Primary and Secondary Control Enhancement Training (PASCET)

Scientific Rating:
2
Supported by Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Primary and Secondary Control Enhancement Training (PASCET) has been rated by the CEBC in the area of: Depression Treatment (Child & Adolescent).

Target Population: Children and adolescents aged 8-15 who are depressed

For children/adolescents ages: 8 – 15

For parents/caregivers of children ages: 8 – 15

Brief Description

PASCET is a structured individual psychotherapy intervention for depression. Treatment sessions and take-home practice assignments are built on research findings concerning cognitive and behavioral features of depression in children and adolescents, and on the two-process model of perceived control and coping. As suggested by that model, children are trained to gain control of their mood by developing skills that will help them cultivate primary control (i.e., changing objective conditions to make them fit their wishes) and secondary control (i.e., changing themselves [e.g., their expectations, interpretations] so as to adjust to objective conditions and thus control their subjective impact). The sessions include within-session exercises and take-home practice (i.e., homework) assignments, guided by an ACT & THINK Practice Book that each child uses throughout the program, and keeps afterward.

Program Goals:

The goals of Primary and Secondary Control Enhancement Training (PASCET) are:

  • Reduction in depressive symptoms
  • Reduction in rates of depressive disorders

Essential Components

The essential components of Primary and Secondary Control Enhancement Training (PASCET) include:

  • PASCET program is based on the two-process model of control and coping. In this model, primary control involves efforts to cope by making objective conditions (e.g., the activities one engages in, the outcome of a sports event, one’s acceptance by others) conform to one’s wishes. In contrast, secondary control involves efforts to cope by adjusting oneself (e.g., one’s beliefs or interpretations of events) to fit objective conditions, so as to influence their subjective impact without altering the events themselves. The model holds that depression may be addressed, in part, by learning to apply primary control to distressing conditions that are modifiable, and secondary control to those conditions that are not. PASCET teaches youths primary control (or ACT) and secondary control (or THINK) skills and general problem solving skills.
  • ACT Skills:
    • Activities that Solve Problems & Activities - Mood Boosters - One session is devoted to teaching the child a systematic way to solve problems using the Problem Solving STEPS. STEPS is an acronym that helps the child remember to:
      • Say what the problem is
      • Think of solutions
      • Evaluate the pros and cons of each solution
      • Pick the solution with the most advantages
      • See if the solution the child picked is working.
      • Another session is devoted to teaching the child that engaging in pleasant activities is a coping strategy he/she can use to improve his/her mood and to helping the child identify a list of activities that can be done alone, can be done with others, use energy, or help someone else.
    • Calm & Confident – Two sessions are devoted to teaching the child to be calm and act confident. In one session, the child is taught that staying calm and relaxing is a good way to relieve stress and tension, and to improve one’s mood. The child is taught deep breathing, progressive muscle relaxation, and guided imagery. In the second session, the child is taught positive self-presentation skills (e.g., eye-contact, posture, tone of voice) and how to present oneself in a more positive way in order to improve interactions with other children and adults. The child is also taught that presenting oneself more positively is an effective way to elicit help and support from others.
    • Talents – One session is devoted to helping the child develop a talent or skill as a way for the child to feel better about him/herself and as a way to enhance his/her mood. The child is taught a specific 4-step plan for developing a new talent or skill and is encouraged to practice the skill.
  • THINK Skills:
    • Think Positive – One session is devoted to identifying, challenging, and changing negative thoughts. The child is taught that one way to control how you feel about a situation is to change your thoughts about the situation, especially when you cannot change the given situation.
    • Help from a Friend – Part of one session is devoted to teaching the child how to seek appropriate social support. The child is encouraged to identify a list of children and adults he/she would feel comfortable talking to about a variety of problems or situations.
    • Identify the Silver Lining – Part of one session is devoted to teaching the child the adage “Every cloud has a silver lining” and helping the child identify the good things (or silver linings) that came from a bad situation (or rain cloud).
    • No Replaying Bad Thoughts – Part of one session is devoted to teaching the child about rumination and how to stop ruminating about an event by distracting oneself with an activity.
    • Keep Thinking – Don’t Give Up! – The remaining sessions are devoted to reviewing the previously learned skills, teaching sequential coping strategies, encouraging pro-active approaches to mood regulation, explaining perseverance, and planning for future challenges.
  • Individual child sessions are complemented by contact with parents in these two forms:
    • An individual parent session is held prior to the first meeting with the child. During this individual parent session, the therapist explains the treatment program and solicits the parent’s perspective on the child’s depression and his/her mood and behavior at home. The therapist also explains the parent’s role in treatment and discusses appropriate ways for the parent to effectively support treatment.
    • At the end of each individual child session, a parent (or both, if available) joins the therapist and child for 10-15 minutes, in which the main points of the day’s session are briefly discussed (excluding information the child does not want to have discussed) and the parent engages in an activity with the child demonstrating the skills. The child’s practice assignment for the upcoming week is described, the parent is encouraged to assist the child with this practice assignment, and a handout including all the above information is given to the parent.
  • As an optional feature, the therapist can make a home visit, to meet the child’s family and learn about the environment where the child lives, and one school visit, to meet the child’s teacher and hear the teacher’s perspective on the child and his/her behavior at school and with peers.

Child/Adolescent Services

Primary and Secondary Control Enhancement Training (PASCET) directly provides services to children/adolescents and addresses the following:

  • Depression

Parent/Caregiver Services

Primary and Secondary Control Enhancement Training (PASCET) directly provides services to parents/caregivers and addresses the following:

  • A child 8-15 years old who is depressed

Delivery Settings

This program is typically conducted in a(n):

  • Outpatient Clinic
  • School

Homework

Primary and Secondary Control Enhancement Training (PASCET) includes a homework component:

Youths complete a homework assignment in their practice book for every primary and secondary control skill they learn. Homework is reviewed at the beginning of the next session.

Languages

Primary and Secondary Control Enhancement Training (PASCET) does not have materials available in a language other than English.

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Therapists will need a private office that is large enough for role-playing and in-vivo exercises
  • The program manual and accompanying ACT & THINK Practice Book, a relaxation CD (provided by program). Optional resources that are helpful in session include: a ball, stickers, bubbles, markers/crayons, paper, Jenga game, desk bell, sunglasses, timer, Tempa-Dots, hula hoop or jump rope, UNO cards, and silly putty.

Minimum Provider Qualifications

A Master's degree in psychology, social work, or a related field

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:

Trainings are scheduled for each group and may occur at Judge Baker Children's Center or the group's organization.

Number of days/hours:

Two days, six-seven hours per day

Additional Resources:

There currently are additional qualified resources for training:

Implementation Information

Since Primary and Secondary Control Enhancement Training (PASCET) 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.

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Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Primary and Secondary Control Enhancement Training (PASCET).

Formal Support for Implementation

There is formal support available for implementation of Primary and Secondary Control Enhancement Training (PASCET) as listed below:

Coaching/consultation in the use of PASCET is available from any of the individuals identified in the Training section above.

Fidelity Measures

There are fidelity measures for Primary and Secondary Control Enhancement Training (PASCET) as listed below:

There is a PASCET fidelity measure that can be used to code therapy session recordings.

Implementation Guides or Manuals

There are no implementation guides or manuals for Primary and Secondary Control Enhancement Training (PASCET).

Research on How to Implement the Program

Research has not been conducted on how to implement Primary and Secondary Control Enhancement Training (PASCET).

Relevant Published, Peer-Reviewed Research

This program is rated a "2 - Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The program must have at least one rigorous randomized controlled trial with a sustained effect of at least 6 months. The article(s) below that reports outcomes from an RCT showing a sustained effect of at least 6 months has an asterisk (*) at the beginning of its entry. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

*Weisz, J. R., Thurber, C., Sweeney, L., Proffitt, V. D., & LeGagnoux, G. L. (1997). Brief treatment of mild-to-moderate child depression using primary and secondary control enhancement training. Journal of Consulting and Clinical Psychology, 65, 703-707.

Type of Study: Randomized controlled trial
Number of Participants: 48

Population:

  • Age — Mean=9.6 years
  • Race/Ethnicity — 30 Caucasian and 18 ethnic minority (primarily African American)
  • Gender — 26 Males and 22 Females
  • Status — Participants were children from 3 elementary schools in Grades 3-6.

Location/Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study examined the effectiveness of Primary and Secondary Control Enhancement Training (PASCET) in ameliorating the mild-to-moderate levels of depression seen in elementary school settings. Participants were randomly assigned to a no treatment control group (n = 32) or an 8-session PASCET program (n = 16). Measures included the Children’s Depression Inventory (CDI), which assesses childhood depression, and the Revised Children’s Depression Rating Scale (CDRS-R), which is a semi-structured interview assessing symptoms such as unhappiness, guilt, and low self-esteem. At immediate post-treatment and 9-month follow-up, the treatment group showed greater reductions than the control group in depressive symptomatology on the CDI and the CDRS-R. The treatment group-control group difference was maintained at 9-month follow-up, and normative comparisons showed that treated children were significantly more likely than control children to shift into the normal range (from the higher range of depression scores) on both depression measures. The lack of participants with severe levels of depression limits the generalizability of the treatment to more severe patients.

Length of postintervention follow-up: 9 months.

*Weisz, J. R., Southam-Gerow, M. A., Gordis, E. B., Connor-Smith, J. K., Chu, B. C., Langer, D. A., …Weiss, B. (2009). Cognitive-behavioral therapy versus usual clinical care for youth depression: An initial test of transportability to community clinics and clinicians. Journal of Consulting and Clinical Psychology, 77, 383-396.

Type of Study: Randomized controlled trial
Number of Participants: 57

Population:

  • Age — 8-15 years
  • Race/Ethnicity — 33% Caucasian, 26% African American, 26% Latino, and 4% nonreported
  • Gender — 56% Female and 44% Male
  • Status — Participants were urban and low-income families; children had depressive disorders and multiple comorbidities.

Location/Institution: Seven urban community mental health clinics

Summary: (To include comparison groups, outcomes, measures, notable limitations)
All youths were randomized to CBT (Primary and Secondary Control Enhancement Training (PASCET) ) or usual care (UC) and treated until normal termination. Measures used included the Children’s Depression Inventory (CDI) (child & parent report), Diagnostic Interview Schedule for Children (DISC) (child & parent report), Child Behavior Checklist (CBCL), Expectations of Therapy Outcome Scale (ETOS), Therapeutic Alliance Scale for Children (TASC) (youth & parent report), Service Assessment for Children and Adolescents (SACA), PASCET Brief Adherence Scale (PBA), and Therapy Process Observational Coding System for Child Psychotherapy—Strategies Scale (TPOCS-S). Session coding showed more use of CBT by PASCET therapists and more psychodynamic and family approaches by UC therapists. At post-treatment, depression symptom measures were at subclinical levels, and 75% of youths had no remaining depressive disorder, but PASCET and UC groups did not differ on these outcomes. However, compared with UC, PASCET was (a) briefer (24 vs. 39 weeks), (b) superior in parent-rated therapeutic alliance, (c) less likely to require additional services (including all psychotropics combined and depression medication in particular), and (d) less costly. The findings showed advantages for PASCET in parent engagement, reduced use of medication and other services, overall cost, and possibly speed of improvement. Limitations included the relatively small sample, with reduced power to detect effects, the heterogeneity of therapists, youth and Usual Care treatments, and the possibility that a Hawthornre effect was present, as there appear to be some differences in the Usual Care condition when compared to historical pre-trial data.

Length of postintervention follow-up: 9 months for usual care, 6 months for intervention group.

References

Bearman, S. K., Ugueto, A., Alleyne, A., & Weisz, J. R. (2010). Adapting CBT for depression to fit diverse youths and contexts: Applying the deployment-focused model of treatment development and testing. In J. R. Weisz, & A. E. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents, (2nd ed.) (pp. 466-481). New York: Guilford.

Bearman, S. K., & Weisz, J. R. (2009). Primary and Secondary Control Enhancement Training (PASCET): Applying the deployment-focused model of treatment development and testing. In C. A. Essau (Ed.), Treatments for adolescent depression: theory and practice (pp. 97-122). Oxford, UK: Oxford University Press.

Connor-Smith, J. K., & Weisz, J. R. (2003). Applying treatment outcome research in clinical practice: Techniques for adapting interventions to the real world. Child and Adolescent Mental Health, 8, 3-10.

Contact Information

Name: John Weisz, PhD
Email:
Phone: (617) 495-3515

Date Research Evidence Last Reviewed by CEBC: January 2017

Date Program Content Last Reviewed by Program Staff: November 2016

Date Program Originally Loaded onto CEBC: December 2010