ABSTRACT
The aim of this study was to examine the relative effectiveness of Collaborative and Proactive Solutions (CPS) and Parent Management Training (PMT) for youth with oppositional defiant disorder (ODD) in a community setting. Based on a semistructured diagnostic interview, 160 youth with ODD (ages 7-14; 72% male; ethnicity representative of the wider Australian population) were randomized to CPS (nâ¯=â¯81) or PMT (nâ¯=â¯79) for up to 16 weekly sessions. The primary hypothesis was that participants in the CPS group, treated in a community setting, would exhibit significant improvement in ODD, equivalent to that of an evidence-based treatment, PMT. Assessment was conducted at baseline, post-intervention, and at 6-month follow-up, using independently rated semistructured diagnostic interviews, parent ratings of ODD symptoms, and global ratings of severity and improvement. Analyses were conducted with hierarchical growth linear modeling, ANCOVA, and equivalence testing using an intent-to-treat sample. Both treatments demonstrated similar outcomes, with 45-50% of youth in the nonclinical range after treatment, and 67% considered much improved. No differences were found between groups, and group equivalency was shown on the independent clinician and parent-rated measures. Gains were maintained at the 6-month follow-up. In conclusion, CPS works as effectively as the well-established treatment, PMT, for youths with ODD, when implemented in a community-based setting. As such, CPS provides a viable choice for families who seek alternate treatments.
Subject(s)
Attention Deficit and Disruptive Behavior Disorders , Parenting , Adolescent , Child , Female , Humans , Male , Australia , ParentsABSTRACT
AIM: Cognitive behaviour therapy (CBT) is a clinically indicated treatment for first-episode psychosis. Despite this, CBT for early psychosis is not routinely available as part of standard mental health services in Australia. The aim of this pilot project was to develop a CBT for early psychosis service to be provided as an adjunct to existing community mental health services. This study examined the feasibility of this service model, delivered in a real-world setting. A secondary aim was to explore the effectiveness of this service, as measured by clinical and functional outcomes. METHODS: Participants living in northern Sydney, Australia, and who had recently experienced a first episode of psychosis, were offered up to 20 sessions of individual CBT. Service feasibility was measured via attrition rates, therapy attendance and referrer feedback. Measures of psychosis, depression, anxiety and psychosocial functioning, were assessed pretreatment, after six and 12 sessions, and at 3 months post-treatment. RESULTS: Nineteen clients attended treatment to completion. Survey feedback from referrers affirmed the positive impact of the service on clients' recovery. Additionally, clients showed improvements in symptoms of psychosis over the first three time points. Psychosocial functioning also shifted from the moderately to mildly impaired range by the end of treatment. CONCLUSIONS: The CBT for early psychosis service has been successfully integrated into the mental health landscape of northern Sydney. Outcomes of this pilot project are discussed with reference to the achievements of the service, as well as the obstacles encountered, and how they were overcome.
Subject(s)
Cognitive Behavioral Therapy/methods , Early Medical Intervention/methods , Program Development , Psychotic Disorders/therapy , Adolescent , Adult , Community Mental Health Services/methods , Feasibility Studies , Female , Humans , Male , Middle Aged , Patient Compliance , Pilot Projects , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
Worry is a common phenomenon in children and adolescents, with some experiencing excessive worries that cause significant distress and interference. The metacognitive model of generalized anxiety disorder (Wells 1995, 2009) was developed to explain cognitive processes associated with pathological worry in adults, particularly the role of positive and negative beliefs about worry. This review evaluates the application of the model in understanding child and adolescent worry. Other key issues reviewed include the link between cognitive and metacognitive development and worry, and the measurement of worry and metacognitive worry in young people. Implications of these findings and directions for future research are discussed.
