Components Analysis of a Cognitive Behavioral Therapy Treatment Program for Children and Adolescents with Major Depressive Disorder
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This study examined whether the receipt of specific CBT components in a CBT treatment program, parent or family involvement, and dosage across four domains (i.e., frequency, duration, length, and intensity) were associated with risk of occurrence of relapse among children and adolescents with Major Depressive Disorder (MDD). Children and adolescents aged 8 to 17 with MDD (n=75) completed a continuation phase CBT- focused treatment program after responding to an acute phase pharmacotherapy intervention. Study therapists completed session checklists following each session to document which components were introduced during session, as well as documenting parent/family involvement, and dosage variables (e.g., length of session, etc.). Depression severity was also measured through the CDRS-R, which allowed for measurement of relapse status, which was the outcome variable for the current study. Cox Proportional Hazard Regression Models were utilized to investigate whether two primary components (i.e., Wellness, Relapse-Prevention), dosage, and parent/family involvement were related to hazard of relapse. Inclusion of Wellness and Relapse-Prevention components were not significantly related to risk of relapse. Similarly, parent/family involvement was not significantly related to hazard of relapse. Regarding dosage, however, results indicate that a higher frequency of sessions, as well as a longer period of time over which treatment is delivered (e.g., length) were significantly related to a reduced risk of relapse. However, there was no statistically significant finding regarding risk of relapse based on cumulative number of minutes spent in session. Further, when length of treatment was controlled, an increase in number of weeks that elapse between each session (e.g., intensity) was related to a higher risk of relapse, suggesting that sessions that occur closer to one another are related to a reduced risk of relapse. These findings are congruent with some of the existing research on this subject, and ultimately support the idea that treatment dosage should be measured across several domains (e.g., frequency, duration, length, intensity). Additional research with a larger sample size should be conducted regarding the influence of receipt of specific CBT components as well as parent/family involvement given the lack of statistically significant findings in the current study.