Associate Professor Andrew Lewis1
Professor John Toumbourou1
Associate Professor Lina Ricciardelli1
Dr Tess Knight1
Dr Melanie Bertino1
Dr Melissa O’Shea2
1 Deakin University
2 Barwon Health
beyondblue Victorian Centre of Excellence
Project completion year
The co-morbidity of anxiety and depression with substance abuse in young people represents a significant health problem that impacts on family, social and educational functioning. Depression in adolescence is linked to an increased risk of mental health disorders, drug dependence and abuse, as well as suicide.
This project aimed to test the relative benefits of reducing parent and adolescent depressive symptoms through a family substance abuse education program (the BEST Program), a purpose-designed enhanced adolescent cognitive therapy (delivered over eight weeks), and a combination of both (delivered over 12 weeks).
The researchers hypothesised that all treatments will produce clinically and statistically significant reductions in the self-reported rate of depressive and anxiety psychopathology, and the use of substances and risk of substance abuse. It is also thought that combined therapy will be more effective than either method in isolation.
It was further hypothesised that the family program would result in greater reductions in parent and sibling mental health symptoms, and reduced adolescent substance use than the cognitive therapy, while the cognitive therapy will produce greater reductions in depressive symptoms.
The project was designed as a randomised comparative trial of two interventions for youth and families, where the young person (12 to 25) presents with depression, anxiety, or alcohol and other drug (AOD) problems.
The purpose of the trial is to evaluate the efficacy of using a family-based treatment program (Behaviour Exchange Systems Training; BEST Plus) versus a standard cognitive-behavioural individual treatment program for the youth, (Self Help for Alcohol/Other Drug problems and Depression – Youth; SHADEY CBT), versus receiving both the family and the CBT intervention (COMBINED condition). The program was designed as a multicentre trial, and includes referrals from both clinical and community samples (JIGSAW Youth Mental Health Services in Geelong, Deakin University, and Drummond Street Services in Carlton). The interventions are delivered by trained and supervised Clinical Psychology Masters students, and supervised by both staff at these services and by the trainers in the respective interventions.
The study builds on over a decade of research and development of an innovative family-based intervention for young people with mental health problems. The intervention evaluated is known as the Behaviour Exchange Systems Training (BEST) program and has been developed over three distinct stages.
The BEST intervention was originally developed by Toumbourou and Bamberg initially as a professionally led, multifamily group education program for parents, with content focused on alcohol and other drug (AOD) use by adolescents. This version of the intervention was shown to reduce parental mental health symptoms and family stresses. To increase efficacy for the youth themselves, the second stage of development (BEST-Plus) included siblings who join their parents in the group for the final four weeks of the eight week program. Evaluations showed additional positive changes in the family system were produced in mental health and stress symptoms, family cohesion and increases in action by young people to address their substance use. In the third stage of the development, which is referred to as BEST-YMH, Lewis, Toumbourou, Knight, Ricciardelli and Bertino – in collaboration with clinical staff of the industry partner Drummond Street Services – have drawn on the current funding for this project to further develop and evaluate BEST as a broader intervention suitable for youth who present with depression and anxiety – as well as AOD abuse.
The current team have also focused on the pervasive clinical problem of engaging young people in mental health treatments. This is one of the major challenges for delivering evidence-based interventions in community-based services. As a result, in addition to the evaluation report, a suite of integrated engagement, assessment and treatment options, including a tailored clinical assessment and structured interview and a 90-minute community-based parenting seminar used to recruit and promote mental health literacy, have been developed. Together with BEST-YMH, this suite of interventions is known as Deakin Family Options.
Lewis AJ, Bertino M, Toumbourou JW, Ricciardelli L & Knight T (2010) Deakin family options: A report on the clinical trial of family education and cognitive therapy for youth depression, anxiety and substance use, Deakin University Australia, Geelong.
Bertino MD, Connell G & Lewis AJ (2012) ‘The association between parental personality patterns and internalising and externalising behaviour problems in children and adolescents’, Clinical psychologist, vol. 16, no. 3, pp. 110-117, Wiley-Blackwell Publishing, Oxford, England.
Two additional projects building on this research have been funded by beyondblue:
Deakin Family Options: A randomised controlled trial of enhanced cognitive therapy and family education for youth depression, anxiety and substance use (DFO 2), 2012, beyondblue Victorian Centre of Excellence.
Deakin Family Options: Engaging youth with high prevalence mental health problems using family based interventions (DFO 3), 2013, ARC Linkage Grant.