scores and higher relational interventions were associated with lower post-treatment depression scores. However, subsequent analyses revealed that higher aggregated behavioral-problem-solving interventions scores were associated with lower post-treatment depression scores, while higher aggregated cognitive-relational intervention scores were associated with higher post-treatment depression scores. Implications, limitations, and recommendations for further areas of research are discussed. / text

Depression in youth is a serious mental health concern affecting many different domains of functioning. Currently, cognitive behavioral therapy (CBT) is the most extensively studied psychosocial treatment for depression; however, there is limited research on how the specific components of CBT function to produce effective treatment outcomes. In addition to identifying the components responsible for effective treatment outcome, it is also important to investigate the changes in youth with depression that account for the reduction of symptomatology. Problem-solving is one of the effective CBT strategies used to improve depressive symptoms. The purpose of the current study was to investigate the association between problem-solving interventions and depression. The current study also sought to investigate if depressive symptoms are mediated through changes in the view of the future. Participants were 40 girls, aged 9 to 14, who completed a manualized CBT protocol for depression in a group format. Participants completed a diagnostic interview for depression and self-report measures assessing the view of the future dimension of the cognitive triad. Group therapy sessions were coded for problem-solving interventions using an investigator developed coding system. The results indicated that the level of problem-solving intervention implemented by the therapist failed to predict a decrease in depressive symptoms, after controlling for the girls’ initial levels of depression severity. Level of problem-solving intervention was significantly related to positive future views on the cognitive triad, after controlling for initial levels of the future subscale on the cognitive triad. Results also indicated that participants with a more positive view of their future were less depressed at post-treatment. Treatment specificity could not be conducted because the relation between problem-solving interventions and treatment outcome was not significant. An exploratory analysis was conducted with additional control variables. After controlling for mastery of problem-solving skills, level of expectancies for change, and initial level of depression, problem-solving intervention was a significant predictor of treatment outcome. Exploratory analysis also concluded that levels of consequential thinking and levels of brainstorming were related to treatment outcome. Implications, limitations, and recommendations for future research are presented. / text

Anxiety and depressive disorders are common conditions for adolescents and are associated with significant impairments in functioning. Cognitive behavior therapy (CBT) is an effective treatment modality for these youth, and the behavioral components of CBT protocols, in particular, are thought to be one of the active mechanisms through which positive symptom changes are produced. However, few procedures are available to measure the behavioral changes taking place in adolescents’ daily lives as they make therapeutic progress. This study examined adolescents’ “behavioral engagement” throughout treatment, a construct defined as time spent in social, athletic and academic activities. Behavioral engagement was measured using the Daily Phone Diary (DPD), a validated measure of daily activities utilized in the child health literature, which employs the principles of Ecological Momentary Assessment (EMA). Twenty-four adolescents reported each activity they engaged in throughout the day, in chronological order, over the past 24 hours. Participants were diverse in their ages, ethnicities, socioeconomic statuses and internalizing disorder diagnoses. Activities were reported during phone calls scheduled before, during, and after treatment using a transdiagnostic formulation of CBT and, for a randomized subset of the sample (N=8), both before and following a Waitlist comparison condition. Results indicated that “behavioral engagement” is a construct that is measurable and that daily phone diaries are an acceptable method of data collection for this population. Based on theoretical and empirical literature, three key categories of activities on the DPD comprised behavioral engagement: 1) Time spent socially engaged with others; 2) Time spent on any physical or athletic activity; and 3) Time doing homework. Results supported good inter-rater reliability and potentially reasonable test-retest reliability; data collection via the DPD was feasible and acceptable in this context. Tests of convergent validity with other measures of anxiety and depressive symptoms suggested that prior to treatment, more time spent in some activity categories was associated with more internalizing symptoms for those with anxiety disorders only, but fewer internalizing symptoms for those with depression as well as anxiety. Tests of convergent validity with other measures of weekly mood were promising. Future studies will explore alternate definitions of behavioral engagement, examine this construct in a larger sample that has completed a full course of CBT, and explore this construct’s potential role as a mediator of clinical improvement.

Presentation in J. Cohen's Successful Strategies for Treating Traumatized Children in Challenging Circumstances.

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Background: The World Health Organization report shows that about 30% of all women who have been in a relationship have experienced physical or sexual violence in intimate relationships. 38% of all murders of women is made of a close partner. In Sweden, an estimated 22 000 cases of violence against women a year, where domestic violence is the single largest portion. The two most common treatment models for men who used violence in close relationships is Domestic Abuse Intervention Program and cognitive behavioral therapy. The government's goal is to stop men's violence against women. Therefore, the issue of men's violence against women is raised as a fourth milestone in equality policy to draw attention to the violence linked to the patterns and norms that exist in society. Socialstyrelsen underlines that there are few evaluations of activities using cognitive behavioral therapy. Aim: Examining the effect of CBT as a treatment for men who used violence in close relationships. Method: Systematic literature study. Results: Based on the results obtained it is possible to gently draw positive conclusions that motivation and attitude are important components in the changing process. There is some evidence to suggest that CBT can be an effective treatment for men who used violence in relationships during a follow-up of four to nine months if the participant’s got motivation and willingness to change.

Transition age youth with disabilities are at an elevated risk to experience depression and anxiety compared to youth without disabilities. The current study evaluates the implementation feasibility, acceptability, and potential efficacy of the Think, Be, Do curriculum (a mental health curriculum) for transition age students in special education classrooms. The Think, Be, Do curriculum is a teacher delivered, ten-session mental health curriculum, based in cognitive behavioral and ecological theory, that promotes behavior activation and cognitive reframing of negative thoughts. A total of 11 classrooms were recruited and 115 students participated in a randomized controlled trial. Classrooms were randomly assigned to either treatment (n = 7) or control condition (n = 4). Treatment condition classrooms were exposed to the Think, Be, Do curriculum twice a week for five weeks. Control condition classrooms were instructed to continue business as usual. Results from the pre-post feasibility trial indicate that the Think, Be, Do curriculum was feasible to implement with high fidelity, and was acceptable to the teachers who implemented the curriculum and for student participants. In addition, student knowledge increased on common mental health concerns (e.g., depression and anxiety) for participants in the treatment condition. There were no clinically meaningful differences found between conditions on the putative mechanisms (e.g., behavior activation, negative thoughts), internalizing and externalizing symptoms, and academic competence. Implications for research and practice are discussed, including the need for further curriculum adaptation, development of reliable and valid mental health measures, and the need for a more targeted implementation approach.