Effectiveness of outpatient cognitive-behavioral therapy for adolescents under routine care conditions on behavioral and emotional problems rated by parents and patients: an observational study

Abstract

Few studies have examined the effectiveness of outpatient cognitive-behavioral therapy (CBT) delivered in routine care settings for children and adolescents with mental disorders. This observational study examined changes in behavioral and emotional problems of adolescents with mental disorders during routine outpatient CBT delivered at a university outpatient clinic and compared them with a historical control group of youths who received academic tutoring of comparable length and intensity. Assessments were made at the start and end of treatment (pre- and post-assessment) using parent ratings of the German versions of the Child Behavior Checklist (CBCL) and self-ratings of the Youth Self-Report (YSR) scale. For the main analysis, 677 adolescents aged 11‒21 years had complete data. Changes from pre- to post-assessment showed significant reductions in mental health problems on both parent- and self-ratings. Pre- to post-effect sizes (Cohen's d) were small-to-medium for the total sample (d = 0.23 to d = 0.62) and medium-to-large for those adolescents rated in the clinical range on each (sub)scale at the start of treatment (d = 0.65 to d = 1.48). We obtained medium net effect sizes (d = 0.69) for the CBCL and YSR total scores when patients in the clinical range were compared to historical controls. However, a substantial part of the sample remained in the clinical range at treatment end. The results suggest that CBT is effective for adolescents with mental disorders when administered under routine care conditions but must be interpreted conservatively due to the lack of a direct control condition.

Systematic Review and Meta-analysis: Outcomes of Routine Specialist Mental Health Care for Young People With Depression and/or Anxiety

“…A total of 12 publications were excluded because they reported on the same study sample as a publication(s) already included. For example, six publications [55][56][57][58][59][60][61][62][63][64][65][66][67][68] were based on only one study sample; therefore, data from the original paper 55 were included in the final meta-analysis. Seven studies were excluded because additional information was not provided by the corresponding authors on request.…”

The cooperative revolution reaches clinical psychology and psychotherapy: An example from Germany

“…As in the adult clinics, the diagnoses are based on validated struc tured clinical interviews. The results of the questionnaires CBCL/6-18R and YSR/11-18R are comparable with a clinical control group of an outpatient sample in a child and ado lescent psychiatric clinic (Walter et al, 2018). The categorical and dimensional diagnostic assessments as well as the comorbidity rate of almost 50% underline the clinical severity and the breadth of the problems treated in the participating child and adolescent clinics.…”

Übereinstimmung zwischen Eltern und Kind zur kindlichen Psychopathologie und deren Bedeutung für den Therapieerfolg

“…Die ambulante Psychotherapie führt zu einer signifikanten Symptomreduktion, die sich jedoch insbesondere im Elternurteil nicht immer in einem Wert unter dem Cut-off von T = 60 niederschlägt. Dieses Ergebnis steht in Einklang mit Therapieerfolgsmessungen im Rahmen der deutschen Routineversorgung [Walter et al, 2015[Walter et al, , 2018. Da das Ziel der Studie keine generelle Prüfung der klinischen Bedeutsamkeit von Routineversorgung war, sollte in diesem Rahmen die Abnahme von durchschnittlich 7 T-Wertpunkten durchaus als Erfolg gewertet werden.…”