Designing and Testing a Family Therapy for Adolescent Depression

Adolescent depression causes persistent feelings of sadness, loss of self-worth,
discouragement, and loss of interest in usual activities. Treatments for adolescent
depression have mixed success, with 25% to 40% of depressed adolescents still experiencing
depressive symptoms at the end of the most effective treatments and gains made in treatment
sometimes fading over time. Research suggests that family processes are associated with the
effectiveness of treatments for adolescent depression and with reducing symptoms over time.
Evidence also shows that treatments developed and tested in a research setting are not
easily applied to community settings. This study will first design a cognitive behavioral
therapy for adolescent depression that will involve the families of the depressed
adolescents and then test the therapy in several settings, including clinics.

Development of this therapy will involve five different groups of participants. Each group
will include both depressed adolescents and a parent or guardian. The first group of
participants will partake in a focus group, in which they will break into two discussion
groups, one of parents and guardians and one of adolescents, that will discuss what kind of
help and information would be useful to them and why they would consider seeing a therapist.

The second group will participate in alpha testing, which will involve receiving the first
version of the therapy. The therapy is anticipated to include 8 to 12 weekly treatment
sessions, with homework assignments to practice their learned skills in everyday life.
Participants in alpha testing will also complete interviews and questionnaires at Week 7 and
at the end of treatment to assess satisfaction with treatment, treatment clarity, and
usefulness of the information and strategies they learned. After alpha testing, the therapy
will be revised based on the feedback received. The third group will participate in beta
testing, which will involve receiving the second version of the therapy and completing the
same assessments as those done by the alpha group.

The fourth group of participants will receive pilot testing of the finalized therapy. This
finalized version will involve 11 to 15 weekly sessions. The fifth group will receive
treatment as usual from a mental health clinic and serve as a control group to compare to
the pilot testing group. Before and after treatment, both of these groups will complete
questionnaires and interviews assessing the effectiveness of their treatment and
questionnaires and observations of family functioning. All sessions throughout the study
involving the newly designed family therapy will be videotaped.

Inclusion Criteria:

- Family with an adolescent between 14 and 18 years of age and at least one parent or
permanent guardian with whom the adolescent resides

- Family's primary concerns include depressive symptoms

- Adolescent has a score above 24 on the Center for Epidemiological Studies-Depression
Scale

- Family will be seeking services at the community mental health center that is
associated with the study

Exclusion Criteria:

- Adolescents presenting with evidence of severe difficulties associated with comorbid
conditions, such that the focus of treatment would need to shift to nonaffective
symptoms

- Adolescents evidencing symptoms of mania or psychoses or with suicidal behaviors
requiring inpatient care

- Adolescents with cognitive limitations of severity that will preclude meaningful
participation in the study