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



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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.