Social Cognitive Training to Enhance the Efficacy of CBT for Depression in Youth: A Developmental Approach

项目摘要 青年抑郁症是一种复发性和损害性疾病。尽管一些治疗方法显示出适度的效果， 在儿童和青少年中[例如，认知行为疗法（CBT）]，仍然迫切需要改善 这些疗法，以达到更多的青年抑郁症。假设一个变量会影响 儿童的人际关系，以及他们如何学习CBT中教授的技能，是他们的水平， 社会认知能力的发展，特别是与社会功能和CBT相关的能力（例如，社会 观点采择，心理理论）。拟议项目的第一阶段（R61）将测试一部小说是否 旨在提高儿童社会认知（SC）能力（“目标”）的干预措施将改善儿童的 SC技能，以及他们对CBT中教授的策略的吸收（例如，认知再评价），目标是 降低抑郁水平。患有抑郁症诊断或临床水平的青少年（12-17岁; N=42） 抑郁症状（CESD ≥ 20）和目标SC技能缺陷将被随机分配至 社会认知训练增强CBT（SCT-CBT）或常规护理（UC）比较条件。前后 治疗评估将评估目标（例如，社会认知）和抑郁症。“目标”参与将 定义为SCT-CBT与UC对目标SC指标的比较中的中等效应量（≥.40）， 后测，控制前测SC水平。我们还将在第3和第6节课后对目标进行评估， 剂量（即，达到目标的时间点）。在第二阶段（R33），我们将进行复制试验， 82名青少年（年龄12-17岁）的新样本再次随机分配到SCT-CBT或常规护理。青年将成为 评估目标SC能力，以及他们对CBT技能的了解，抑郁水平 基线和干预后（R61和R33）以及4个月随访时的症状和社会功能 （R33）。所有分析将控制年龄、性别和智商。最后，在R33中，我们将测试中介-这将增加 SC能力部分解释了条件（SCT-CBT vs. UC）和抑郁症减少之间的关系。 症状，以及条件和CBT技能的增加之间的关系。如果SCT-CBT干预显着 提高儿童的SC能力，增加他们接受CBT策略的能力，减少他们的抑郁， 症状，并改善他们的社会功能，那么这将为治疗师提供一个更有效， 抑郁症的个性化治疗，从而大大改善临床护理。

PROJECT SUMMARY Depression in youth is a recurrent and impairing disorder. Although some treatments have shown modest effects in children and adolescents [e.g., cognitive behavior therapy (CBT)], there remains a critical need to improve upon these therapies in order to reach even more youths with depression. One variable hypothesized to affect children’s interpersonal relationships, as well as how well they learn the skills taught in CBT, is their level of social cognitive development on abilities particularly relevant to social functioning and to CBT (e.g., social perspective taking, theory of mind). The first phase (R61) of the proposed project will test whether a novel intervention that aims to increase children’s social cognitive (SC) abilities (the “target”) will improve children’s SC skills, and also their uptake of the strategies taught in CBT (e.g., cognitive reappraisal), with the goal of reducing levels of depression. Youths (ages 12-17; N=42) with depression diagnoses or clinical levels of depressive symptoms (CESD ≥ 20) and a deficit in the targeted SC skills will be randomly assigned to either the social cognitive training enhanced CBT (SCT-CBT) or to a usual care (UC) comparison condition. Pre- and post- treatment evaluations will assess the target (e.g., social cognitions) and depression. “Target” engagement will be defined as a medium effect size (≥.40) in the comparison of SCT-CBT vs. UC on the target SC measure at post-test, controlling for pre-test level of SC. We also will assess the target after sessions 3 and 6 to examine dose (i.e., at what point the target is reached). In the second phase (R33), we will conduct a replication trial with a new sample of 82 youths (ages 12-17) again randomized to either SCT-CBT or usual care. Youth will be evaluated with regard to the target SC abilities, as well as their knowledge of CBT skills, level of depressive symptoms, and social functioning at baseline and post-intervention (R61 and R33), and at a 4-month follow-up (R33). All analyses will control for age, sex, and IQ. Finally, in the R33 we will test for mediation – that increases in SC abilities partially account for the relation between Condition (SCT-CBT vs. UC) and decreases in depressive symptoms, and also between Condition and increases in CBT skills. If the SCT-CBT intervention significantly improves children’s SC abilities, increases their capacity to uptake CBT strategies, decreases their depressive symptoms, and improves their social functioning, then this will provide therapists with a more efficient and personalized treatment of depression, and thereby substantially improve clinical care.