Investigating the role of cognitive and behavior components in cognitive behavioral treatment for depressed early adolescent girls



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Depression is a significant mental health concern with a pivotal increase of incidence during adolescence, specifically for females. Currently, cognitive behavioral therapy (CBT) is the most widely tested treatment for depression. Yet, it is unclear how CBT functions to produce effective outcomes. Adult studies have shown that behavioral components of CBT are more effective than cognitive components in reducing depression at acute treatment. Both behavioral and cognitive components have been shown to be effective in preventing relapse of depressive symptoms at follow up. Yet less is understood about how treatment components work together to provide positive outcomes, particularly for depressed youth. The overall goal of this study was to examine which parts of treatment (cognitive and/or behavioral) aid in symptom reduction and to determine if treatment outcome is mediated by cognitive change. Forty two pre-adolescent girls, aged 9-14, participated in a 20-session manualized group CBT program. The first portion of treatment (session 1-9) focused the behavioral intervention and the second portion of treatment (sessions 11-19) focused on cognitive interventions while continuing to reinforce behavioral interventions when necessary. Self report measures and diagnostic interviews were completed at pre-treatment and post-treatment. Using multiple regression analyses, the findings of this study supported the role of behavioral and cognitive interventions in reducing depression. Behavioral interventions were found to significantly reduce depression at post-treatment. Additionally, cognitive interventions were found to play a small, but significant role in post-treatment outcome, with preliminary evidence that cognitive interventions could also be linked to treatment outcome one year later. Treatment specificity could not be tested, as the cognitive change of depressed girls was not directly influenced by the behavior and cognitive interventions. Exploratory analysis demonstrated the significant role of behavioral techniques such as behavior activation, positive reinforcement, homework review, and skills training in predicting outcome of treatment. Implications of the results, limitations, and recommendations for future research are provided.