Effects of Psychotherapy for Youth Depression: Preliminary Meta-Analytic Findings

Transcription

1 Effects of Psychotherapy for Youth Depression: Preliminary Meta-Analytic Findings Adolescent Depression Webcast Symposium University of Calgary, December 6, 2010 John Weisz, Ph.D., ABPP Dept. of Psychology, Harvard University and Judge Baker Children s Center, Harvard Medical School

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3 Treatment Study & Effect Size Calculation 1. PRE - TREATMENT Full Sample Tx Group Control Group Tx Group 2. TREATMENT PHASE Control Group Receives Target Treatment No Treatment, Waitlist, Placebo 3. POST- TREATMENT ASSESSMENT Treatment Group* * scores on outcome measure Control Group* SD of outcome measure EFFECT SIZE

4 INTERPRETING EFFECT SIZE STATISTICS COHEN S STANDARD EFFECT SIZE PERCENTILE LARGE MEDIUM SMALL BENEFICIAL EFFECT NO EFFECT DETRIMENTAL EFFECT

5 MEAN EFFECT SIZES IN META-ANALYSES OF ADULT AND YOUTH STUDIES ADULT YOUTH 1 Large Medium Small Smith & Glass Shapiro & Shapiro Casey & Berman Weisz et al Kazdin et al Weisz et al Weisz et al. 2007

6 Overview of the Study Set 30 peer-reviewed, published randomized trials treating youth depression Published , median year 2001 Age: Mean 14, median 15, Range Gender: 40% male

7 *17% Ethnicity unknown/not reported

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9 Diagnostic Information Mean % of Sample Mean % of Sample

10 Representation of Treatment Approaches and Types of Control Group Examples of Treatment Methods Used o CBT 42.76% o Interpersonal Therapy 8.62% o Relaxation/Desensitization 4.23% o Social Skills Training 2.20% o Eclectic or Combination Treatments 17.07% Types of Control Group o No Treatment or Waitlist 60.47% o Attention Placebo 23.90% o Case Management 12.19% o Medication Placebo 3.11%

11 Therapy Modality Mean % of Groups

12 Treatment Dose Planned Treatment Length (weeks) o Mean o Median 12.0 o Range 5-36 Planned Treatment Length (sessions) o Mean 15.0 o Median 12.0 o Range 6-36 Planned Length of Sessions (minutes) o Mean o Median 60.0 o Range

13 Therapist Characteristics Degree Held at Treatment Delivery Therapist Discipline Mean % of Groups Mean % of Groups

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23 Do CBT/Cognitive Treatments Outperform Non-Cognitive Treatments?

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28 Q & A about Depression Treatment Effects How does depression treatment fare vs. other problems? Not so well: ES.31 vs..69 Better outcomes for teens than children? Negligible: Adol ES.32, Child ES.27 How lasting are effects? Not bad. ES drops.39 to.25 over 22 weeks after treatment. Are effects specific to depression? Yes, a bit of spillover for anxiety, but not for externalizing problems [ES:.33,.16,.05] Harder to get effects with diagnosed samples? Not really: ES Diag.32, ES Not Diag.33

29 Q & A about Treatment Effects, cont d Better to do individual than group treatment? Not according to our data: ES Indiv.41, ES Group.39 Better to do CBT/cog than other method? Not according to our data: ES CBT/cog.26 ES Non-cog.61 Better to have parents involved in treatment or not? Inconclusive: ES with parents.33, ES without parents.31 Better to be treated by pro clinicians than others (e.g., grad students)? Some support in our data: ES Majority clinicians.58, ES Other.33

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32 Possible Answers Maybe most treatments are too complex. Maybe less more. (consider relaxation, social skills, IPT) Maybe our treatments don t have enough skills, components, to cover diverse ways of being depressed. Maybe our long fixation on cognitions/cbt has been a mistake. Changing cognitions may not be the golden bullet. Maybe it s a mistake to treat depression without tackling the comorbidity? (see next slide) Maybe we need to learn how to personalize treatment fit interventions to individual youths. To address comorbidity and personalize: MATCH

33 # DIAGNOSES: DEPRESSED YOUTHS % 8% 15% 27% 2 27% 3-4 MEAN: ODD, CD, ADHD: 81%

34 Co-morbidity in Outpatient Youths [N=436] DISORDER % With That % With ONLY % With That Disorder that Disorder Disorder + Others Depression 23% 3% 20% Anxiety 39% 12% 27% Conduct Disorder 18% 2% 16% Opp Defiant Dis 42% 9% 33%

35 TREATMENT OF FOUR PROBLEM-DISORDER CLUSTERS via MATCH-ADTC Anxiety Depression Trauma Conduct

36 Anxiety, incl PTSD Depression Conduct PsychoEd Parent Getting Acquainted Fear Ladder PsychoEd Child Practice Maintence Cognitive Stop Wrap Up 1 on 1 Time Booster Session Looking Ahead Daily Report Card Making a Plan Time Out Rewards Effective Instruct Active Ignoring Praise PsychoEd Parent Engaging Parents Plans for Coping Cognitive TLC Cognitive BLUE Positive Self Quick Calming Relaxation Activity Selection Problem Solving PsychoEd Parent PsychoEd Child Getting Acquainted

37 Individual Youth Dashboard (Internalizing) Are results on track? Do the practices fit the problem? Is family engagement OK?

38 Take Home Thoughts Psychotherapies for youth depression do have beneficial effects (but fairly modest in size, and lower than treatments for other youth problems) CBT and other cognitively-focused treatments are prominent, but may not be the most potent As we give more research attention to the less cognitive alternatives, we may see larger mean effects of therapy for depression A major challenge is finding ways to. Deal with comorbidity, which is so common in youth depression Personalize figure out which treatments will work best for which youths