Background:Cognitive-behavioral therapy (CBT) is first choice of treatment for depressive symptoms and disorders in adolescents, however improvements are necessary because overall efficacy is low. Insights on CBT components and contextual and structural characteristics might increase the efficacy. The aim of our approach is to evaluate the efficacy of CBT for youth with depression and investigate the influence of specific components, contextual and structural factors that could improve effects.Methods:A systematic review of randomized controlled trials was conducted, searches were undertaken in CINAHL, CENTRAL, EMBASE, MEDLINE/PubMed and PsycINFO. Outcomes were meta-analyzed and confidence in results was assessed using the GRADE-method. Meta-regression was used to pinpoint components or other factors that were associated with an in- or decrease of effects of CBT.Results:We included 31 trials with 4335 participants. Moderate-quality evidence was found for CBT reducing depressive symptoms at the end of treatment and at follow-up, and CBT as indicated prevention resulted in 63% less risk of being depressed at follow-up. CBT containing a combination of behavioral activation and challenging thoughts component (as part of cognitive restructuring) or the involvement of caregiver(s) in intervention were associated with better outcomes for youth on the long term.Conclusions:There is evidence that CBT is effective for youth with a (subclinical) depression. Our analyses show that effects might improve when CBT contains the components behavioral activation and challenging thoughts and also when the caregiver(s) are involved. However, the influential effects of these three moderators should be further tested in RCTs.

This thesis is submitted by Reham Al Taher in partial fulfilment for the degree of Doctor in Clinical Psychology (DClinPsy) at the University of Birmingham. It contains three chapters.Chapter one of the thesis comprises a literature review: a meta-ethnography exploring personal accounts of the facilitators and barriers to seeking help for First-Episode Psychosis (FEP). The process of the meta-ethnography consisted of extracting, appraising, and synthesizing a total of 15 qualitative and mixed-method empirical studies. The second chapter is a qualitative study using Interpretive Phenomenological Analysis (IPA) to explore how spiritual care staff make sense of experiences otherwise termed as "psychosis". The third and final chapter presents a "press release" of both chapter one and two, outlining its main findings in a manner that is suitable and appropriate for public dissemination.No man is an island and this wouldn't have been possible without so many people's support, encouragement, and guidance. I would like to first thank Dr. Andy Fox -I cannot thank you enough for choosing to be my research supervisor and for taking an interest in this topic.You have been nothing but exceptional. To Carol Wilson, this project would not have gotten off the ground if it wasn't for all of your help, and I always enjoyed our conversations together about spiritual metaphysics. I would like to also express my gratitude to the participants who volunteered to take part in this research project -each and every one of you had so much passion and interest and it gave me the fuel I needed from the beginning to the end. I would like to thank Dr. Shazma Thabusom and Dr. Nick Zygouris for allowing me to pick your brain at the beginning when I was thinking about exploring spirituality and psychosis.You both not only encouraged me to speak to the University about turning this topic into a research project, but also let me know you believed this is worth exploring and that I was capable of doing it.To Dr. Michelle Fisher -you were a constant figure of strength over the past three years.From the day of the doctoral interview to now you have always made me feel emotionally safe and I'm forever grateful for that. To the University of Birmingham, thank you for accepting me onto your doctoral programme -it has been metamorphosizing (and that's putting it lightly!)To my trainee family -being around you felt like having a home away from home. In particular I want to thank Simone, Emily, and Nikita -I've lost track of the amount of times we went through similar experiences, experiences so difficult to articulate that can only be understood if you went through it. Not only did we have shared experiences, but our bond was also filled with support, warmth, and cheerleading each other the past 3 years.To Mama, Baba, Khaled, Ola, Hania, Saif, and Lara -I wouldn't be me without you. I love you and need you forever and I look forward to the day we're all together again. To Omar, Amanda, Barbara, and Sheila -you have always believed that I could do this and ...