Browsing by Subject "Mechanisms of change"
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Item Mechanisms of change in CBT for depressed early adolescent girls : mediating effects of the cognitive triad on cognitive interventions for depressive symptoms(2009-12) Monnat, Lynn Mie 1970-; Stark, Kevin DouglasDepression is an increasingly common health problem among youth. There is growing empirical evidence that CBT is a promising treatment for childhood depression. It remains unclear what treatment-specific effects of CBT contribute to therapeutic gains. Cognitive theories propose that a primary mechanism of change in CBT are cognitive interventions that target depressogenic cognitions regarding the self, world, and future (cognitive triad), which are thought to mediate depression. The effects of cognitive interventions on depressive symptoms are thus hypothesized to be mediated by changes in the cognitive triad. No studies have investigated whether CBT for depressed youth works by treating the cognitive triad through the implementation of cognitive techniques. As part of a larger study analyzing the mechanisms of change in CBT for depressed youth, the purpose of this study was to investigate: (1) whether specific cognitive techniques are related to depressive symptom reduction in youth, and (2) if improvements in depressive symptoms are mediated through the cognitive triad of depressed youth. Participants were 42 girls, aged 8 to 14, who completed a manualized CBT protocol for depression in group format. Girls completed a diagnostic interview for depression and self-report measures assessing the cognitive triad. Group therapy sessions were coded for cognitive interventions. Results indicated a non-significant relation between levels of cognitive interventions and post-treatment depression scores, after controlling for pre-treatment depression. Therefore, tests of mediation were discontinued. Relevant control variables were added to the model to reduce error variance. After controlling for pre-treatment depression, age, presence of learning disorder, mastery of therapeutic skills, and behavioral interventions, cognitive interventions were significantly and positively associated with post-treatment depression. The relation between cognitive interventions and the cognitive triad was non-significant and meditational analyses were discontinued. Exploratory factor analysis revealed four cognitive interventions factors that were consistent with CBT theory. Further analyses revealed that all factors were not significantly related to post-treatment depression. Tests of interactions between cognitive interventions and behavioral interventions, age, and mastery level of therapeutic skills were also non-significant. Implications, limitations, and recommendations for further areas of research are presented.Item Mechanisms of change in cognitive behavioral therapy for depressed early adolescent females : mediating effects of the cognitive triad on cognitive, behavioral, problem solving, and relational components of the ACTION treatment for depression(2012-08) Arora, Prerna, 1980-; Carlson, Cindy I., 1949-; Stark, Kevin Douglas; Tharinger, Deborah J.; Pituch, Keenan A.; Loukas, Alexandra; Kaslow, Nadine J.Childhood depression is a widespread, stable disorder, and recurring disorder (Kovacs, Feinberg, Crouse-Novak, Paulauskas, & Finkelstein, 1984). Cognitive-Behavioral therapy is an empirically supported intervention for the treatment of depression (Weersing & Weisz, 2002; Weisz, McCarty, & Valeri, 2006). CBT for depression is often comprised of cognitive, behavioral, problem-solving, and relational interventions (McCarty & Weisz, 2007). While it is evident that CBT as a whole is efficacious, there exists a dearth of knowledge concerning the specific components within CBT, which contribute to symptom reduction in youth (Kazdin & Weisz, 1998; Kennard et al., 2009). Therefore, the manner in which CBT accomplishes change is not well understood (Shirk & Karver, 2006). Specifically, while cognitive theories assert that interventions targeted at modifying negative cognitions reduce depression (Beck, 1967), few studies, particularly with regards to depressed youth, have addressed this (Stice, Rohde, Seeley, & Gau, 2010). As such, this hypothesis concerning the role of depressogenic cognitions as mediators between certain CBT interventions and symptom reduction remains unsubstantiated (Weersing, Rozenman, & Gonzales, 2009). The current study assessed whether higher levels of cognitive, behavioral, problem solving, and relational components were associated with lower levels of post-treatment depression, as well as whether they were mediated through changes in the cognitive triad, a measure of depressogenic thinking. No studies have assessed the effectiveness of discrete interventions incorporated in CBT treatments for depression in youth, further examining whether noted changes in depression are mediated through cognitions, specifically the cognitive triad. Participants included 40 depressed females, aged 9 to 14, assessed using self-report measures and a diagnostic interview for depression, who engaged in treatment using a manualized group CBT treatment protocol. Results from hierarchical linear models indicated that higher participant cognitive triad scores and higher relational interventions were associated with lower post-treatment depression scores. However, subsequent analyses revealed that higher aggregated behavioral-problem-solving interventions scores were associated with lower post-treatment depression scores, while higher aggregated cognitive-relational intervention scores were associated with higher post-treatment depression scores. Implications, limitations, and recommendations for further areas of research are discussed.