Counseling Outcomes for Youth With Oppositional Behavior: A Meta‐Analysis

This meta‐analysis of clinical trials explored the effectiveness of treatments targeted at changing oppositional behavior. The meta‐analysis included 31 peer‐reviewed treatment studies with school‐age youth ages 6–17 years identified as having oppositional defiant disorder. Results were synthesized using a random effects model for mean difference and mean gain effect size estimates. Findings suggest that counseling/psychotherapy is effective in treating oppositional behavior in school‐age youth at termination, but the long‐term efficacy of such treatment is less stable.     

Choosing Assessment Instruments for Depression Outcome Research With School‐Age Youth

Using effect size results from Erford et al.'s (2011) meta‐analysis for treatment of depression in school‐age youth, the authors analyzed 6 commonly used instruments for practical and technical strengths and weaknesses. Effect size estimates from these 6 instruments were compared to indicate likely results when used in future depression outcome research.     

Six‐month follow‐up of two mother–infant psychotherapies: Convergence of therapeutic outcomes

Fifty‐eight mothers and infants participating in two infant–mother psychotherapeutic interventions in a comparative infant–mother clinical intervention study were followed six months after treatment ended. One treatment was an infant‐led psychotherapy, Watch, Wait, and Wonder (WWW). The other was a more traditional mother–infant psychodynamic psychotherapy (PPT). Infants ranged in age from 10 to 30 months at the outset of treatment, which took place in weekly sessions over approximately five months. Results indicated that positive effects observed from the beginning to the end of treatment in both treatment groups in infant symptoms, parenting stress, and mother–infant interaction were maintained or improved further at six‐month follow‐up. Additionally, decreased maternal depression, gains in infant cognitive development and emotion regulation, and improved infant–mother attachment security or organization had been observed posttreatment only in the WWW group. Interestingly, between the posttreatment to follow‐up period the PPT group also showed such gains. Thus, for these variables it would be more accurate to say that the outcomes were similar for the two treatment groups but change emerged at a different pace. Nevertheless, an advantage persisted in the WWW group in relation to mothers' comfort dealing with infant behaviors and their ratings of parenting stress which improved more in this group from the end of treatment to follow‐up. The direct inclusion of the infant as an initiator in WWW was set forth as an explanation of differentially timed treatment effects. ©2002 Michigan Association for Infant Mental Health.     

Thoughts of Self‐Harm and Help‐Seeking Behavior among Youth in the Community

The association between thoughts of self‐harm and help‐seeking among youth with symptoms of depression was examined. Data were drawn from the Health Behavior of School‐aged Children Study (n = 15, 686), a nationally representative sample of youth in the United States. Analyses focused on comparing help‐seeking behaviors among youth with and without thoughts of deliberate self‐harm (DSH) when depressed. Depressed youth with thoughts of DSH exhibited different patterns of help‐seeking than those without. Both groups most frequently sought help from friends and parents. However, adolescents with thoughts of DSH were statistically more likely than youth without to seek help from friends (DSH: 69.9%; no DSH: 57.8%; AOR = 1.46), but less likely to seek help from parents (DSH: 53.7%; no DSH: 73.1%; AOR = 0.47). Youth with DSH were more likely to seek help from school officials (AOR = 1.05), health professionals (AOR: 1.83), or a counselor (AOR = 1.93) compared with those without thoughts of DSH who were more likely to seek help from a sibling (AOR: 0.77) or other relatives (AOR: 0.78). Results may help inform programs to improve identification of youth at risk of self‐harm in community and school settings.     

Psychotherapy and (or) Medications for Depression in Youth? An Evidence-Based Review with Recommendations for Treatment

This article reviews existing research pertaining to antidepressant medications, psychotherapy, and their combined efficacy in the treatment of clinical depression in youth. Based on this review, we recommend that youth depression and its treatment can be readily understood from a social-psycho-bio model. We maintain that this model presents an alternative conceptualization to the dominant biopsychosocial model, which implies the primacy of biological contributors. Further, our review indicates that psychotherapy should be the frontline treatment for youth with depression and that little scientific evidence suggests that combined psychotherapy and medication treatment is more effective than psychotherapy alone. Due primarily to safety issues, selective serotonin reuptake inhibitors should be initiated only in conjunction with psychotherapy and/or supportive monitoring.     

Reducing the Risk of Internalizing Symptoms among High‐risk Hispanic Youth through a Family Intervention: A Randomized Controlled Trial

Familias Unidas is an intervention that has been found to be efficacious in preventing and reducing substance use, sexual risk, and problem behaviors among Hispanic youth. While it does not specifically target youth internalizing symptoms, the intervention works to strengthen parenting and family factors associated with reduced risk of internalizing symptoms (i.e., depression, anxiety symptoms). This study examines the effects of Familias Unidas on internalizing symptoms among high‐risk youth, as well as the role of family level factors in the intervention's effects. A total of 242 12–17‐year‐old Hispanic youth with a history of delinquency and their primary caregivers were recruited from the school and juvenile justice systems, and randomly assigned to the Familias Unidas intervention or community practice control. A linear latent growth model was used to examine intervention effects on the trajectory of adolescent internalizing symptoms from baseline to 6 and 12 months post‐baseline. Results show that the Familias Unidas intervention was more efficacious than control in reducing youth internalizing symptoms. Baseline youth externalizing and internalizing symptoms did not moderate the intervention's effects on the trajectory of youth internalizing symptoms. While parent – adolescent communication did not significantly moderate the intervention's effects, changes in parent – adolescent communication mediated the intervention's effects on internalizing symptoms, showing stronger intervention effects for youth starting with poorer communication. Findings indicate that the Familias Unidas intervention can reduce internalizing symptoms among high‐risk Hispanic youth, and that improving parent – youth communication, a protective family factor, may be one of the mechanisms by which the intervention influences youth internalizing symptoms.     

Treating Youth Depression and Anxiety: A Randomised Controlled Trial Examining the Efficacy of Computerised versus Face‐to‐face Cognitive Behaviour Therapy

Barriers to accessing psychologists for the treatment of depression and anxiety include a shortage of specialised therapists, long waiting lists, and the affordability of therapy. This study examined the efficacy of a computerised‐based self‐help program (MoodGYM) delivered in‐conjunction with face‐to‐face cognitive behavioural therapy (CBT) to expand the delivery avenues of psychological treatment for young adults (aged 18–25 years). Eighty‐nine participants suffering from depression and/or generalised anxiety were randomly allocated to a control intervention or to one of three experimental groups: receiving face‐to‐face CBT, receiving computerised CBT (cCBT), or receiving treatment in‐conjunction (face‐to‐face CBT and cCBT). While MoodGYM did not significantly decrease depression in comparison to the control group, significant decreases were found for anxiety. MoodGYM delivered in‐conjunction with face‐to‐face CBT is more effective in treating symptoms of depression and anxiety compared with standalone face‐to‐face or cCBT. This study suggests that for youth who are unable to access face‐to‐face therapy—such as those in rural or remote regions, or for communities in which there is stigma attached to seeking help—computerised therapy may be a viable option. This is an important finding, especially in light of the current capacity‐to‐treat and accessibility problems faced by youth when seeking treatment for depression and/or anxiety.     

Effects of psychotherapy for depression in children and adolescents: a meta-analysis

Serious sequelae of youth depression, plus recent concerns over medication safety, prompt growing interest in the effects of youth psychotherapy. In previous meta-analyses, effect sizes (ESs) have averaged .99, well above conventional standards for a large effect and well above mean ES for other conditions. The authors applied rigorous analytic methods to the largest study sample to date and found a mean ES of .34, not superior but significantly inferior to mean ES for other conditions. Cognitive treatments (e.g., cognitive-behavioral therapy) fared no better than noncognitive approaches. Effects showed both generality (anxiety was reduced) and specificity (externalizing problems were not), plus short- but not long-term holding power. Youth depression treatments appear to produce effects that are significant but modest in their strength, breadth, and durability.     

Scaling‐Up Youth‐Led Social Justice Efforts through an Online School‐Based Social Network

The exploration of social networking sites (SNS) in promoting social change efforts offers great potential within the field of community psychology. Online communities on SNS provide opportunities for bridging across groups, thus fostering the exchange of novel ideas and practices. Currently, there have only been limited efforts to examine SNS within the context of youth‐led efforts. To explore the potential of SNS to facilitate the diffusion of social justice efforts between distinct youth groups, we linked three school‐based youth‐led participatory action research projects involving 54 high school students through a SNS. This study offers an innovative methodological approach and framework, utilizing social network analysis and strategic sampling of key student informants to investigate what individual behaviors and online network features predict student adoption of social change efforts. Findings highlight prospective facilitators and barriers to diffusion processes within a youth‐led online network, as well as key constructs that may inform future research. We conclude by providing suggestions for scholars and practitioners interested in examining how SNS can be used to enhance the diffusion of social justice strategies, youth‐led engagement efforts, and large‐scale civic organizing.     

Finding the Sweet Spot: Investigating the Effects of Relationship Closeness and Instrumental Activities in School‐based Mentoring

School‐based mentoring programs are popular prevention programs thought to influence youth development; but rigorous evaluations indicate that these programs often have small effects on youth outcomes. Researchers suggest that these findings may be explained by (a) mentors and mentees failing to develop a close relationship and (b) mentors not setting goals or focusing on specific skills necessary improve outcomes. We assessed these explanations using data from approximately 1360 mentor and mentee pairs collected through a national study of school‐based mentoring (called, “The Student Mentoring Program”). Specifically, we tested the influence of mentee‐reported relationship quality and mentor‐reported use of goal‐setting and feedback‐oriented activities on academic, behavioral, and social‐emotional outcomes. Results suggested that youth reported relationship quality was associated with small to medium effects on outcomes. Moreover, goal‐setting and feedback‐oriented activities were associated with moderate to large effects on outcomes. We also found significant interactions between relationship quality and goal‐setting and feedback‐oriented activities on youth outcomes. We conclude that there appears to be a “sweet‐spot” wherein youth outcomes are maximized. The results of this study suggest a need for school‐based mentoring programs to monitor and support mentors in developing a close relationship while also providing opportunities to set goals and receive feedback.     

The role of self‐image as a predictor of psychotherapy outcome

The present study examined the relationship between self‐image and outcome in psychotherapy. Patients (n = 170) received treatment‐as‐usual at a university clinic, and met diagnostic criteria for mostly anxiety and depression related disorders. Self‐image was measured with the Structural Analysis of Social Behavior (SASB‐I) introject pre and post‐treatment. Using multiple regression analyses, higher levels of Self‐ignore and Self‐blame pre‐treatment predicted a poorer treatment outcome in terms of symptoms (SCL‐90‐R) and interpersonal problems (IIP‐64), respectively. Increase in Self‐love and decrease in Self‐blame (pre to post) predicted reduced symptoms at post‐treatment, whereas decrease in Self‐attack and Self‐control, as well as increase in Self‐affirm, predicted reduced interpersonal problems. The results suggest that self‐image improvement may be important in order to achieve a good outcome in psychotherapy.     

The association between stress,self‐esteem and depressive symptoms in adolescents

This cross‐sectional study investigated gender and age differences on domains of stress, self‐esteem and depressive symptoms, as well as the association between those domains using a sample of Norwegian adolescents (N = 1,239). The data was analysed using Pearson product moment correlation, t‐tests, and hierarchical multiple regression analyses. The results showed significant differences between genders. Girls scored higher on five of seven stressor domains comprising peer pressure, home life, school attendance, school/leisure conflict and school performance as well as depression, while boys scored significantly higher on self‐esteem. The hierarchical multiple regression analysis showed that higher stress from school performance and school attendance related significantly to more depressive symptoms in both genders. Additionally, stress of home life significantly related to more depressive symptoms in girls, whereas stress of peer pressure was significant in association with depressive symptoms in boys. A strong, inverse association was found between self‐esteem and depression controlled for stress, especially in girls. Self‐esteem was not found to be a moderator of any stressor‐depression interactions. In conclusion, the results give support for the significant role of stress and self‐esteem on the experience of depressive symptoms in adolescents.     

School absenteeism and mental health among sexual minority youth and heterosexual youth

Adolescent school absenteeism is associated with negative outcomes such as conduct disorders, substance abuse, and dropping out of school. Mental health factors, such as depression and anxiety, have been found to be associated with increased absenteeism from school. Sexual minority youth (youth who are attracted to the same sex or endorse a gay, lesbian, or bisexual identity) are a group at risk for increased absenteeism due to fear, avoidance, and higher rates of depression and anxiety than their heterosexual peers. The present study used longitudinal data to compare sexual minority youth and heterosexual youth on excused and unexcused absences from school and to evaluate differences in the relations between depression and anxiety symptoms and school absences among sexual minority youth and heterosexual youth. A total of 108 14- to 19-years-old adolescents (71% female and 26% sexual minority) completed self-report measures of excused and unexcused absences and depression and anxiety symptoms. Compared to heterosexual youth, sexual minority youth reported more excused and unexcused absences and more depression and anxiety symptoms. Sexual minority status significantly moderated the effects of depression and anxiety symptoms on unexcused absences such that depression and anxiety symptoms were stronger predictors of unexcused absences for sexual minority youth than for heterosexual youth. The results demonstrate that sexual minority status and mental health are important factors to consider when assessing school absenteeism and when developing interventions to prevent or reduce school absenteeism among adolescents.     

Effects of school‐based mindfulness training on emotion processing and well‐being in adolescents: evidence from event‐related potentials

In a non‐randomized controlled study, we investigated the efficacy of a school‐based mindfulness curriculum delivered by schoolteachers to older secondary school students (16–18 years). We measured changes in emotion processing indexed by P3b event‐related potential (ERP) modulations in an affective oddball task using static human faces. ERPs were recorded to happy and sad face oddballs presented in a stimulus stream of frequent faces with neutral expression, before and after 8 weeks of mindfulness training. Whilst the mean amplitude of the P3b, an ERP component typically elicited by infrequent oddballs, decreased between testing sessions in the control group, it remained unchanged in the training group. Significant increases in self‐reported well‐being and fewer doctor visits for mental health support were also reported in the training group as compared to controls. The observed habituation to emotional stimuli in controls thus contrasted with maintained sensitivity in mindfulness‐trained students. These results suggest that in‐school mindfulness training for adolescents has scope for increasing awareness of socially relevant emotional stimuli, irrespective of valence, and thus may decrease vulnerability to depression.     

Depression and Anxiety in Older and Middle‐aged Adults With Diabetes

This study aims to compare rates of depressive and anxious symptoms among older adults with and without diabetes. The study also examines differences in depression, anxiety, and diabetes‐related emotional distress between middle‐aged and older adults with diabetes. A total of 224 participants completed a range of questionnaires measuring depression, anxiety, and diabetes‐related emotional distress (if applicable). One hundred and three adults with diabetes (55 middle‐aged, mean age = 47 years, range 40–59 years and 48 older, mean age = 69 years, range 60–81 years) were recruited from a tertiary diabetes clinic. One hundred and twenty‐one adults without diabetes (72 middle‐aged, mean age = 52 years, range 40–59 years and 49 older, mean age = 65 years, range 60–76 years) were recruited from either a university student pool or a registry of adults aged 50 and above. Older adults with diabetes had significantly higher levels of depression and comparable levels of anxiety with older adults without diabetes. Older adults with diabetes had significantly lower levels of depression, anxiety, and diabetes‐related distress than middle‐aged adults with diabetes. Diabetes is associated with high rates of depression and anxiety, with middle‐aged adults more adversely affected than older adults.     

The design of the MBT‐G adherence and quality scale

Few group psychotherapy studies focus on therapists' interventions, and instruments that can measure group psychotherapy treatment fidelity are scarce. The aim of the present study was to evaluate the reliability of the Mentalization‐based Group Therapy Adherence and Quality Scale (MBT‐G‐AQS), which is a 19‐item scale developed to measure adherence and quality in mentalization‐based group therapy (MBT‐G). Eight MBT groups and eight psychodynamic groups (a total of 16 videotaped therapy sessions) were rated independently by five raters. All groups were long‐term, outpatient psychotherapy groups with 1.5 hours weekly sessions. Data were analysed by a Generalizability Study (G‐study and D‐study). The generalizability models included analyses of reliability for different numbers of raters. The global (overall) ratings for adherence and quality showed high to excellent reliability for all numbers of raters (the reliability by use of five raters was 0.97 for adherence and 0.96 for quality). The mean reliability for all 19 items for a single rater was 0.57 (item range 0.26–0.86) for adherence, and 0.62 (item range 0.26–0.83) for quality. The reliability for two raters obtained mean absolute G‐coefficients on 0.71 (item range 0.41–0.92 for the different items) for adherence and 0.76 (item range 0.42–0.91) for quality. With all five raters the mean absolute G‐coefficient for adherence was 0.86 (item range 0.63–0.97) and 0.88 for quality (item range 0.64–0.96). The study demonstrates high reliability of ratings of MBT‐G‐AQS. In models differentiating between different numbers of raters, reliability was particularly high when including several raters, but was also acceptable for two raters. For practical purposes, the MBT‐G‐AQS can be used for training, supervision and psychotherapy research.     

Therapeutic outcomes in the Welsh Government's school‐based counselling strategy: An evaluation

Aims: The purpose of this study was to evaluate the outcomes of school‐based counselling, as delivered in the Welsh Government's School‐based Counselling Strategy, for reducing psychological distress in young people aged 11–18. Method: The study used a quantitative cohort design, comparing levels of distress on either the Young Person's CORE (YP‐CORE) or the Strengths and Difficulties Questionnaire (SDQ) from baseline to endpoint. Data were available on 3613 episodes of counselling, across 42 datasets. Meta‐analytical procedures were used to identify the mean effect size and predictors of outcomes. Results: Within each dataset, counselling was associated with significant reductions in psychological distress, with a mean effect size (d) of 0.93(95% CI = 0.89–0.97) using a fixed effects model and 1.09 (95% CI = 0.97–1.22) using a random effects model. Datasets using the YP‐CORE had larger effect sizes than those using the SDQ, and datasets with more complete response rates had lower outcomes than those with poorer response rates. Conclusion: The results confirm that school‐based counselling, as delivered in the UK, is associated with significant reductions in psychological distress, comparable to adult counselling and psychotherapy services.     

Workforce Support for Urban After‐School Programs: Turning Obstacles into Opportunities

Organized after‐school programs can mitigate risk and build resilience for youth in urban communities. Benefits rely on high‐quality developmental experiences characterized by a supportive environment, structured youth–adult interactions, and opportunities for reflective engagement. Programs in historically disenfranchised communities are underfunded; staff are transient, underpaid, and undertrained; and youth exhibit significant mental health problems which staff are variably equipped to address. Historically, after‐school research has focused on behavior management and social‐emotional learning, relying on traditional evidence‐based interventions designed for and tested in schools. However, after‐school workforce and resource limitations interfere with adoption of empirically supported strategies and youth health promotion. We have engaged in practice‐based research with urban after‐school programs in economically vulnerable communities for nearly two decades, toward building a resource‐efficient, empirically informed multitiered model of workforce support. In this paper, we offer first‐person accounts of four academic–community partnerships to illustrate common challenges, variability across programs, and recommendations that prioritize core skills underlying risk and resilience, align with individual program goals, and leverage without overextending natural routines and resources. Reframing obstacles as opportunities has revealed the application of mental health kernels to the after‐school program workforce support and inspired lessons regarding sustainability of partnerships and practice.     

Typical and atypical self‐regulation in adolescence: the importance of studying change over time

Researchers, parents, and teachers alike are concerned with the healthy development of self‐regulation, particularly because of its influence on a wide range of academic, economic, social, and health outcomes. However, little is known about how to characterize typical and atypical self‐regulation development, especially among adolescents, a population that is uniquely challenged with competing demands and expectations. The arguments of the present review are twofold: (1) it is critical to use fine‐grained longitudinal data to study change over time in self‐regulatory traits among youth, in order to fully understand typical and atypical self‐regulation; and (2) one compelling way to study the typical and atypical development of self‐regulation is through its intersection with externalizing problems. A thorough examination of the literature reveals that, on average, youth struggle with self‐regulation in adolescence, as evidenced by a decline in self‐regulatory capacities from age 10 to 14 and an improvement in self‐regulatory skills from age 14 to 19. Concomitantly, youth show mean‐level increases in externalizing problems (e.g., delinquency, aggression, alcohol/drug use, school behavioral problems) during adolescence. Further, co‐developmental associations indicate that poor self‐regulation leads adolescents to show greater increases in externalizing problems over time (vulnerability model); the act of engaging in these problematic behaviors leads youth to experience greater decreases in self‐regulation over time (scar model); self‐regulation and externalizing problems are distinct developmental constructs (spectrum model). The implications of studying trait and behavior change over time are highlighted, and future directions in this area of research are discussed.     

Exploring Domain‐Specific Perfectionism

ABSTRACT The main objective of this research was to explore the extent to which perfectionism is a general personality trait across areas of functioning rather than a context‐specific trait. The study also explored the degree to which domain‐specific contingent self‐worth, perceived competence, and task value were associated with domain‐specific perfectionism. In a sample of 187 academically talented youth, a comparison of perfectionistic tendencies and cognitive appraisal processes in the school versus sports domain revealed significantly higher levels of perfectionism, perceptions of competence, task value, and contingent self‐worth in the school domain. Hierarchical regression analysis showed a significant main effect for contingencies of self‐worth on perfectionistic tendencies in both the school and sports domains. The results argue for the centrality of contingent self‐worth to the understanding of perfectionism.