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Intervention Summary

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Adolescent Coping With Depression (CWD-A)

The Adolescent Coping With Depression (CWD-A) course is a cognitive behavioral group intervention that targets specific problems typically experienced by depressed adolescents. These problems include discomfort and anxiety, irrational/negative thoughts, poor social skills, and limited experiences of pleasant activities. CWD-A consists of 16 2-hour sessions conducted over an 8-week period for mixed-gender groups of up to 10 adolescents. Each participant receives a workbook that provides structured learning tasks, short quizzes, and homework forms. To encourage generalization of skills to everyday situations, adolescents are given homework assignments that are reviewed at the beginning of the subsequent session.

The CWD-A course was originally adapted from the adult version of the Coping With Depression course. In modifying the course for use with adolescents, in-session material and homework assignments were simplified, experiential learning opportunities (e.g., role-plays) were enhanced, and problem-solving skills were added to the curriculum.

Descriptive Information

Areas of Interest Mental health treatment
Outcomes Review Date: July 2007
1: Recovery from depression
2: Self-reported symptoms of depression
3: Interviewer-rated symptoms of depression
4: Psychosocial level of functioning
Outcome Categories Mental health
Social functioning
Ages 13-17 (Adolescent)
Genders Male
Female
Races/Ethnicities White
Race/ethnicity unspecified
Settings Outpatient
Geographic Locations No geographic locations were identified by the developer.
Implementation History CWD-A has been implemented with adolescents in diverse settings including inner-city and rural areas, schools, juvenile detention centers, and State correctional facilities. Numerous trainings in the CWD-A have been conducted with therapists across the United States (Alabama, Alaska, Iowa, Nebraska, New York, Oregon, Utah, Washington, Wisconsin) and in Canada (Banff, Calgary, Toronto). More than 500 therapists have received some training in the intervention.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: Yes
Adaptations No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories IOM prevention categories are not applicable.

Quality of Research
Review Date: July 2007

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Lewinsohn, P. M., Clarke, G. N., Hops, H., & Andrews, J. (1990). Cognitive-behavioral treatment for depressed adolescents. Behavior Therapy, 21, 385-401.

Study 2

Clarke, G. N., Rohde, P., Lewinsohn, P. M., Hops, H., & Seeley, J. R. (1999). Cognitive-behavioral treatment of adolescent depression: Efficacy of acute group treatment and booster sessions. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 272-279.  Pub Med icon

Study 3

Rohde, P., Clarke, G. N., Mace, D. E., Jorgensen, J. S., & Seeley, J. R. (2004). An efficacy/effectiveness study of cognitive-behavioral treatment for adolescents with comorbid major depression and conduct disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 660-668.  Pub Med icon

Supplementary Materials

Clarke, G. (1998). Intervention fidelity in the psychosocial prevention and treatment of adolescent depression. Journal of Prevention and Intervention in the Community, 17, 19-33.

Kaufman, N. K., Rohde, P., Seeley, J. R., Clarke, G. N., & Stice, E. (2005). Potential mediators of cognitive-behavioral therapy for adolescents with comorbid major depression and conduct disorder. Journal of Consulting and Clinical Psychology, 73(1), 38-46.  Pub Med icon

Rohde, P., Lewinsohn, P. M., Clarke, G. N., Hops, H., & Seeley, J. R. (2005). The Adolescent Coping With Depression Course: A cognitive-behavioral approach to the treatment of adolescent depression. In E. D. Hibbs & P. S. Jensen (Eds.), Psychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice (2nd edition) (pp. 219-238). Washington, DC: American Psychological Association.

Rohde, P., Seeley, J. R., Kaufman, N. K., Clarke, G. N., & Stice, E. (2006). Predicting time to recovery among depressed adolescents treated in two psychosocial group interventions. Journal of Consulting and Clinical Psychology, 74(1), 80-88.  Pub Med icon

Outcomes

Outcome 1: Recovery from depression
Description of Measures Recovery from depression was defined as a posttreatment recovery in which an individual no longer met DSM criteria for major depression or dysthymia using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS-E). The K-SADS-E is a semistructured diagnostic interview in which both a parent and the adolescent are interviewed separately regarding the teenager's symptoms. Based on this information, the examiner makes a summary clinical judgment as to the presence or absence of depressive symptoms. This summary rating is the final rating on which diagnosis for each teenager is based.
Key Findings In one study, at the end of treatment, about 55% of youth receiving CWD-A still met diagnostic criteria for depression. In contrast, among youth in a wait-list control condition, almost 95% still met diagnostic criteria for depression at follow-up. In another study, adolescents who were treated with CWD-A had higher depression recovery rates (67%) compared with youth in a wait-list control condition (48%). The study authors found the recovery rate for wait-list participants to be unexpectedly high (48% vs. about 5% in a previous study) and could offer no obvious explanation for this finding.

Among adolescents with two diagnosed disorders (major depression and conduct disorder), recovery rates from major depression at posttreatment were greater among the CWD-A participants (39%) than among participants in life skills training (19%). These differences in recovery rates represent a small effect size (odds ratio = 2.66). Recovery rates for conduct disorder did not differ between the two conditions.
Studies Measuring Outcome Study 1, Study 2, Study 3
Study Designs Experimental
Quality of Research Rating 3.7 (0.0-4.0 scale)
Outcome 2: Self-reported symptoms of depression
Description of Measures Self-reported depression symptoms were measured using the 21-item Beck Depression Inventory and Beck Depression Inventory Second Edition (BDI and BDI-II).
Key Findings Adolescent depression scores from the BDI decreased in each of the three studies from pre- to posttreatment for the CWD-A group versus comparison groups. In one study, the change in BDI scores for CWD-A youth averaged more than 10 symptom-severity points, compared with only 3 points for the wait-list group (p < .001). In another study, the CWD-A intervention was associated with significantly greater reductions in BDI scores (p < .01) compared with a wait-list group during the acute or active treatment phase (measured immediately following treatment). This level of symptom change represents a medium effect size (Cohen's d = 0.61).
Studies Measuring Outcome Study 1, Study 2, Study 3
Study Designs Experimental
Quality of Research Rating 3.7 (0.0-4.0 scale)
Outcome 3: Interviewer-rated symptoms of depression
Description of Measures Interviewer-rated depression symptoms were rated using the Hamilton Depression Rating Scale (HDRS). The HDRS is a 17-item scale in which a clinical interviewer provides ratings on overall depression, guilt, suicide, insomnia, problems related to work, psychomotor retardation, agitation, anxiety, gastrointestinal and other physical symptoms, hypochondriasis, and weight loss.
Key Findings Adolescents receiving CWD-A treatment showed greater improvement on the HDRS immediately following treatment when compared with youth who received only life skills/tutoring (p < .05).
Studies Measuring Outcome Study 3
Study Designs Experimental
Quality of Research Rating 3.8 (0.0-4.0 scale)
Outcome 4: Psychosocial level of functioning
Description of Measures Across the two studies that assessed level of psychological functioning, trained interviewers used two common rating scales to measure this outcome. The first study used the 100-point Children's Global Assessment Scale (CGAS), which measures psychological, social, and school functioning in children aged 6 to 17. The highest scores (91 through 100) reflect superior functioning in all life areas (home, school, peers) and indicate that the child has numerous hobbies and interests, is basically confident and happy, and has no symptoms of mental illness. At the other extreme, scores of 1 to 10 would reflect an adolescent's need for constant supervision or virtually 24-hour care to accommodate severely self-destructive or aggressive behaviors, problems in reality testing, or self-care issues. The second study used the 100-point Global Assessment of Functioning (GAF) scale from the DSM III-R to measure level of functioning.
Key Findings In the first study, adolescents who had two diagnosed disorders (major depression and conduct disorder) and participated in the CWD-A intervention improved significantly in social functioning over the course of treatment (p < .02). These youth improved an average of 5 points on the CGAS from baseline to follow-up, whereas youth receiving life skills tutoring improved by roughly 2 points.

In the second study, adolescents treated with CWD-A showed greater improvements in functioning compared with wait-listed youth, as indicated by average GAF scores (p < .05). The study demonstrated a medium effect size (Cohen's d = 0.54) for this change in functioning.
Studies Measuring Outcome Study 2, Study 3
Study Designs Experimental
Quality of Research Rating 3.6 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 13-17 (Adolescent) 61% Male
39% Female
Data not reported/available
Study 2 13-17 (Adolescent) 70.8% Female
29.2% Male
Data not reported/available
Study 3 13-17 (Adolescent) 51.6% Male
48.4% Female
80.6% White
19.4% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Recovery from depression 4.0 4.0 3.3 3.0 3.8 4.0 3.7
2: Self-reported symptoms of depression 4.0 4.0 3.3 3.0 3.8 4.0 3.7
3: Interviewer-rated symptoms of depression 4.0 4.0 3.0 4.0 3.5 4.0 3.8
4: Psychosocial level of functioning 3.5 4.0 3.0 3.3 3.8 4.0 3.6

Study Strengths

The study authors generally used "gold standard" measures that have had their reliability documented by numerous, independent investigators. Observational and clinical interview measures demonstrated high interviewer agreement rates (i.e., strong Kappa statistics). Studies used rigorous designs, and the authors did a good job attending to the fidelity of the interventions.

Study Weaknesses

Relatively small baseline samples led to some sample size concerns such as lowered statistical power.

Readiness for Dissemination
Review Date: July 2007

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Clarke, G., Lewinsohn, P., Hops, H., & Grossen, B. (1990). Leader's manual for adolescent groups: Adolescent Coping With Depression course. Retrieved from http://www.kpchr.org/public/acwd/CWDA_manual.pdf

Clarke, G., Lewinsohn, P., Hops, H., & Grossen, B. (1990). Student workbook: Adolescent Coping With Depression course. Retrieved from http://www.kpchr.org/public/acwd/CWDA_workbook.pdf

CWD-A Protocol Adherence Session Checklists

Leader Adherence and Competence Form

Program Web site, http://www.kpchr.org/public/acwd/acwd.html

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
3.5 1.5 3.3 2.8

Dissemination Strengths

Program materials provide a high level of implementation detail as well as scripted lesson plans for each session. Detailed, easy-to-use quality assurance scales are available to rate therapist adherence to protocol and general therapeutic competence.

Dissemination Weaknesses

Very little training and technical assistance is available to potential implementers. No protocols for clinical supervision are provided to support quality assurance.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Leader manual Free Yes
Student workbook Free Yes
Treatment adherence scale Free No
Therapist competence rating scale Free No
Contact Information

To learn more about implementation or research, contact:
Paul Rohde, Ph.D.
(541) 484-2123
paulr@ori.org

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

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