Adolescence - Treatment Flashcards
James et al (2013)
Meta-analysis of 88 studies showed moderate quality evidence for CBT better than passive control in short-term, but when controlling for non-treatment-specific factors such as time in therapy, not a benefit to CBT for adolescents compared to treatment as usual
Ginsburg et al (2011)
Large RCT reported poorer remission rates from CBT for adolescents compared to children, likely caused by different parenting behaviours or other environmental factors uniquely experienced by adolescents
James et al (2020)
Meta-analysis showing no moderation of age on CBT outcomes
Bennett et al (2013)
Criticise previous meta-analysis of CBT effectiveness as mostly bottom-up adaptations of pre-adolescent interventions, and broad ages in RCTs may mask age-related effects
Conducted individual patient data meta-analysis (IPDMA; gold standard) among 4 age brackets from 6-19 (reference of 8-11 as protocols designed for this group) showing no age effects, with sensitivity and power analyses showing this robust
However, no CAMS study (Walkup et al., 2008), addressed by stating it had two different CBT protocols for pre-adolescents vs adolescents, so not controlled test of age effects
Possible reasons for poorer adolescent CBT outcomes (Bennett et al., 2013)
Adolescents take longer than adults and children to habituate to fear extinction which suggests teenagers less responsive to exposures in CBT, a key component
Cognitive immaturity may hamper ability to regulate emotions and process CBT material to engage in treatment
Strivings for autonomy may lead to rejection of help
Supported by Chu et al (2013) who showed adolescents less symptom improvement in early treatment relative to children, despite no differences in symptoms posttreatment
Kendall and Peterman (2015)
Systematic review of studies, assessing the content, background, and outcomes for CBT for adolescent ADs, showing outcomes from RCTs evaluating adolescent-only samples fairly comparable to those from mixed-age samples, showing comparable effectiveness to broad-age meta-analyses (e.g., James et al., 2013 ~60% remission)
Adaptations of CBT - Brief CBT (Kendall and Peterman, 2015)
Only one study assessing effectiveness at time of writing, but specifically with PD, with comparable outcomes to standard CBT
Contrast to brief GPD-CBT for pre-adolescents, which shows much more support in more studies and different testing situations (e.g., Creswell et al., 2023)
Spence et al (2011)
BRAVE-Online - for Teenagers evidence-based, with content, length, and number of sessions replicating clinic-based treatment, incorporating AMS-Ex model as well as parent sessions
115 AD adolescents and parents either BRAVE-Online, clinic based treatment, or control, with posttreatment assessment significantly greater reductions in AD and symptoms for both NET and CLIN compared with WLC, with improvements maintained or further enhanced for both conditions, with minimal differences, at 6mo and 12mo follow-ups > comparable to CAMS (Walkup et al., 2008)
High ratings of treatment credibility from both parents and adolescents, only slightly higher in CLIN (Radez et al., 2017; Reardon et al., 2017)
Spence et al (2011) Criticisms
Waite et al (2019) showed BRAVE-Online to not only not have to include parent sessions, but also not significantly different from waitlist control
Outcomes for both CLIN and NET groups at posttreatment lower than clinic-based therapy (James et al., 2013), and lower remission rates using same intervention when clinic-Internet combined (Spence et al., 2006) > perhaps due to NET less likely to complete all 10 sessions at 12mo follow-up (as compared to Spence et al., 2006), but results over 12mo follow-up showed continued improvement, so perhaps despite lack of completion in NET, clinical outcomes equivalent long-term
No health economics measures
