Initial Test of a Principle-Guided Approach to Transdiagnostic Psychotherapy With Children and Adolescents

Abstract

To address implementation challenges faced by some evidence-based youth psychotherapies, we developed an efficient transdiagnostic approach-a potential "first course" in evidence-based treatment (EBP)-guided by five empirically supported principles of therapeutic change. An open trial of the resulting FIRST protocol was conducted in community clinics. Following a 2-day training, staff practitioners treated 24 clinically referred youths ages 7-15, 50% male, 87% White and 13% Latino, all with the Schedule for Affective Disorders and Schizophrenia for School-Age Children Diagnostic and Statistical Manual of Mental Disorders (4th ed.) anxiety, depressive, or conduct-related disorders, and averaging 2.21 disorders. We evaluated the protocol's (a) feasibility for use in everyday clinical practice (examining therapy process, client engagement, and therapist adherence and competence in using the protocol), (b) acceptability (examining therapeutic alliance and treatment satisfaction by youths, caregivers, and therapists), and (c) potential for clinical benefit (examining treatment outcomes across multiple measures and time points). FIRST scored well on measures of feasibility, acceptability to clients and clinicians, and clinical outcomes, matching or exceeding the corresponding scores in most benchmarking comparisons. Observational coding of sessions showed high levels of protocol adherence (86.6%) and good therapist competence in the evidence-based skills. Weekly assessments throughout treatment showed effect sizes for clinical improvement ranging from .41 to 2.66 on weekly total problems and problems deemed "most important" by caregivers and youths. The FIRST protocol showed evidence of feasibility, acceptability, and clinical benefit when used by practitioners with referred youths treated in community clinics. The findings suggest sufficient potential to justify a full randomized controlled trial of FIRST.

Addressing critical gaps in the treatment of eating disorders

“…Such a treatment would be considered a best‐buy intervention. In particular, transdiagnostic treatments help solve the “too many empirically supported treatments problem" (Weisz et al, ) (p. 58) and have the advantage of having greater clinical range and thus more practicality, which may enhance adoption by therapists (Weisz et al, ). In that sense, IPT might be considered a best‐buy intervention given, as previously mentioned, the ability of this intervention to not only address eating disorders but also a variety of other problems, including depression, anxiety, and post‐traumatic stress disorder (Cuijpers et al, ; Markowitz et al, ; Weissman et al, ).…”

Practitioner Review: Empirical evolution of youth psychotherapy toward transdiagnostic approaches

“…This state of affairs did not appear to make clinicians using FIRST, in our benchmarking trial (Weisz, Bearman et al, 2017), markedly less effective than clinicians who had used MATCH in previous research; but it will be important to be alert to this potential downside of the principle-guided approach in future trials. For example, one trade-off reflected in the approach is that the advantages of a relatively brief conceptually oriented protocol are accompanied by the potential disadvantage that clinicians are given less detailed guidance on exactly what procedures to follow in their therapy sessions.…”

“…FIRST was recently tested in an open benchmarking trial with children and adolescents who had been referred through normal pathways to receive community mental health clinic treatment (Weisz, Bearman et al, 2017). Treatment in the study was provided in the clinic setting by practicing clinicians employed there, who had been trained to use FIRST.…”

Transdiagnostic treatment approaches for greater public health impact: Implementing principles of evidence‐based mental health interventions

“…FIRST is conceptualized as a "first course" in EBT for youth with anxiety, depression, and conduct problems (Weisz, Bearman, et al, 2017;Weisz, Kuppens, et al, 2017). FIRST was structured around five broad empirically supported principles underlying evidence-based practices among youth: (a) Feeling calm (engaging in relaxation and calming activities), (b) Increasing motivation (managing contingencies in the environment to make adaptive behavior more rewarding), (c) Repairing thoughts (identifying and changing maladaptive cognitions), (d) Solving problems (building problem-solving skills including goal-setting and generating solutions), and (e) Trying the opposite (engaging in activities that are the opposite of the behavioral problem; Weisz, Bearman, et al, 2017;Weisz, Kuppens, et al, 2017). FIRST was structured around five broad empirically supported principles underlying evidence-based practices among youth: (a) Feeling calm (engaging in relaxation and calming activities), (b) Increasing motivation (managing contingencies in the environment to make adaptive behavior more rewarding), (c) Repairing thoughts (identifying and changing maladaptive cognitions), (d) Solving problems (building problem-solving skills including goal-setting and generating solutions), and (e) Trying the opposite (engaging in activities that are the opposite of the behavioral problem; Weisz, Bearman, et al, 2017;Weisz, Kuppens, et al, 2017).…”