Adolescent Coping With Depression Course (CWD-A)

Scientific Rating:
3

(provisional rating)

Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium

(provisional rating)

See descriptions of 3 levels

Provisional Rating

Adolescent Coping With Depression Course (CWD-A) currently has a provisional rating for the 60 days between: April 17, 2017 and June 16, 2017. If you would like to respond to the Scientific Rating, please submit feedback via the Contact Us page.

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Adolescent Coping With Depression Course (CWD-A) has been rated by the CEBC in the area of: Depression Treatment (Child & Adolescent).

Target Population: High school aged (14-18) adolescents with depression

For children/adolescents ages: 14 – 18

Brief Description

The Adolescent Coping With Depression Course (CWD-A) is a cognitive-behavioral group intervention that targets specific problems typically experienced by depressed adolescents. These problems include discomfort and anxiety, irrational/negative thoughts, poor social skills, and limited experiences of pleasant activities. The CWD-A consists of 16 two-hour sessions that are conducted over an 8-week period for mixed-gender groups of up to 10 adolescents.

Core components of the program include:

  • Cognitive-Behavioral Therapy (CBT) model of change
  • Mood monitoring
  • Increasing pleasant activities (behavioral activation)
  • Social skills training
  • Relaxation training
  • Identification of negative thoughts and cognitive restructuring
  • Communication and problem-solving training
  • Relapse prevention

Each participant receives a workbook that provides structured learning tasks, short quizzes, and homework forms. To encourage generalization of skills to everyday situations, adolescents are given homework assignments that are reviewed at the beginning of the subsequent session.

Program Goals:

The goals of Adolescent Coping With Depression Course (CWD-A) are:

  • Reduction of current depressive symptoms
  • Remission from current depressive disorder
  • Improvements in psychosocial functioning

Essential Components

The essential components of Adolescent Coping With Depression Course (CWD-A) include:

  • Recommended group size of 5-8 depressed adolescents
  • Program based on a Cognitive-Behavioral theoretical change orientation
  • Training in 8 core skills to treat depression:
    • Mood monitoring (e.g., rating moods daily on a 7-point scale, noting antecedents)
    • Social skills training (e.g., nonverbal communication skills, introducing yourself to others, starting conversations)
    • Relaxation (e.g., practice in progressive muscle relaxation, deep breathing)
    • Behavioral activation (e.g., tracking baseline level of activity and making a contract to increase positive activities)
    • Cognitive restructuring (e.g., identifying common personal negative thoughts, developing positive counter-thoughts, alternative methods of handling negative thoughts)
    • Communication (e.g., active listening, effective methods of expressing positive and negative thoughts)
    • Problem-solving (e.g., defining the problem, brainstorming solutions, evaluating the solutions, creating a contract)
    • Relapse prevention (e.g., developing plans to handle daily hassles, creating a prevention plan for future major life events).
  • Availability of a detailed manual providing guidance in the delivery of intervention content, in addition to methods for client assessment and recruitment, and therapist training
  • Presence of a companion 9-session group intervention for parents to (a) inform them of the skills their son/daughter is learning, (b) teach them the same communication and problem-solving skills taught to their child, and (c) have an opportunity to practice problem-solving in conjoint sessions with the adolescent group

Child/Adolescent Services

Adolescent Coping With Depression Course (CWD-A) directly provides services to children/adolescents and addresses the following:

  • Depression.
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: A 9-session optional companion Parent Course is available for the parents of adolescents in the CWD-A. The parent course teaches parents the Cognitive-Behavioral Therapy (CBT) skills being taught to their teen and provides parents with training and practice in the same communication and problem-solving skills their teen was taught.

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Outpatient Clinic
  • School

Homework

Adolescent Coping With Depression Course (CWD-A) includes a homework component:

As with most cognitive-behavioral therapy interventions, the CWD-A asks participants to complete brief home practice exercises after every session. These homework assignments focus on collecting data on mood, thinking, and activity levels and on practicing new coping skills to improve mood, thinking, and behaviors (e.g., relaxation skills, social skills, cognitive restructuring, communication, and problem-solving).

Languages

Adolescent Coping With Depression Course (CWD-A) does not have materials available in a language other than English.

Resources Needed to Run Program

The typical resources for implementing the program are:

The CWD-A works best if therapists have access to a room large enough to accommodate a group of 5-8 adolescents. Ideally, the room contains a large table for participants to write on during the session and a white/marker board for the group leader to use to present material.

Minimum Provider Qualifications

This therapeutic intervention can be incorporated into the practice of any qualified licensed mental health professional. A broad range of mental health professionals would have the necessary skills, assuming they have had some training in the assessment and treatment of adolescent affective and nonaffective disorders. The list includes psychologists, psychiatrists, psychiatric social workers and psychiatric nurse practitioners, and counselors. Individuals who are not adequately trained for independent practice (e.g., students, and teachers who do not have a mental health background) should only conduct the course under the supervision of a licensed mental health professional.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

Training can be provided via online or in-person training (generally 4 or 8 hours), a self-directed DVD training program, or self-study by reading the therapist manual.

Number of days/hours:

Varies depending on the provider’s background and previous experience.

Additional Resources:

There currently are additional qualified resources for training:

People could also contact the original developer, Greg Clarke, Ph.D., at:

Kaiser Permanente
Center for Health Research
Phone: (503) 335-6673
Fax: (503) 335-6311
Email: greg.clarke@kpchr.org

Implementation Information

Since Adolescent Coping With Depression Course (CWD-A) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Adolescent Coping With Depression Course (CWD-A).

Formal Support for Implementation

There is no formal support available for implementation of Adolescent Coping With Depression Course (CWD-A).

Fidelity Measures

There are fidelity measures for Adolescent Coping With Depression Course (CWD-A) as listed below:

Detailed checklists are available from the program representative listed at the end of the entry to assess treatment adherence and therapist competence. Protocol adherence can be measured using session-specific checklists for the concepts, skills, and exercises that are outlined in the session script. Each item is rated on 10-point scales that cover full, partial, or minimal presentation. General Cognitive-Behavioral Therapy (CBT) facilitator competence are rated using 12 items rated on 10-point scales that assess various general indices of a competent group therapist (e.g., leader expresses ideas clearly and at an appropriate pace, leader keeps group members on task during session). These scales can be rated reliably (intra-class correlation between two raters = .72). Therapists can self-monitor their adherence and competence as checks or sessions can be recorded and rated by supervisors or colleagues knowledgeable in CBT (and ideally the Adolescent Coping With Depression course). Fidelity monitoring services are not offered at this time.

Implementation Guides or Manuals

There are implementation guides or manuals for Adolescent Coping With Depression Course (CWD-A) as listed below:

The CWD-A therapist manual contains several introductory chapters that provide valuable information for implementing the intervention.

Research on How to Implement the Program

Research has not been conducted on how to implement Adolescent Coping With Depression Course (CWD-A).

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Lewinsohn, P. M., Clarke, G. N., Hops, H., & Andrews, J. (1990). Cognitive-behavioral treatment for depressed adolescents. Behavior Therapy, 21, 385-401. doi:10.1016/S0005-7894(05)80353-3

Type of Study: Randomized controlled trial with waitlist
Number of Participants: 59

Population:

  • Age — 14-18 years
  • Race/Ethnicity — Not specified
  • Gender — 61% Female
  • Status — Participants were adolescents meeting criteria for depression.

Location/Institution: Eugene and Portland, Oregon

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this study was to test the efficacy of two versions of Coping with Depression Course for Adolescents (CWD-A) [now called Adolescent Coping with Depression Course (CWD-A)]. Participants were randomly assigned to one of three conditions: Adolescent-and-Parent, Adolescent-Only (CWD-A), and Waitlist. At the conclusion of the 7-8 week waiting period subjects in the waitlist control group completed the postassessment measures and subsequently participated in a CWD-A group. Measures utilized include the Schedule for Affective Disorder and Schizophrenia for School Age Children–Epidemiologic Version (K-SADS-E), the Beck Depression Inventory (BDI), the Center for Epidemiological Studies-Depression Scale (CES-D), the Child Behavior Checklist (CBCL), and the Development of Abbreviated Measures for Adolescent Target Behaviors. Results indicate that both treatment groups significantly improved at posttreatment, with substantial reductions in diagnosis and depression scores and improvement in behaviors targeted by the CWD-A, whereas the waitlist control group improved very little. The proportion of adolescents still meeting diagnosis criteria was significantly reduced at posttreatment and continued to decline over the 24-month follow-up period. Contrary to expectation, there was no difference on the depression measures between treatment groups. Additionally at the 6-month follow-up parents of the Adolescent-Only group continued to become more positive in their CBCL ratings, matching the level of the Parent and Adolescent group. Paralleling these reports was a significant reduction in parent-reported parent-adolescent conflict, from the posttreatment to the 6-month follow-up for both groups. Limitations include small sample size, no control group at postintervention follow-up time points listed below as waitlist group was offered enrollment in a CWD-A group immediately following the postintervention interview, generalizability due to gender of participants, and subjects were actively recruited and did not constitute a representative clinical sample.

Length of postintervention follow-up: 1, 6, 12, and 24 months.

Clarke, G. N., Rohde, P., Lewinsohn, P. M., Hops, H., & Seeley, J. R. (1999). Cognitive-behavioral treatment of adolescent depression: Efficacy of acute group treatment and booster sessions. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 272-279. doi:10.1097/00004583-199903000-00014

Type of Study: Randomized controlled trial
Number of Participants: 123

Population:

  • Age — 14-18 years
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were adolescents with major depression or dysthymia.

Location/Institution: Eugene and Portland, Oregon

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study examined the effects of both acute and maintenance cognitive-behavioral therapy (CBT) for depressed adolescents. Participants were randomly assigned to either Adolescent Coping With Depression Course (CWD-A), (n=45), CWD-A with a separate parent group (n=42), or waitlist control (n=36). Measures utilized include the Schedule for Affective Disorders and Schizophrenia for School Age Children-Epidemiologic (K-SADS-E), the Longitudinal Interval Follow-up Evaluation (LIFE), the Beck Depression Inventory (BDI), the Child Behavior Checklist (CBCL) and the Hamilton Depression Rating Scale (HAM-D). Results indicate that acute CBT groups (CWD-A) yielded higher depression recovery rates than the waitlist and greater reduction in self-reported depression. Outcomes for adolescent-only and adolescent + parent conditions were not significantly different. The booster sessions did not reduce the rate of recurrence in the follow-up period but appearance to accelerate recovery among participants who were still depressed at the end of the acute phase. Limitations include small sample size, high dropout rate for follow-up sessions, and low attendance for booster sessions.

Length of postintervention follow-up: 12 and 24 months.

Clarke, G. N., Hornbrook, M., Lynch, F., Polen, M., Gale, J., Beardslee, W.,...Seeley, J. (2001). A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents. Archives of General Psychiatry, 58(12), 1127-1134.

Type of Study: Randomized controlled trial
Number of Participants: 94

Population:

  • Age — 13-18 years
  • Race/Ethnicity — Control group: 8.5% Minority; Treatment group: 10% Minority
  • Gender — Not specified
  • Status — Participants were depressed children of depressed parents recruited through the family’s health maintenance organization (HMO) physician.

Location/Institution: Oregon

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study uses the same initial group of families and the same assessments as Clarke et al. (2002). Adolescent children of depressed parents, who were determined to have depression scores of medium severity by clinical interview and by the Center for Epidemiological Studies—Depression Scale (CES-D) were randomly assigned to receive a 15-session version of the Coping with Depression for Adolescents Course (CWD-A) or to care as usual. Analysis showed improved scores on the CES-D and the Global Assessment of Functioning Scale (GAF) scales for the CWD-A group in comparison with care as usual, with the comparison group being over 5 times more likely to develop depression at one year. However, the authors note that the protective effect of treatment was no longer significant at two years.

Length of postintervention follow-up: 2 years.

Clarke, G. N., Hornbrook, M., Lynch, F., Polen, M., Gale, J., O’Connor, E., ... Debar, L. (2002). Group cognitive-behavioral treatment for depressed adolescent offspring of depressed parents in a health maintenance organization. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 305-313. doi:10.1097/00004583-200203000-00010

Type of Study: Randomized controlled trial
Number of Participants: 123

Population:

  • Age — Youth: 13-18 years, Parents: 30-65 years
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were adolescents whose parents with diagnosed with major depression or dysthymia.

Location/Institution: Kaiser Permanente, Portland, Oregon

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study examined the effectiveness of group cognitive-behavioral therapy (CBT) for depressed adolescent offspring of depressed parents in a health maintenance organization (HMO). Participants were randomly assigned to either usual HMO care (n = 47) or usual care plus a 16-session Adolescent Coping With Depression Course (CWD-A, n = 41). Measures utilized include the Family Schedule for Affective Disorders and Schizophrenia (F-SADS), the Schedule for Affective Disorders and Schizophrenia for School Age Children-Epidemiologic (K-SADS), the Center for Epidemiologic Studies-Depression Scale (CES-D), the Child Behavior Checklist (CBCL) and the Hamilton Depression Rating Scale (HAM-D). Results indicate that there were no significant advantages of the CWD-A program over usual care for depression diagnoses, continuous depression measures, nonaffective measures, or functioning outcomes. Limitations include small sample size, study would be hard to duplicate due to selection process, and generalizability due to ethnicity, and age of participants.

Length of postintervention follow-up: 12 and 24 months.

Rohde, P., Clarke, G. N., Mace, D. E., Jorgensen, J. S., & Seeley, J. R. (2004). An efficacy/effectiveness study of cognitive-behavioral treatment for adolescents with comorbid major depression and conduct disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 660-668. doi:10.1097/01.chi.0000121067.29744.41

Type of Study: Randomized controlled trial
Number of Participants: 93

Population:

  • Age — 13-17 years
  • Race/Ethnicity — 75 White
  • Gender — 45 Female
  • Status — Participants were adolescents meeting criteria for major depression disorder and conduct disorder.

Location/Institution: Department of Youth Services of Lane County, Oregon

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study evaluated the effectiveness of the Adolescent Coping With Depression Course (CWD-A) with nonincarcerated adolescents. Participants were randomly assigned to either CWD-A or a life skills/tutoring control condition. Measures utilized include the Schedule for Affective Disorder and Schizophrenia for School Age Children–Epidemiologic Version 5 (K-SADS-E-5), the Longitudinal Interval Follow-up Evaluation (LIFE), the Beck Depression Inventory II (BDI-II), the Children’s Global Adjustment Scale, the Social Adjustment Scale–Self-Report for Youth, the Child Behavior Checklist (CBCL) and the Hamilton Depression Rating Scale (HAM-D). Results indicate that major depressive disorder recovery rates posttreatment were greater in CWD-A compared with life skills/tutoring control. CWD-A participants reported greater reductions in BDI-II and HAM-D scores and improved social functioning post-treatment. Group differences in major depressive disorder recovery rates at 6- and 12-month follow-up were nonsignificant, as were differences in conduct disorder both posttreatment and during follow-up. Limitations include small sample size, retrospective recall may have been compromised, and unable to differentiate condition from therapist effects, may not generalize to other racial/ethnic groups or to the broader population of depressed adolescents with comorbid conduct disorder and other psychiatric disorders, and randomization process resulted in unequal gender representation in the two conditions.

Length of postintervention follow-up: 6 and 12 months.

Clarke, G. N., Debar, L., Lynch, F., Powell, J., Gale, L., O’Connor, E., … Hertert, S. (2005). A randomized effectiveness trial of brief cognitive-behavioral therapy for depressed adolescents receiving antidepressant medication. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 888-898. doi:10.1016/S0890-8567(09)62194-8

Type of Study: Randomized controlled trial
Number of Participants: 152

Population:

  • Age — Youth: 12-18 years, Parents: 30-65 years
  • Race/Ethnicity — Not specified
  • Gender — Youth: 78% Female, Parent: 92% Female
  • Status — Participants were diagnosed with major depression.

Location/Institution: Kaiser Permanente Northwest Region, Portland, Oregon

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study examined the effectiveness of collaborative-care, cognitive-behavioral therapy (CBT) program adjunctive to selective serotonin reuptake inhibitor (SSRI) treatment in health maintenance organization (HMO) pediatric primary care. Participants were randomly assigned to either treatment-as-usual (TAU) control condition consisting primarily of SSRI medication delivered outside the experimental protocol (n = 75) versus TAU SSRI plus brief CBT (adult and Adolescent Coping With Depression Course [CWD-A], n = 77). Measures utilized include the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL), the Short Form-12 Mental Component Scale, the Social Adjustment Scale-Self Report for Youth, the Child Behavior Checklist (CBCL), the Center for Epidemiological Studies–Depression Scale (CES-D), the Hamilton Depression Rating Scale (HAM-D), the Youth Self-Report (YSR), and the Children’s Global Adjustment Scale. Results indicate CBT advantages on the Short Form-12 Mental Component Scale, reductions in TAU outpatient visits, and days’ supply of all medications. No effects were detected for major depressive disorder episodes; a nonsignificant trend favoring CBT was detected on the CES-D. Limitations include attrition at the latter follow-up points, telephone administration of self-report measures may have yielded different results than if those instruments had been completed privately by participants, and outcomes are not reported per treatment program therefore cannot determine which program had effect on participants.

Length of postintervention follow-up: 12 and 24 months.

Rohde, P., Waldron, H. B., Turner, C. W., Brody, J., & Jorgensen, J. (2014). Sequenced versus coordinated treatment for adolescents with comorbid depressive and substance use disorders. Journal of Consulting and Clinical Psychology, 82, 342-348. doi:10.1037/a0035808

Type of Study: Randomized controlled trial
Number of Participants: 170

Population:

  • Age — 13-18 years
  • Race/Ethnicity — 61% Non-Hispanic White
  • Gender — 22% Female
  • Status — Participants were adolescents meeting criteria for major comorbid depressive disorder and substance use disorders.

Location/Institution: Portland, Oregon, and Albuquerque, New Mexico

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study evaluated the effectiveness of three methods of integrating interventions for depression (Adolescent Coping With Depression Course [CWD-A]) and substance use disorders (Functional Family Therapy; FFT), examining (a) treatment sequence effects on substance use and depression outcomes and (b) whether the presence of major depressive disorder (MDD) moderated effects. Participants were randomized to (a) FFT followed by CWD-A (FFT/CWD), (b) CWD-A followed by FFT (CWD/FFT), or (c) coordinated FFT and CWD-A (CT). Measures utilized include the Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and Life Version (K-SADS-PL), the Children’s Depression Rating Scale–Revised (CDRS–R), and the Timeline Followback Interview (TLFB). Results indicate that FFT/CWD achieved better substance use outcomes than CT at posttreatment, and 6- and 12-month follow-ups; substance use effects for CWD/FFT were intermediate. For participants with baseline MDD, the CWD/FFT sequence resulted in lower substance use than either FFT/CWD or CT. Depressive symptoms decreased significantly in all 3 treatment sequences with no evidence of differential effectiveness during or following treatment. Attendance was lower for the second of both sequenced interventions. A large proportion of the sample received treatment outside the study, which predicted better outcomes in the follow-up. Limitations include lack of control group, the CWD-A intervention was modified for use with this populations, and specific outcomes not reported for each intervention.

Length of postintervention follow-up: 6 and 12 months.

The following studies were not included in rating CWD-A on the Scientific Rating Scale...

Clarke, G. N., Hawkins, W., Murphy, M., Sheeber, L. B., Lewinsohn, P. M., & Seeley, J. R. (1995). Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: A randomized trial of a group cognitive intervention. Journal of the American Academy of Child and Adolescent Psychiatry, 34(3), 312-321.

Note: This study was not used in rating the Adolescent Coping with Depression Course (CWD-A) since it used a modification of the program. This study attempted to prevent unipolar depressive episodes in high school adolescents with an elevated risk of depressive disorder utilizing a modification of CWD-A. High school students in health classes were screened for depression using the Center for Epidemiological Studies—Depression Scale (CES-D) and those with elevated scores underwent a diagnostic interview. Students diagnosed with current depression were referred to services. The remaining at-risk group was randomly assigned to receive preventive treatment, or to care as usual. Participants were re-evaluated for depression at 6 and 12 months. Results showed that 14.5% of the intervention group and 25.7% of the care-as-usual group had incidences of affective disorders during the follow-up period according to diagnostic interview data, although scores on the CES-D, and the Hamilton Depression Rating Scale did not show a difference, possibly due their use only at isolated points in time.

References

Lewinsohn, P. M., & Rohde, P. (1993). The cognitive-behavioral treatment of depression in adolescents: Research and suggestions. The Clinical Psychologist, 46, 177-183.

Rohde, P., Lewinsohn, P. M., Clarke, G. N., Hops, H., & Seeley, J. R. (2005). The Adolescent Coping With Depression Course: A cognitive-behavioral approach to the treatment of adolescent depression. In E. D. Hibbs & P. S. Jensen (Eds.), Psychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice (2nd ed., pp. 219-238). Washington DC: APA.

Rohde, P. (in press). Cognitive behavioral treatment for adolescent depression. In J. R. Weisz & A. E. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents (3rd ed.). New York: Guilford Press.

Contact Information

Name: Paul Rohde, PhD
Agency/Affiliation: Oregon Research Institute
Website: www.ori.org
Email:
Phone: (541) 484-2123
Fax: (541) 484-1108

Date Research Evidence Last Reviewed by CEBC: December 2016

Date Program Content Last Reviewed by Program Staff: April 2017

Date Program Originally Loaded onto CEBC: April 2017