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Randomized Controlled Trial
. 2014 Apr;82(2):202-11.
doi: 10.1037/a0035718. Epub 2014 Feb 3.

Social problem solving among depressed adolescents is enhanced by structured psychotherapies

Laura J Dietz  1 , Michael P Marshal  1 , Chad M Burton  1 , Jeffrey A Bridge  2 , Boris Birmaher  1 , David Kolko  1 , Jamira N Duffy  3 , David A Brent  1
Affiliations
Randomized Controlled Trial

Social problem solving among depressed adolescents is enhanced by structured psychotherapies

Laura J Dietz et al. J Consult Clin Psychol. 2014 Apr.

Abstract

Objective: Changes in adolescent interpersonal behavior before and after an acute course of psychotherapy were investigated as outcomes and mediators of remission status in a previously described treatment study of depressed adolescents. Maternal depressive symptoms were examined as moderators of the association between psychotherapy condition and changes in adolescents' interpersonal behavior.

Method: Adolescents (n = 63, mean age = 15.6 years, 77.8% female, 84.1% White) engaged in videotaped interactions with their mothers before randomization to cognitive behavior therapy (CBT), systemic behavior family therapy (SBFT), or nondirective supportive therapy (NST) and after 12-16 weeks of treatment. Adolescent involvement, problem solving, and dyadic conflict were examined.

Results: Improvements in adolescent problem solving were significantly associated with CBT and SBFT. Maternal depressive symptoms moderated the effect of CBT, but not SBFT, on adolescents' problem solving; adolescents experienced increases in problem solving only when their mothers had low or moderate levels of depressive symptoms. Improvements in adolescents' problem solving were associated with higher rates of remission across treatment conditions, but there were no significant indirect effects of SBFT on remission status through problem solving. Exploratory analyses revealed a significant indirect effect of CBT on remission status through changes in adolescent problem solving, but only when maternal depressive symptoms at study entry were low.

Conclusions: Findings provide preliminary support for problem solving as an active treatment component of structured psychotherapies for depressed adolescents and suggest one pathway by which maternal depression may disrupt treatment efficacy for depressed adolescents treated with CBT.

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Figures

Figure 1
Figure 1
An illustration of planned analyses for hypotheses testing. 1 Each structured psychotherapy is represented by a dummy-coded variables: a) CBT or (b) SBFT, compared to those adolescent who received NST. 2 Three observed indices of adolescents’ interpersonal behavior were assessed during interactions with mothers before and after treatment: adolescent involvement, adolescent problem solving, and dyadic conflict. Changes in adolescents’ interpersonal behavior were estimated by controlling for pre-treatment behavior in regression models. 3 Path c represents the association between each structured psychotherapy and adolescent remission status at post treatment; Path c′ represents the indirect effects of each structured psychotherapy on adolescent remission status through changes in each adolescent interpersonal behavior (involvement, problem solving, dyadic conflict).
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