The relative effectiveness of problem-solving skills on the effectiveness of Cognitive Behavioural Therapy among adolescents with subclinical depressive symptoms

Abstract

Background: Cognitive Behavioral Therapy (CBT) has proven to be effective in preventing and treating depression among adolescents. However, the effect might not be the same for all adolescents. Determining what differentiates those who do versus who do not benefit from CBT is therefore a task of significant importance. The first aim of the study was to determine the relative effectiveness of a problem-solving module on the level of subclinical depressive symptoms, compared to modules focusing on cognitive restructuring, activity scheduling and relaxation training. The second aim of the study was to examine to what extent the level of problem-solving skills pretreatment moderates the relationship between the level of subclinical depressive symptoms pre- and posttreatment, when a problemsolving module is offered. Method: This study is part of the STARr-project, an intervention program which is designed as a randomized controlled trial (RCT) with four parallel conditions (n = 211). In this study, the outcome of the first three sessions of the intervention program were the primary focus. Within each condition, one of four CBT-modules was completed. Results: Adolescents who completed the problem-solving module reported no different levels of subclinical depressive symptoms posttreatment than adolescents who completed one of the three other modules. Besides, the level of subclinical depressive symptoms after a problem-solving module is likely moderated by problem-solving skills pretreatment. Conclusions: A focus on changing the overall problemsolving orientation, including accompanying problem- solving techniques, may reduce subclinical depressive symptoms. Suggestions for future research are discussed.