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

项目总结 青年时期的抑郁症是一种反复发作的损害健康的疾病。尽管一些治疗方法显示出不大的效果 在儿童和青少年[例如，认知行为疗法(CBT)]中，仍然迫切需要改进 以帮助更多患有抑郁症的年轻人。假设一个变量会影响 孩子们的人际关系，以及他们学习CBT所教技能的程度，是他们的水平 对与社会功能和CBT特别相关的能力的社会认知发展(例如，社会 观点采择、心理理论)。拟议项目的第一阶段(R61)将测试一个新的 旨在提高儿童社会认知(SC)能力的干预(目标)将改善儿童的 SC技能，以及他们对CBT教授的策略的理解(例如，认知重新评估)，目标是 降低抑郁程度。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到 社会认知训练增强型CBT(SCT-CBT)或至平时护理(UC)对照状态。之前和之后- 治疗评估将评估目标(例如，社会认知)和抑郁。“目标”接洽将 在SCT-CBT与UC在目标SC测量上的比较中被定义为中等效应大小(≥.40 测试后，控制SC的测试前水平。我们还将在第三次会议和第六次会议后评估目标以进行检查 剂量(即达到目标的时间点)。在第二阶段(R33)，我们将使用 82名青年(年龄12-17岁)的新样本再次被随机分为SCT-CBT或常规护理。青春将会是 根据目标SC能力以及他们对CBT技能、抑郁水平的了解进行评估 基线和干预后(R61和R33)的症状和社会功能，以及4个月的随访 (R33)。所有的分析都将控制年龄、性别和智商。最后，在R33中，我们将测试中介-这增加了 在SC中，能力部分地解释了条件(SCT-CBT与UC)和抑郁下降之间的关系 症状，以及在条件和CBT技能增加之间。如果SCT-CBT干预显著 改善儿童的SC能力，提高他们接受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更有效和 个性化治疗抑郁症，从而大幅改善临床护理。

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.