Depressive disorders in adolescence are highly prevalent and associated with significant impairment and health risks, including substance abuse and suicide, as well as a range of future problems continuing into adulthood. A substantial body of research has demonstrated cognitive-behavioral therapy (CBT) to be an efficacious intervention for adolescent depression, however a large portion of adolescents typically remain depressed following CBT interventions (e.g. TADS, 2004), and relapse following successful treatment is also common (Brent et al., 1999). One strategy for strengthening CBT, so that more adolescents benefit from treatment, is to identify and enhance the treatment's most active ingredients. One active ingredient that has been identified in the adult CBT literature is client adherence to between-session tasks assigned by therapists (homework), which facilitates in-session therapeutic work as well as the generalization of new skills to the client's life, which in turn may support the maintenance of treatment gains following treatment termination. However, little empirical attention has been given to the role of homework in the treatment of depressed adolescents. Existing research indicates adolescents typically complete only half of CBT homework assignments, suggesting this may be a relatively diluted treatment ingredient and in need of enhancement. The goals of the current study are to evaluate adolescents'adherence to homework as a predictor of outcomes in a school-based, open trial of CBT for adolescent depression, and to identify therapist homework-related behaviors that predict increased homework adherence. Participants are 48 adolescents who met diagnostic criteria for a depressive disorder and completed at least two sessions of treatment. Adherence to homework and five therapist behaviors thought to promote homework adherence will be coded from audiotapes of therapy sessions. Greater homework adherence is expected to predict better treatment outcomes, and the five therapist behaviors will be tested as predictors of improved homework adherence. Additional analyses will examine whether some therapist behaviors are more useful for improving poor prior adherence and others are more useful for maintaining good prior adherence. The proposed research seeks to contribute to the strengthening of CBT for adolescent depression. Identification and enhancement of active treatment ingredients can also inform ongoing efforts to effectively transport evidence-based treatments, such as CBT, to community- and school-based clinic settings, where dilution of treatment components is a major concern.
|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|