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Programs that Work

Adolescent Coping with Depression Course


Program Info
Program Overview
Program Participants
Evaluation Methods
Key Evaluation Findings
Probable Implementers
Funding
Implementation Detail
Issues to Consider
Example Sites
Contact Information
Available Resources
Bibliography
Last Reviewed

 

Program Info

Outcome Areas
Healthy and Safe Children

Indicators
Children not experiencing anxiety or mood disorders, such as depression

Topic Areas

     Age of Child
       Middle Childhood (9-12)
       Adolescence (13-18)
     Type of Setting
       Middle School
       High School
       Community-Based Service Provider
       Health Care Provider
     Type of Service
       Health Care Services
       Health Education
       Youth Development
     Type of Outcome Addressed
       Mental Health

Evidence Level  (What does this mean?)
Proven

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Program Overview

The Adolescent Coping with Depression Course (CWD-A) is a skills-based small-group treatment program for actively depressed adolescents. The intervention consists of 16 sessions delivered over a period of eight weeks, with six monthly continuation sessions. Adolescents are taught several skills hypothesized to relieve depression, including assertiveness, relaxation skills, cognitive restructuring techniques, mood monitoring, increasing pleasant activities, and communication and conflict-resolution techniques. A parent component helps keep parents aware of what their teens are learning in the program regarding general topics discussed, skills taught, and the rationale for their use.

CWD-A has been adapted for adolescents at risk for depression (not currently depressed); that program, the Coping with Stress Course, is also listed as a Proven Program.

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Program Participants

Adolescents with depression symptoms

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Evaluation Methods

Seven studies of CWD-A meet the PPN inclusion criteria.

Kahn et al. (1990) studied the effects of the CWD-A program in a sample of 6th-to-8th-grade students from a large suburban middle school in Utah. A school-wide self-report screening for depression was administered, using an adapted version of the Children's Depression Inventory (CDI) and the Reynolds Adolescent Depression Scale (RADS). One hundred eighty-six students (14.4 percent) scored above the predetermined cutoffs for having depression. To rule out situational or transitory mood disorders, assessment procedures were repeated one month after the initial screening. At the reassessment, 110 students (59 percent) met the criteria for depression. Seven students did not obtain consent to participate and nine students left the study school, leaving a total of 94 students. These students were assessed on a structured interview, the Bellevue Index of Depression (BID), and 79 students met BID cutoff scores for depression. Six of these students moved out of the study area, two were excluded for receiving concurrent outpatient psychological/psychiatric services, and three did not receive parental consent. The final sample was 68 students, who were randomly assigned to one of four groups: (1) CWD-A, (2) relaxation treatment (which involved progressive relaxation skills and basic relaxation training), (3) self-modeling treatment (which involved repeated observation of oneself on edited or rehearsed videotapes showing only desired target behaviors), or (4) a waitlist control group. There were 17 students in each of the four groups. Posttesting on the RADS, CDI, and BID occurred immediately upon completion of the intervention and at a one-month follow-up.

Lewinsohn et al. (1990) studied CWD-A in a sample of 59 Oregon high school students, aged 14-18. A total of 69 adolescents met the inclusion criteria for elevated levels of depression. Participants were randomly assigned to one of three groups: (1) adolescent-only (19 students); (2) adolescent + parent, an identical group for adolescents with their parents enrolled in a separate parent group (21 students); and (3) waitlist control (19 students). Ten students withdrew before or during treatment, leaving a total of 59 study participants (no significant differences were found between completers and noncompleters). When treatment and control groups were compared prior to the intervention, the only significant difference found between groups was that control subjects had a higher average number of siblings than did subjects in the treatment groups. Outcomes were assessed immediately posttreatment and at a one-month and a six-month follow-up. Adolescent outcomes were assessed on the interviewer-rated Schedule for Affective Disorders and Schizophrenia for School-Aged Children, Epidemiological Version (K-SADS-E). Youth self-reports were measured on the Beck Depression Inventory (BDI), the Center for Epidemiological Studies Depression Scale (CES-D), three scales assessing depressogenic cognitions or thoughts, the Pleasant Events Schedule, the Spielberger State Anxiety Questionnaire, and the Issues Checklist (a measure of conflict resolution). Parent reports of their child's behavior problems and depression were assessed on the Child Behavior Checklist (CBCL), and reports of disagreements between parent and teen assessments were measured on the Issues Checklist.

CWD-A was evaluated by Rohde, Lewinsohn, and Seeley (1994) in a sample of 14-to-18-year-old students from Oregon. Students were screened and included if they were diagnosed with major depressive disorder (MDD), without concurrent bipolar disorder, panic disorder, generalized anxiety disorder, alcoholism, conduct disorder, or drug use disorder; without current involvement in other treatment for depression; and without a need for immediate treatment or hospitalization. Eighty-four students met the criteria for inclusion, with a subsequent attrition rate of 22 percent. The average participant age was 16.3 years, 74 percent of the students were female, 99 percent were white, and 49 percent had had a previous episode of MDD. Subjects were randomly assigned to one of three groups: (1) CWD-A for adolescents only (31 students); (2) CWD-A for adolescents with a separate group for parents (29 students); or (3) a waitlist control group (24 students). Analyses were conducted separately for low-severity and high-severity groups with regard to past history of MDD. Outcomes were assessed at posttest on the Hamilton Depression Rating Scale (HAM-D) using a structured interview and adolescent self-reports of depression on the BDI and the CES-D.

The longer-term effects of CWD-A were studied by Clarke et al. (1999) in a sample of 123 adolescents from Oregon. Three hundred thirty-one adolescents aged 14-18 and at least one of their parents participated in a screening interview. Eligible adolescents were determined by the interview to have MDD or dysthymia (moderate depression); a total of 171 adolescents met these criteria. Twenty-seven adolescents were excluded because they exhibited current mania/hypomania, panic disorder, generalized anxiety disorder, conduct disorder, psychoactive substance abuse/dependence, lifetime organic brain syndrome, mental retardation, or schizophrenia, or because they were determined to need immediate, acute treatment. An additional 21 adolescents were excluded for concurrently receiving other treatment for depression. The final sample of 123 adolescents was randomly assigned to one of three groups: (1) CWD-A (45 students), (2) CWD-A with a separate parent group (42 students), or (3) waitlist control (36 students). Of the initial 123 study participants, 27 did not complete the intervention, leaving a total of 96 (37 in the adolescent-only group, 32 in the adolescent + parent group, and 27 in the control group). Attrition was not significantly related to experimental group, demographic characteristics of adolescents, intake diagnosis of MDD versus dysthymia, intake BDI or HAM-D scores. Of the 96 adolescents, 71 percent were female, and the adolescents has had a mean age of 16.2 years. The three experimental groups did not differ significantly on any of the demographic or baseline outcome variables. Immediately after posttest assessment, participants completing the CWD-A groups were randomly reassigned to one of three groups for the two-year follow-up period: (1) booster sessions plus assessments every four months (24 students), (2) assessments only every four months (16 students), or (3) assessments only once per year (24 students). At posttest and follow-up, outcomes were measured on the K-SADS-E interview, the HAM-D interview, the interviewer-rated Global Assessment of Functioning Scale (GAF), the adolescent-reported BDI, and the parent-reported CBCL scales.

Clarke and colleagues (2002) evaluated CWD-A in a sample of depressed youths with depressed parents in a health maintenance organization (HMO). The sampling frame consisted of approximately 410,000 members enrolled in a Kaiser Permanente Northwest HMO, around Portland, Oregon. Recruitment letters were sent to parents of offspring ages 13-18 who had a documented diagnosis of depression. Introductory study letters signed by each parent's treating physician were mailed to 2,995 adults. Of these families, 2,514 declined or were not reached before the baseline assessment. Four hundred sixty-three youth completed the baseline assessment but were not randomized, for reasons such as the family was not eligible, the youth was categorized as "resilient," or the youth declined. In the final sample, 88 eligible adolescents aged 13-18 who met current Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria for major depression and/or dysthymia were randomly assigned to either usual HMO behavioral health care (47 adolescents) or usual care plus CWD-A (41 adolescents). Assessments were conducted immediately posttreatment (86 youths), at 12-month follow-up (80 youths), and at 24-month follow-up (73 youths). At baseline, the treatment and control groups did not differ with respect to rates of current and past psychiatric disorder, the amount of "usual care" mental health and general health care services consumed during any phase of the day, or on any other key demographic, depression severity, functioning, or psychological measures. Outcomes were assessed via the K-SADS interview, the HAM-D interview, the interviewer-rated GAF scale, parent reports on the CBCL, and parent and youth reports on the CES-D scale.

Rohde et al. (2004) assessed the effects of CWD-A in a sample of 93 adolescents aged 13-17. All adolescents were under the supervision of an intake, probation, or parole officer and were not incarcerated at the time of entry into the study. Referred adolescents were screened for depression, and 93 adolescents meeting DSM-IV criteria for MDD and conduct disorder were randomly assigned to either CWD-A (45 youth) or a life skills intervention (48 youth). The life skills intervention consisted of training in life skills, such as filling out a job application and an application for renting an apartment, and academic tutoring. A comparison of baseline demographic and clinical characteristics (including current and past episodes of psychiatric disorders and treatment) found that the only significant difference between groups was gender; the CWD-A group had significantly more female participants than the Life-Skills/Tutoring condition (60 percent versus 38 percent). Participants were assessed posttreatment and at 6- and 12-month follow-up. Outcomes were assessed on the Longitudinal Interval Follow-Up Evaluation (LIFE) interview, the K-SADS-E-5 interview, the HAM-D interview, the interviewer-rated Children's Global Adjustment Scale, the self-reported Social Adjustment Scale, the self-reported BDI, the parent-reported CBCL scales, and youth criminal records.

Finally, Garber et al. (2009) conducted a trial of CWD-A across four major U.S. cities in which 316 youth were randomly assigned to CWD-A or usual care. Adolescents were required to be between aged 13-17 and have current depressive symptoms (score of 20 or higher on CES-D) or a prior episode of a DSM-IV depressive disorder. They were also required to have at least one parent who had experienced one episode of MDD during the past three years, or three or more years in a depressive state in their lifetime. Depressive episodes for parents and youth were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I).

The CWD-A intervention consisted of eight weekly 90-minute treatment sessions (the "acute" phase) and six monthly follow-up sessions (the "continuation" phase). Study outcomes were assessed prior to intervention, post-acute phase, and post-continuation phase. The primary study outcome was rate of subsequent depressive episodes, as diagnosed by clinical interviewers using the Depression Symptom Rating (DSR) scale from the LIFE Secondary outcomes included depression symptom ratings using the CES-D and Children's Depression Rating Scale-Revised (CDRS-R). There were no significant differences across treatment groups on any demographic or clinical characteristic at baseline.

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Key Evaluation Findings

The study of 68 Utah middle school students by Kahn et al. (1990) found the following:

  • Outcomes supported the efficacy of all three treatment groups (CWD-A, relaxation, and self-modeling) compared with the control group. Posttest scores on the self-reported RADS and CDI measures and on the BID interview showed that the majority of students in the CWD-A and relaxation groups moved from the dysfunctional to the functional range and remained there at the one-month follow-up. More specifically,
    • RADS: 88 percent of CWD-A, 65 percent of relaxation, and 70 percent of self-modeling students moved from the dysfunctional to the functional range at posttest. At one-month-follow-up, 88 percent of CWD-A, 65 percent of relaxation, and 50 percent of self-modeling students remained in the functional range.

    • CDI: 88 percent of CWD-A, 76 percent of relaxation, and 59 percent of self-modeling students were in the functional range at posttest. At one-month follow-up, 76 percent of CWD-A, 65 percent of relaxation, and 44 percent of self-modeling students remained in the functional range.

    • BID: 76 percent of CWD-A, 65 percent of relaxation, and 59 percent of self-modeling students had moved from the dysfunctional to the functional range at posttest. (No one-month follow-up interviews were conducted).

  • Students in the control group showed much lower rates of gains from pretest to posttest, with 81 percent of control students continuing to show significant levels of depressive symptomatology on the RADS, 88 percent showing dysfunctional outcomes on the CDI, and 81 percent showing dysfunctional outcomes on the BID.


Lewinsohn et al. (1990) reported that, immediately following the intervention,
  • 52 percent of the adolescent + parent teens and 57 percent of the Adolescent-Only teens still met diagnostic criteria for depression on the K-SADS-E; in contrast, there was little change in the control condition, with 95 percent of teens meeting diagnostic criteria. When the two treatment groups were pooled, they were found to have significantly lower rates of depression compared with the control group. Analyses showed no significant differences between the two treatment conditions on the K-SADS-E.

  • Adolescent depression scores were significantly lower for the pooled treatment group compared with the control group on both the BDI and the CES-D. No significant differences were found between groups for adolescent reports of conflict on the Issues Checklist.

  • No significant differences were found between pooled treatment and control groups for parent-reported CBCL scales or parent reports on the Issues Checklist.

  • When the two treatment groups were compared, parents in adolescent + parent condition reported significantly lower problem scores for their children on the CBCL scales than did parents in the adolescent-only condition. No differences were found between the groups on the parent-reported Issues Checklist, and no differences were found between groups on any of the adolescent measures.

  • No significant differences were found among groups for anxiety, participation in pleasant activities, or depressogenic thoughts.

  • Treatment effects were assessed for the adolescent + parent and adolescent-only groups at one- and six-month follow-up. Results indicated the following:
    • There were no significant differences between groups for any of the adolescent variables, including the CES-D, the BDI, and the Issues Checklist.

    • Following the initial posttest, the adolescent-only group continued to show improved parent ratings on the CBCL scales, eliminating any significant differences between the two treatment groups by the six-month follow-up.


The study by Rohde, Lewinsohn, and Seeley (1994) found the following:
  • No significant program effects were evident for the low-severity group.

  • The contrast between the high-severity treatment group and the control group was statistically significant for adolescent reports of depression on the BDI.

  • Marginally significant differences between the treatment and control group were found for the adolescent-reported CES-D depression scale and the interviewer-rated HAM-D.

  • No significant differences between the adolescent-only and the adolescent+ parent treatment groups were found for any measures.


Clarke et al. (1999) reported the following:
  • Recovery from depression was defined as no longer meeting DSM-III-R criteria for either major depression or dysthymia for the two weeks following the posttest. Results indicated that the two active treatments groups had significantly better outcomes when compared with controls, and they did not differ significantly from one another. Recovery rates were 65 percent for the adolescent-only group, 69 percent for the adolescent + parent group, and 48 percent for the control group.

  • Compared with the control group, at posttest the combined treatment group was associated with significantly greater reduction in adolescent-reported BDI scores and interviewer-rated GAF scores. Differences in scores between the two treatment groups were not significant.

  • At posttest, no significant differences were found between treatment and control groups for the HAM-D interview and the three parent-reported CBCL scales (depression, internalizing behavior, and externalizing behavior).

  • Recurrence to depression was examined among the 46 adolescents in the two active treatment groups who had recovered at posttest. By both 12- and 24-month follow-ups, no significant differences in recurrence rates were found among groups. At 12 months, recurrence rates were 14 percent in the annual assessment group, 0 percent in the four-month assessment group, and 27 percent in the four-month booster plus assessment group. At 24-months, recurrence rates were 23 percent in the annual assessment group, 0 percent in the four-month assessment group, and 36 percent in the four-month booster plus assessment group.

  • In the longitudinal comparison of the booster condition versus the two assessment-only conditions, the only significant effect found was for CBCL externalizing scores, with parents in the booster condition reporting greater reductions in externalizing symptoms over time.

  • When comparisons were made over time between the two assessment-only conditions, a significantly greater score decline was observed among the frequent assessment participants (every four months) for both CBCL depression and internalizing subscales.


The study of children of depressed parents in an HMO (Clarke et al., 2002) found the following:
  • There were no significant differences between the treatment and control groups for depression diagnoses or depression measures, including the CES-D, HAM-D, CBCL internalizing and externalizing scales, or the GAF scale.


Rohde et al.'s (2004) study of youth involved with a county department of juvenile corrections reported the following:
  • Posttest recovery rates for MDD were significantly greater in the CWD-A group than in the Life-Skills/Tutoring group, (39 percent versus 19 percent, respectively). Recovery rates for conduct disorder did not differ significantly between the groups (9 percent versus 17 percent).

  • Compared with the Life-Skills/Tutoring group, the CWD-A treatment was associated with significant improvements on the BDI, the HAM-D interview, and the youth-reported Social Adjustment Scale. No significant differences were found between groups for parent ratings on the CBC, interviewer ratings on the Children's Global Adjustment Scale, or arrest rates.

  • At 6- and 12-month follow-ups, group differences in MDD and conduct disorder recovery rates were not significant. Similarly, no significant differences were found between groups for the BDI, the HAM-D, the Social Adjustment Scale, the CBCL, the Children's Global Adjustment Scale, or arrest rates.


Clarke et al. (2009) found improvements on all primary and secondary measures for CWD-A participants as compared with those who received usual care:
  • Subsequent rates of depressive episodes were lower for those in CWD-A than for those in usual care at the post-continuation follow-up (21.4 percent versus 32.7 percent of participants).

  • Self-reported depressive symptoms declined at a significantly greater rate for CWD-A participants than for those in the control condition. At post-continuation, CES-D scores were 19 percent lower among CWD-A participants versus those in the control group, and CDRS-R scores were 6 percent lower.

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Probable Implementers

Public and private middle and high schools, community-based organizations, hospitals, clinics, after-school programs, and departments of correction.

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Funding

Funding for the majority of the evaluations of CWD-A has been supported by grants from the National Institute of Mental Health.

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Implementation Detail

Program Design

The CWD-A course combines cognitive and behavioral strategies that address the types of problems that commonly characterize depressed individuals (e.g., pessimism, low self-esteem, infrequent engagement in pleasant activities, social withdrawal, anxiety and tension, low social support, and increased conflict). CWD-A is based on the premise that teaching adolescents a variety of coping skills and strategies allows them to counteract the various factors that contribute to their depressive episodes and helps them deal more effectively with the problems they encounter (Rohde et al., 2005).

Curriculum

CWD-A is a group intervention that includes structured intervention sessions, repeated practice of skills, use of rewards and contracts, and homework assignments. The intervention consists of 16 two-hour sessions delivered over eight weeks to groups of 6-10 adolescents, led by one or two therapists trained in the approach. Each participant receives a workbook that provides structured learning tasks, short quizzes, and homework assignments.

Components of the CWD-A course include

  • increasing social skills (training in basic conversational techniques, planning of social activities, and strategies for making friends)

  • increasing pleasant activities (teaching of basic self-change skills, including self-monitoring to establish a baseline, setting realistic goals, developing a plan for behavior change, and self-reinforcement for achieving the goals of their plan)

  • decreasing anxiety (progressive muscle relaxation and deep breathing)

  • reducing depressive cognitions (cartoon strips illustrate depressive thoughts and alternative positive thoughts that may be used to counter them)

  • communication (acquisition of positive behaviors, such as active listening, and the inhibition of nonproductive behaviors, such as accusations)

  • four steps for problem solving: (a) defining the problem without criticism, (b) brainstorming alternative solutions, (c) evaluating and agreeing on a solution, and (d) specifying the agreement, including positive and negative consequences for compliance and noncompliance

  • planning for the future (integration of skills, anticipation of future problems, and development of a life plan and goals).


A parallel group intervention for the parents of depressed adolescents seeks to inform parents of the CWD-A participants to encourage their support and reinforcement of the adolescent's use of skills, and to teach parents communication and problem-solving skills. Parents meet with a separate therapist weekly for two-hour sessions. Two joint sessions are held in the seventh week, during which the adolescents and the parents practice these skills on relevant family issues. Additional workbooks guide parents through these sessions.

Individualized booster sessions are offered at four-month intervals for a two-year period after treatment in an effort to prevent recurrence of depression. After the follow-up assessment, the therapist works with the family and adolescent or the adolescent alone to determine which of the six booster protocols (pleasant events, social skills and communication, relaxation, cognitions, negotiation and problem solving, and maintaining gains and setting goals) would be most appropriate. The booster sessions focus on ways that specific CWD-A skills might be used to cope with the specific problems that the adolescent faces.

Staffing

CWD-A leaders undergo 60 hours of training and have a minimum of a master's degree in a mental health field. Leaders use a detailed therapist's manual to help with program implementation.

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Issues to Consider

This program received a "proven" rating. All seven studies of the Adolescent Coping with Depression Course employed rigorous evaluation methodology, including randomized assignment, and found significant reductions in interviewer-rated, parent-rated, and self-reported depression symptoms for treatment children when compared with those in a control group or alternative treatment group.

The studies by Rohde, Lewinsohn, and Seeley (1994) and Clarke et al. (1999) found no significant benefit of the inclusion of parent sessions to the intervention. These findings were not entirely consistent, as Lewinsohn et al. (1990) reported that at immediate posttest the parent condition reported significantly lower problem scores for CBCL scales than did the adolescent-only condition. However, these differences disappeared by the six-month follow-up.

In addition, the study by Rohde, Lewinsohn, and Seeley (1994) suggests that the effectiveness of CWD-A may be apparent only for seriously depressed adolescents, as no program effects were found for adolescents with a low severity of depression symptoms at baseline. No strong conclusions can be drawn at this point, as this was the only study that compared program effectiveness for adolescents with a low versus high severity of depression symptoms.

The effects of the addition of booster sessions were assessed by Clarke et al. (1999), who found that parents in the booster condition reported greater reductions in CBCL externalizing symptoms than did parents in assessment-only conditions. Again, since only one study to date has assessed the effect of the booster sessions, and no statistically significant differences were found among groups, no strong conclusions regarding booster-session effectiveness can be made.

Another study suggests that psychiatric comorbidity (i.e., the presence of other mental health problems in addition to depression) is generally not a reason to avoid the use of CWD-A for depressed adolescents (Rohde et al., 2001). The authors found that participants who also had anxiety disorders had higher depression measure scores at intake but a greater decrease in scores by posttest. Overall lifetime comorbidity was unrelated to diagnostic recovery from depression, but lifetime substance abuse/dependence was associated with a slower time to recovery. Study participants with attention-deficit and disruptive behavior disorders were more likely to experience depression recurrence post CWD-A treatment.

The Clarke et al. (2009) study also found that among participants with a parent who was currently depressed, CWD-A was not more efficacious than usual care in preventing depressive episodes.

Finally, it should be noted that the program developers served as authors on all but one of the evaluations of CWD-A.

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Example Sites

Multiple major U.S. cities

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Contact Information

Gregory N. Clarke, Ph.D.
Kaiser Permanente Center for Health Research
3800 N. Kaiser Center Dr.
Portland, OR 97227
phone: (503) 335-6673
greg.clarke@kpchr.org

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Available Resources

The Kaiser Permanente Center for Health Research provides free downloads of the CWD-A therapist manual, the CWD-A teen workbook, the CWD-A parent manual, and the CWD-A parent workbook at http://www.kpchr.org/public/acwd/acwd.html.

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Bibliography

Clarke, Gregory N., Mark Hornbrook, Frances Lynch, Michael Polen, John Gale, et.al., "Group Cognitive-Behavioral Treatment for Depressed Adolescent Offspring of Depressed Parents in a Health Maintenance Organization,"  Journal of the American Academy of Child and Adolescent Psychiatry,  Vol. 41, No. 3, 2002, pp. 305-313. 

Clarke, Gregory N., Paul Rohde, Peter M. Lewinsohn, Hyman Hops, and John R. Seeley, "Cognitive-Behavioral Treatment of Adolescent Depression: Efficacy of Acute Group Treatment and Booster Sessions,"  Journal of the American Academy of Child and Adolescent Psychiatry,  Vol. 38, No. 3, 1999, pp. 272-279. 

Garber J., Gregory N. Clarke, V. Robin Weersing, William R. Beardslee, David A. Brent, et.al., "Prevention of Depression in At-Risk Adolescents: A Randomized Controlled Trial,"  Journal of the American Medical Association,  Vol. 301, No. 21, June 3, 2009, pp. 2215-2224. 

Kahn, James S., Thomas J. Kehle, William R. Jenson, and Elaine Clark, "Comparison of Cognitive-Behavioral, Relaxation, and Self-Modeling Interventions for Depression Among Middle-School Students,"  School Psychology Review,  Vol. 19, No. 2, 1990, pp. 196-211. 

Lewinsohn, Peter M., Gregory N. Clarke, Hyman Hops, and Judy Andrews, "Cognitive-Behavioral Treatment for Depressed Adolescents,"  Behavior Therapy,  Vol. 21, 1990, pp. 385-401. 

Rohde, Paul, Gregory N. Clarke, David E. Mace, Jenel S. Jorgensen, and John R. Seeley, "An Efficacy/Effectiveness Study of Cognitive-Behavioral Treatment for Adolescents with Comorbid Major Depression and Conduct Disorder,"  Journal of the American Academy of Child and Adolescent Psychiatry,  Vol. 43, No. 6, 2004, pp. 660-668. 

Rohde, Paul, Gregory N. Clarke, Peter M. Lewinsohn, John R. Seeley, and Noah K. Kaufman, "Impact of Comorbidity on a Cognitive-Behavioral Group Treatment for Adolescent Depression,"  Journal of the American Academy of Child and Adolescent Psychiatry,  Vol. 40, No. 7, 2001, pp. 795-802. 

Rohde, Paul, Peter M. Lewinsohn, and John R. Seeley, "Response of Depressed Adolescents to Cognitive-Behavioral Treatment: Do Differences in Initial Severity Clarify the Comparison of Treatments?"  Journal of Consulting and Clinical Psychology,  Vol. 62, No. 4, 1994, pp. 851-854. 

Rohde, Paul, Peter M. Lewinsohn, Gregory N. Clarke, Hyman Hops, and John R. Seeley, "The Adolescent Coping with Depression Course: A Cognitive-Behavioral Approach to the Treatment of Adolescent Depression," in Euthymia D. Hibbs and Peter S. Jensen, eds.,  Psychosocial Treatments for Child and Adolescent Disorders: Empirically Based Strategies for Clinical Practice,  2nd ed., Washington, D.C.: American Psychological Association, 2005, pp. 219-237. 

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Last Reviewed

March 2013

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