A major threat to treatment efficacy is the dilution of treatment strength through early drop out, sporadic attendance, and marginal participation. This problem represents a significant public health concern given the high rates of attrition and sporadic attendance in child clinic settings. As a result, children and adolescents who do not receive adequate exposure to active treatment components are unlikely to benefit from empirically supported treatments. We propose that the therapeutic alliance and therapist behaviors that facilitate alliance formation are critical for reducing drop out, promoting regular attendance, and maximizing active participation in sessions. Thus, empirically supported treatments should be complemented with empirically based engagement interventions that contribute to alliance formation, and to evaluate the contribution of engagement interventions and alliance to treatment completion, regular attendance, active participation, and treatment outcome in an open trial of CBT for adolescent depression. The proposal involves two studies. The first involves the development and evaluation of observational measures of therapist engagement interventions, therapy alliance, and treatment participation from audio recordings of completed, controlled trial of CBT for depressed and suicidal adolescents. The second study involves the evaluation of associations among engagement interventions, alliance, participation, treatment continuation/attendance, and outcome in an open trial of an empirically supported treatment, cognitive-behavioral therapy, for adolescent depression. An explicit mediational model of therapy process will be evaluated. The identification of effective engagement interventions into manualized treatments for adolescent depression, specifically, and potentially into manuals for a range of adolescent disorders. It is expected that empirically based guidelines for treatment engagement will be essential for the transportation of empirically supported treatments from research to clinical settings.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Exploratory/Developmental Grants (R21)
Project #
1R21MH065988-01
Application #
6508154
Study Section
Special Emphasis Panel (ZMH1-ITV-D (01))
Program Officer
Sherrill, Joel
Project Start
2002-09-01
Project End
2005-05-31
Budget Start
2002-09-01
Budget End
2003-05-31
Support Year
1
Fiscal Year
2002
Total Cost
$165,726
Indirect Cost
Name
University of Denver
Department
Psychology
Type
Schools of Arts and Sciences
DUNS #
City
Denver
State
CO
Country
United States
Zip Code
80208
Labouliere, Christa D; Reyes, J P; Shirk, Stephen et al. (2017) Therapeutic Alliance With Depressed Adolescents: Predictor or Outcome? Disentangling Temporal Confounds to Understand Early Improvement. J Clin Child Adolesc Psychol 46:600-610
Jungbluth, Nathaniel J; Shirk, Stephen R (2013) Promoting homework adherence in cognitive-behavioral therapy for adolescent depression. J Clin Child Adolesc Psychol 42:545-53
Jungbluth, Nathaniel J; Shirk, Stephen R (2009) Therapist strategies for building involvement in cognitive-behavioral therapy for adolescent depression. J Consult Clin Psychol 77:1179-84
Shirk, Stephen R; Gudmundsen, Gretchen; Kaplinski, Heather Crisp et al. (2008) Alliance and outcome in cognitive-behavioral therapy for adolescent depression. J Clin Child Adolesc Psychol 37:631-9