The present application is in response to Program Announcement (PA) 93-093 for Exploratory/Development Grants (R21) for Psychosocial Treatment Research. As the first step in an eventual controlled treatment trial for children with chronic depression, we propose to: (a) test, refine, and finalize a psychotherapy manual for dysthymic children (ages 7 to 12) and construct a measure of therapist adherence, (b) standardized the final manual and assess the reliability of the measure of therapist adherence, and (c) arrive at a final protocol for the psychotherapy of dysthymia in children. The framework integrates a cognitive-behavioral perspective on depressive symptoms with the broader relational concept of stress and coping, and accommodates the importance of parents in the lives of their offsprings. The treatment will focus on reducing the child's affective symptoms and distress; alleviating other symptoms of depression, behavioral dysregulation, and dysfunction; as well as the teaching of coping skills and the reinforcing of reasonable parent-child interactions. To achieve these goals, the mother (parent) will be enlisted as co-therapist; the family's problems and diffi-culties (including the patient's symptoms) will be reframed from the broad perspective of stress and coping; and a variety of cognitive, behavioral, and related treatment techniques will be used, including emotion-focused or palliative and problem-focused coping strategies. The psychotherapy manual will be refined and finalized using a protocol that consists of three phases: intense treatment, tapering, and a booster phase, with a total of 30-sessions over a 10-month period. Follow-ups will be conducted at 6- and 12-months after termination. Patients will be recruited in 2 Waves. We will use a step-by-step interactive procedure with Wave 1 patients (30 child-mother/ mother surrogate pairs) to finalize our manual and construct the therapist adherence measure. Wave 2 patients (15 child-mother pairs) will serve to standardize the final manual and examine the reliability of the adherence measure. Dysthymic disorder in childhood is a chronic condition, with an average duration of about 4 years. It is associated with a high risk of subsequent episodes of affective disorder as well as functional impairment. Because of the risk of chronicity and long term disability, this mood disorder requires early and effective treatment. The present application will facilitate comparative treatment outcome studies by finalizing a psychotherapy manual and protocol for children with these conditions.
| Kovacs, Maria; Sherrill, Joel; George, Charles J et al. (2006) Contextual emotion-regulation therapy for childhood depression: description and pilot testing of a new intervention. J Am Acad Child Adolesc Psychiatry 45:892-903 |
