Effectiveness and moderators of individual cognitive behavioral therapy versus treatment as usual in clinically depressed adolescents- a randomized controlled trial
Stikkelbroek, Y., Vink, G., Nauta, M. H., Bottelier, M. A., Vet, L. J., Lont, C. M., ... & Bodden, D. H. (2020). Effectiveness and moderators of individual cognitive behavioral therapy versus treatment as usual in clinically depressed adolescents: a randomized controlled trial. Scientific Reports, 10(1), 1-13.
Opposite potential problem with visual inspection –
sensitive to detecting small intervention effects
• Effect size may not have any relation to a change that is
important or clinically significant in the lives of clients
• The general relevance of statistical inference to single-case
data remains a highly controversial topic (Ator, 1999; Baron,
1999; Fisch, 2001).
Drop out rate seemed high
19 completing treatment in the CBT condition only 4 attended all 15 sessions
26 completing treatment in the TAU condition
(24 cbt) (25 tau) post assess
14c,18t follow up1
14c,15t follow up 2
Final study underpowered
44 per condition
Power calculations in STATA
indicated that 70 adolescents per condition (assuming an alpha of 0.05, a statistical power, 1-beta, of 0.80 and a
drop-out of 20% would be required to detect a difference in depression diagnosis between conditions.
Explained randomisation process
Randomization was conducted after pre-treatment
assessment and was executed per adolescent by computer generated block randomization and stratified per
mental health care center by the primary researcher (no involved in other assessments)
CBT v TAU
primary outcome was depressive or dysthymic disorder based on the KSADS
Only for 6 to 18 the participants are 12 to 21 does this effectively assess older people?
The intervention contains
representative CBT components
namely: psycho-education (information about depression and the rationale
for the etiology of the complaints and the treatment of them), setting attainable goals (translate large goals into
realistic short term goals), self-monitoring (registration of the mood, activities and thoughts), activation (planning
frequent, joyful activities), improving social skills and communication skills (improvement and stimulation of social behavior), relaxation techniques, cognitive restructuring (identifying and changing unrealistic negative
thoughts about the self, others and events), role play and problem solution skills (teaching the creation of solutions
for problems via brainstorm, choosing, trying and evaluating) and relapse prevention.
Integrity of treatment between therapists was assessed and found to be good but no statement regarding continuity for client (same therapist every time)
Treatments in both conditions were delivered by psychologists with at least one year of experience
within professional mental health care. The therapist in the CBT condition had also at least one year of
experience in conducting CBT. two day training this manual
37 therapists in each condition -no overlap
The following assessments took place; prior to treatment (pretreatment assessment), within treatment (mediator
assessments), immediately after treatment or after 15 sessions (post treatment assessment), six months after
treatment (six-month follow-up) and 1 year after treatment (1 year follow-up). In this paper, we will present the
post treatment and six-month follow-up results.
Study Aim The aims of this study were to
investigate the (1) effectiveness and (2) potential moderators and predictors (age, gender, educational level of
the adolescent and the parent, suicide criteria, comorbidity and severity of depression) of CBT versus TAU