Cognitive-behavioral Prevention Program Research Articles

ØCD: protocol for the development and evaluation of a cognitive-behavioral prevention program for obsessive-compulsive disorder

BackgroundObsessive-compulsive disorder (OCD) imposes significant burdens on individuals, families, and healthcare systems and the COVID-19 pandemic appears to have exacerbated OCD symptoms. Currently, there are no validated prevention programs for OCD, highlighting a critical gap in mental health services. This study aims to develop and validate the first ØCD prevention program, for at-risk adults, utilizing cognitive-behavioral therapy (CBT) and exposure response prevention (ERP) techniques.MethodsA single-blind, randomized controlled trial comparing the ØCD prevention program to a waitlist control group will be conducted. Participants, at-risk adults (18–65 years) with subclinical OCD symptoms (OCI-R score ≥ 12), will be recruited for the study. The ØCD prevention program compresise of six online group sessions incorporating CBT and ERP techniques over three modules. The primary outcomes are OCD symptom severity (measured by the Obsessive-Compulsive Inventory- revised form; OCI-R), depression symptoms (measured by the Patient Health Questionnaire; PHQ-9), and anxiety symptoms (measured by the Generalised Anxiety Disorder 7-item; GAD-7). Secondary outcomes include OCD-related beliefs, experiential avoidance, resilience, quality of life, uncertainty intolerance, automatic thoughts, and distress. Outcome measures will be collected at baseline, at completion of the intervention, and one year later (follow-up). At follow-up, we will also analyze the OCD diagnostic incidence, using the Structured Clinical Interview for DSM-5. We will employ a multivariate analysis of variance (MANOVA) to explore whether significant differences exist between groups across dependent variables. To compare the OCD incidence levels from the pre-test to the follow-up we will use the chi-squared test.DiscusionThe present study may contribute novel data on the efficacy of OCD prevention approaches, leading to the development of an evidence-based OCD prevention program that could alleviate individual and societal burdens associated with OCD.Trial registrationThis trial was approved by the University Ethical Review Authority (937/ 28.11.2023) at Babeș-Bolyai University and is registered on clinicaltrials.gov (ID: NCT06262464).

A Randomized Controlled Trial of Cognitive Behavioral Group Prevention Program for Mainland Chinese University Students in Hong Kong

Purpose:This study developed a culturally appropriate cognitive behavioral group prevention program for Mainland Chinese university students in Hong Kong and tested its effectiveness.Method:A total of 74 Chinese students were recruited and randomly assigned to an 8-week cognitive behavior prevention program (experimental group) or a waiting list control (WLC) group.Results:Compared with the WLC group, participants in the experimental group significantly reduced psychological distress, acculturative stress, negative emotions, and negative thoughts and increased positive emotions, positive thoughts, and postmigration growth, with medium to large effect sizes. Upon immediate completion of the program, about 46% and 30% of the participants in the experimental group and WLC group, respectively, were classified as non-at-risk cases for developing mental health problems.Discussion:The positive intervention effects and clinical implication of cultural adaptation of cognitive behavioral group therapy to Chinese students are discussed.

Effects of Super Skills for Life on the social skills of anxious children through video analysis.

Super Skills for Life (SSL) is an innovative transdiagnostic cognitive-behavioral prevention program that has demonstrated positive results targeting children's internalizing problems. SSL has a strong component aimed at enhancing social competence, including strategies such as video-feedback with cognitive preparation. This study examined for the first time the immediate impact of SSL on improving social skills in young children with anxiety symptoms, as well as mediating factors predicting SSL anxiety outcomes. Participants were 67 Spanish-speaking children aged 6-8 years old. Children were video-recorded and assessed behaviorally through a 2 minute speech task, before and after the 8-session program. The results revealed significant positive behavioral changes related to children' social skills in several domains. Depression acted as a mediator of change in pre- to post-intervention generalized anxiety scores. This study provides initial support for the usefulness of SSL to immediately improve social skills in young children with anxiety symptoms.

Cost-Effectiveness of Preventing Depression Among At-Risk Youths: Postintervention and 2-Year Follow-Up.

Youth depression can be prevented, yet few programs are offered. Decision makers lack cost information. This study evaluated the cost-effectiveness of a cognitive-behavioral prevention program (CBP) versus usual care. A cost-effectiveness analysis was conducted with data from a randomized controlled trial of 316 youths, ages 13-17, randomly assigned to CBP or usual care. Youths were at risk of depression because of a prior depressive disorder or subthreshold depressive symptoms, or both, and had parents with a prior or current depressive disorder. Outcomes included depression-free days (DFDs), quality-adjusted life years (QALYs), and costs. Nine months after baseline assessment, youths in CBP experienced 12 more DFDs (p=.020) and .018 more QALYs (p=.007), compared with youths in usual care, with an incremental cost-effectiveness ratio (ICER) of $24,558 per QALY. For youths whose parents were not depressed at baseline, CBP youths had 26 more DFDs (p=.001), compared with those in usual care (ICER=$10,498 per QALY). At 33 months postbaseline, youths in CBP had 40 more DFDs (p=.05) (ICER=$12,787 per QALY). At 33 months, CBP youths whose parents were not depressed at baseline had 91 more DFDs (p=.001) (ICER=$13,620 per QALY). For youths with a currently depressed parent at baseline, CBP was not significantly more effective than usual care at either 9 or 33 months, and costs were higher. CBP produced significantly better outcomes than usual care and was particularly cost-effective for youths whose parents were not depressed at baseline. Depression prevention programs could improve youths' health at a reasonable cost; services to treat depressed parents may also be warranted.

Effect of the Cognitive-Behavioral Prevention Program on Levels of Depression Symptoms Among Working Adolescents in Turkey.

The current study was conducted to determine the effect of the Cognitive-Behavioral Prevention Program (CBPP) on levels of depression symptoms, ability to cope with stress, and automatic negative thought patterns among working adolescents in Turkey. The CBPP was conducted once per week for eight sessions and then once per month for six sessions. Data were collected using the Beck Depression Inventory, Automatic Thoughts Questionnaire, and Rosenbaum's Learned Resourcefulness Schedule. Observations were made prior to administration of the CBPP, upon conclusion of the program, and at 6 and 12 months. Chi-square and t tests were used for data analysis. Mean age of participants was 15.85, and they worked a mean 10.84 hours per day. After taking part in the CBPP, participants displayed a decrease in levels of depression symptoms, an increase in their ability to cope with stress, and diminished automatic negative thoughts (all p = 0.001), thus indicating that they benefited from the program and its effectiveness continued through 12-month follow up. [Journal of Psychosocial Nursing and Mental Health Services, 54(7), 43-51.].

Long-term benefits of cognitive–behavioural prevention for adolescents at risk of depression but not if parents are depressed at the onset of the programme

ABSTRACT FROM: Brent DA, Brunwasser SM, Hollon SD, et al . Effect of a cognitive-behavioral prevention program on depression 6 years after implementation among at-risk adolescents: a randomized clinical trial....

Effect of a Cognitive-Behavioral Prevention Program on Depression 6 Years After Implementation Among At-Risk Adolescents: A Randomized Clinical Trial.

Adolescents whose parents have a history of depression are at risk for developing depression and functional impairment. The long-term effects of prevention programs on adolescent depression and functioning are not known. To determine whether a cognitive-behavioral prevention (CBP) program reduced the incidence of depressive episodes, increased depression-free days, and improved developmental competence 6 years after implementation. A 4-site randomized clinical trial compared the effect of CBP plus usual care vs usual care, through follow-up 75 months after the intervention (88% retention), with recruitment from August 2003 through February 2006 at a health maintenance organization, university medical centers, and a community mental health center. A total of 316 participants were 13 to 17 years of age at enrollment and had at least 1 parent with current or prior depressive episodes. Participants could not be in a current depressive episode but had to have subsyndromal depressive symptoms or a prior depressive episode currently in remission. Analysis was conducted between August 2014 and June 2015. The CBP program consisted of 8 weekly 90-minute group sessions followed by 6 monthly continuation sessions. Usual care consisted of any family-initiated mental health treatment. The Depression Symptoms Rating scale was used to assess the primary outcome, new onsets of depressive episodes, and to calculate depression-free days. A modified Status Questionnaire assessed developmental competence (eg, academic or interpersonal) in young adulthood. Over the 75-month follow-up, youths assigned to CBP had a lower incidence of depression, adjusting for current parental depression at enrollment, site, and all interactions (hazard ratio, 0.71 [95% CI, 0.53-0.96]). The CBP program's overall significant effect was driven by a lower incidence of depressive episodes during the first 9 months after enrollment. The CBP program's benefit was seen in youths whose index parent was not depressed at enrollment, on depression incidence (hazard ratio, 0.54 [95% CI, 0.36-0.81]), depression-free days (d = 0.34, P = .01), and developmental competence (d = 0.36, P = .04); these effects on developmental competence were mediated via the CBP program's effect on depression-free days. The effect of CBP on new onsets of depression was strongest early and was maintained throughout the follow-up period; developmental competence was positively affected 6 years later. The effectiveness of CBP may be enhanced by additional booster sessions and concomitant treatment of parental depression. clinicaltrials.gov Identifier:NCT00073671.

Prevention of Depression in At-Risk Adolescents

Adolescent offspring of depressed parents are at high risk for experiencing depressive disorders themselves. To determine whether the positive effects of a group cognitive-behavioral prevention (CBP) program extended to longer-term (multiyear) follow-up. A 4-site randomized clinical trial with 33 months of follow-up was conducted. Recruitment of participants was from August 2003 through February 2006. The study settings included a health maintenance organization, university medical centers, and a community mental health center. Three hundred sixteen adolescent (aged 13-17 years) offspring of parents with current and/or prior depressive disorders; adolescents had histories of depression, current elevated depressive symptoms, or both but did not currently meet criteria for a depressive disorder. The CBP program consisted of 8 weekly 90-minute group sessions followed by 6 monthly continuation sessions. Adolescents were randomly assigned to either the CBP program or usual care (UC). The primary outcome was a probable or definite episode of depression (Depression Symptom Rating score ≥4) for at least 2 weeks through the month 33 follow-up evaluation. Over the 33-month follow-up period, youths in the CBP condition had significantly fewer onsets of depressive episodes compared with those in UC. Parental depression at baseline significantly moderated the intervention effect. When parents were not depressed at intake, CBP was superior to UC (number needed to treat, 6), whereas when parents were actively depressed at baseline, average onset rates between CBP and UC were not significantly different. A 3-way interaction among intervention, baseline parental depression, and site indicated that the impact of parental depression on intervention effectiveness varied across sites. The CBP program showed significant sustained effects compared with UC in preventing the onset of depressive episodes in at-risk youth over a nearly 3-year period. Important next steps will be to strengthen the CBP intervention to further enhance its preventive effects, improve intervention outcomes when parents are currently depressed, and conduct larger implementation trials to test the broader public health impact of the CBP program for preventing depression in youth. clinicaltrials.gov Identifier: NCT00073671.

Negative Life Events and Substance Use Moderate Cognitive Behavioral Adolescent Depression Prevention Intervention

Investigate factors that amplify or mitigate the effects of an indicated cognitive behavioral (CB) depression prevention program for adolescents with elevated depressive symptoms. Using data from a randomized trial (Registration No. NCT00183417; n = 173) in which adolescents (M age = 15.5, SD = 1.2) were assigned to a brief cognitive behavioral prevention program or an educational brochure control condition, we tested whether elevated motivation to reduce depression and initial depressive symptom severity amplified intervention effects and whether negative life events, social support deficits, and substance use attenuated intervention effects. Hierarchical linear modeling (HLM) indicated differential intervention effects for two of the five examined variables: negative life events and substance use. For adolescents at low and medium levels of substance use or negative life events, the CB intervention produced declines in depressive symptoms relative to controls. However, at high levels of substance use or negative life events, the CB intervention did not significantly reduce depressive symptoms in comparison to controls. Results imply that high-risk adolescents with either high rates of major life stress or initial substance use may require specialized depression prevention efforts.

Efficacy of a prevention program for postpartum obsessive–compulsive symptoms

Obsessive–Compulsive Disorder (OCD) has emerged as a common and impairing postpartum condition. Prospective studies have identified psychological vulnerabilities for the emergence of postpartum obsessive–compulsive symptoms (OCS), including general anxiety symptoms, pre-existing OCS, and specific cognitive distortions. The identification of these factors makes feasible the development of prevention programs that could reduce the impact of postpartum OCS. The present investigation examined a cognitive-behavioral prevention program using a randomized, double blind, controlled trial. Expecting mothers in their 2nd or 3rd trimester with an empirically established, malleable risk factor for postpartum OCS received either the prevention program ( N = 38) or a credible control program ( N = 33), both of which were incorporated into traditional childbirth education classes. Results revealed that at 1 month, 3 months, and 6 months postpartum, the prevention program was associated with significantly lower levels of obsessions and compulsions than was the control condition (all p’s < 0.05). Group differences remained significant even after controlling for baseline OCS and depression symptoms. Those in the prevention condition also reported decreasing levels of cognitive distortions, in contrast to the control condition ( p’s < 0.05). Results support the potential utility of incorporating a CBT-based OCS prevention program into childbirth education classes.

Prevention of depression in at-risk adolescents: a randomized controlled trial.

Adolescent offspring of depressed parents are at markedly increased risk of developing depressive disorders. Although some smaller targeted prevention trials have found that depression risk can be reduced, these results have yet to be replicated and extended to large-scale, at-risk populations in different settings. To determine the effects of a group cognitive behavioral (CB) prevention program compared with usual care in preventing the onset of depression. A multicenter randomized controlled trial conducted in 4 US cities in which 316 adolescent (aged 13-17 years) offspring of parents with current or prior depressive disorders were recruited from August 2003 through February 2006. Adolescents had a past history of depression, current elevated but subdiagnostic depressive symptoms, or both. Assessments were conducted at baseline, after the 8-week intervention, and after the 6-month continuation phase. Adolescents were randomly assigned to the CB prevention program consisting of 8 weekly, 90-minute group sessions followed by 6 monthly continuation sessions or assigned to receive usual care alone. Rate and hazard ratio (HR) of a probable or definite depressive episode (ie, depressive symptom rating score of > or = 4) for at least 2 weeks as diagnosed by clinical interviewers. Through the postcontinuation session follow-up, the rate and HR of incident depressive episodes were lower for those in the CB prevention program than for those in usual care (21.4% vs 32.7%; HR, 0.63; 95% confidence interval [CI], 0.40-0.98). Adolescents in the CB prevention program also showed significantly greater improvement in self-reported depressive symptoms than those in usual care (coefficient, -1.1; z = -2.2; P = .03). Current parental depression at baseline moderated intervention effects (HR, 5.98; 95% CI, 2.29-15.58; P = .001). Among adolescents whose parents were not depressed at baseline, the CB prevention program was more effective in preventing onset of depression than usual care (11.7% vs 40.5%; HR, 0.24; 95% CI, 0.11-0.50), whereas for adolescents with a currently depressed parent, the CB prevention program was not more effective than usual care in preventing incident depression (31.2% vs 24.3%; HR, 1.43; 95% CI, 0.76-2.67). The CB prevention program had a significant prevention effect through the 9-month follow-up period based on both clinical diagnoses and self-reported depressive symptoms, but this effect was not evident for adolescents with a currently depressed parent. clinicaltrials.gov Identifier: NCT00073671.

Impact of comorbidity in prevention of adolescent depressive symptoms.

Despite the well-known relevance of comorbidity, few studies have examined the impact of comorbid anxiety or externalizing symptoms on the prevention of depressive symptoms in adolescents. To replicate earlier positive effects of a cognitive-behavioral prevention program of depressive symptoms and to test the hypothesis that the prevention program would be less effective in adolescents with comorbid anxiety and externalizing symptoms, the authors conducted a study involving 301 8th-grade students randomly divided into an intervention group and a nonintervention control group. The randomized design included baseline, postintervention, and 6-month follow-up. The prevention program included 10 sessions held in a regular school setting. The prevention program showed positive effects on depressive symptoms independent of comorbid symptoms. These effects were found mainly with girls independent of their depressive symptoms at baseline, and in part with boys with less severe depressive symptoms at baseline. It is surprising that negative effects of the prevention program on depressive symptoms were found on the depression of boys with more severe depressive symptoms at baseline. The prevention program’s low rate of attrition and high recruitment rate support the generalizability of the results.

Prevention of marital distress by enhancing the coping skills of couples: 1-year follow-up-study

This article presents a new preventive approach (Couples Coping Enhancement Training: CCET) aimed at expanding upon the scope of current prevention programs by focussing on stress issues and individual and dyadic coping skills. The cognitive behavioral prevention program is based on stress and coping research in couples and seeks to improve important skills with an 18-hour course. The effectiveness of the approach is examined with respect to 143 couples over a period of one year. The results show that couples participating in the program benefit in terms of a significant increase in marital quality and that intervention couples appraise their relationship even after one year as substantially improved in a number of domains (quality of marital communication, intimacy etc.). Our results support the importance of prevention for couples with low marital satisfaction even if they have been living together for many years.

The prevention of depression and anxiety.

A brief and inexpensive cognitive–behavioral prevention program was given to university students at risk for depression. At risk was defined as being in the most pessimistic quarter of explanatory style. Two hundred thirty-one students were randomized into either an 8week prevention workshop that met in groups of 10, once per week for 2 hr, or into an assessment-only control group. Participants were followed for 3 years and the authors report the preventive effects of the workshop on depression and anxiety. First, the workshop group had significantly fewer episodes of generalized anxiety disorder than the control group and showed a trend toward fewer major depressive episodes. The workshop group had significantly fewer moderate depressive episodes but no fewer severe depressive episodes. Second, the workshop group had significantly fewer depressive symptoms and anxiety symptoms than the control group, as measured by self-report but not by clinicians' ratings. Third, the workshop group had significantly greater improvements in explanatory style, hopelessness, and dysfunctional attitudes than the control group and these were significant mediators of depressive symptom prevention in the workshop group.