Maintenance of treatment effects from cognitive-behavioral therapy and parent training on family functioning and girls' depressive symptoms



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Improving treatment for early adolescent girls with depression by understanding factors that promote the maintenance of treatment effects is an important area of research given the association of depression with functional impairment and negative future outcomes. The effectiveness of CBT for treating depressed youth in the short-term has been well-established. However, limited research exists on the impact of CBT beyond one year post-treatment and on factors that enhance treatment maintenance for children and adolescents with depression. An intervention strategy that may yield the maintenance of treatment effects is the inclusion of primary caregivers. However, there is presently insufficient evidence to ascertain whether including primary caregivers in girls’ depression treatment produces additional benefits because they have rarely been incorporated into clinical trials of depression treatment for youth. This approach warrants study since families of depressed youngsters are often characterized by disturbances in family functioning and because aspects of the family environment are related to the development and maintenance of depressive disorders in youth.

The current study addressed gaps in the existing literature about the maintenance of treatment effects for girls with depression by examining the impact of a parent training (PT) component added to a school-based, group-administered CBT intervention on girls’ depressive symptoms and key areas of family functioning (i.e., conflict, cohesion, communication, and family sociability). Participants included 9- to 14-year-old girls with a depressive disorder, one primary caregiver for each girl who completed measures, and caregivers in the parental treatment component. Girls were randomly assigned to a CBT, CBT+PT, or minimal contact control condition. Ratings of girls’ depressive symptoms and the family functioning variables were obtained from girls and primary caregivers at pre-treatment, post-treatment, and annually for up to four years following treatment.

Results from growth curve modeling using hierarchical linear models indicated no significant differences in rate of change of girls’ depressive symptoms over time depending on whether they were in the CBT or CBT+PT condition. However, subsequent analyses revealed two significant factors associated with treatment maintenance: child attendance at CBT meetings and parental attendance at PT meetings. Specifically, higher rates of child and parental attendance were generally predictive of a sustained decline in girls’ depressive symptoms over time. In addition, findings supported the positive impact of CBT with PT on aspects of the family environment from pre- to post-treatment, but not from post-treatment through the four years of follow-up assessment. Implications, limitations, and recommendations for further areas of research are discussed.