Dr Glenn Melvin
Dr Meredith Levi
Ms Ann Locarnini
Professor Bruce Tonge
Centre for Developmental Psychiatry and Psychology, Monash University
beyondblue Victorian Centre of Excellence
Project completion year
Depressive disorders experienced during adolescence have a broad impact on the young person’s development, peer and family relationships, physical health and academic performance. The most effective psychological treatment currently available is cognitive behavioral therapy, yet it has a response rate variably rated as between 50 to 70 per cent, meaning that an important minority are not receiving benefit from the existing best available treatments.
Previous research conducted by this group found that perceived self-efficacy or beliefs about ability to cope with symptoms of depression measured before treatment predicted treatment outcome immediately after acute treatment and also at six month follow-up assessment (Gordon, Tonge & Melvin, in press). This finding demonstrated the unique contribution that self-efficacy plays in predicting treatment outcome and is concordant with previous findings that suggest that self-efficacy is a strong predictor of future behavior and that high levels of perceived self-efficacy may contribute to response to depression treatment, therefore justifying self-efficacy as a specific target for treatment intervention. As such, this project developed and piloted a Self-Efficacy Focused Cognitive-Behavioural Therapy (SEFCBT) for adolescents with depressive disorders.
A 13-session SEFCBT treatment manual was developed for young people (12 to 18 years) with depressive disorders and their parents. A dual-clinician model was used to conduct treatment. Participants were assessed at pre-treatment, post-treatment and at six months following the end of treatment using a multi-informant, multi-method assessment. Young people were recruited from mental health services, general practitioners, school welfare staff and paediatricians.
Self-Efficacy Focused Cognitive Behavioural Therapy was successfully piloted. A treatment manual was developed and implemented. Nine out of 10 young people who had a depression diagnosis at initial assessment, did not have a depression diagnosis immediately following treatment. Self-reported self-efficacy for managing depressive symptoms and everyday academic, social and family relationships improved significantly following treatment. Suicidal ideation, as measured by the Suicidal Ideation Questionnaire-Jnr, also demonstrated significant improvement over time. Treatment gains were universally maintained or improved upon six months after the end of treatment. There were no adverse events and no ethical issues.
A treatment manual has been developed for SEFCBT. The successful piloting of the treatment now justifies a larger randomized controlled trial. Evidence of SEFCBT’s superiority to existing treatments is required before the manual can be disseminated.
Translation of findings into practice,
With further validation, it may be confirmed that SEFCBT is an effective intervention for youth depression, providing clinicians with a viable alternative to currently available treatments. However, this was an uncontrolled study and, prior to dissemination, evidence is now required to suggest that SEFCBT is superior, or at least equivalent, to currently available treatments for youth depression, including standard CBT or anti-depressant medication. The investigators have a long history of disseminating best practice cognitive behavioural therapy treatment skills to clinicians (GPs, psychologists, psychiatry registrars, youth workers, social workers) having conducted workshops across Victoria.
Benefits to consumer and carers
Our experiences showed an enthusiastic response from young people and parents, as evidenced by the low drop-out rate (n=1). The rapidity of the response in many cases acted to prevent accumulation of more pathology and prevented further negative impact of depression on family functioning. Again, once evidence about the efficacy of SEFCBT is available, consumers and carers will receive the benefit of treatment.
Melvin, G., Tonge, B., Locarnini, A., Levi, M., Gordon, M. & Dudley, A. (2010). Self-efficacy: A new target in adolescent depression treatment. Paper presented at 27th International Congress on Applied Psychology. Melbourne, Australia.
Tonge, B. (November, 2010). Connect the dots between self-efficacy and resilience. Invited keynote address presented at The 2010 School Counsellors and Psychologist Conference ’Beyond the Rhetoric’. Melbourne, Australia.
Tonge, B. (March, 2010). Promoting recovery from youth mental illness. The 2010 Winston S Rickards Memorial Oration, Mental Health for the Young and their Families. University of Melbourne, Melbourne, Australia.