A Randomized Trial of the Positive Thoughts and Action Program for Depression Among Early Adolescents

Abstract

This study was conducted to compare the outcomes of a group-based cognitive-behavioral preventive intervention (Positive Thoughts and Actions [PTA]) tailored to youth in middle school with a brief, individually administered supportive intervention (Individual Support Program [ISP]). A randomized, controlled trial was conducted with 120 early adolescents (72 girls, 48 boys; age = 11–15 years) who had elevated depressive symptoms and were selected from a school-based population. Measures of internalizing problems, externalizing problems, personal adjustment, school problems, and interpersonal relations were obtained from parents, youth, and/or teachers at preintervention (Time 1) and postintervention (Time 2, 5–7 months after preintervention). General linear model repeated measures analyses yielded a significant Group × Time interaction on youth-reported, but not parent-reported, depressive symptoms and internalizing symptoms. Youth in the PTA group showed greater decreases following intervention compared to youth who received ISP, yielding effect sizes (Cohen's d) of 0.36 for depressive symptoms, 95% CI [–.02, .73], and 0.44, 95% CI [.05, .82], for internalizing symptoms. PTA youth also showed improvements in their personal adjustment (sense of inadequacy, self-esteem), and parent-reported social skills, but no differences emerged between groups for externalizing symptoms, school problems, or interpersonal relationships. Cognitive-behavioral preventive interventions in which youth engage in personal goal-setting and practice social-emotional skills, such as PTA, may be beneficial for the reduction of depressive symptoms over and above general support and empathy.

Acknowledgments

This research was supported by Grant #R34 MH083076 from the National Institute of Mental Health (awarded to C. McCarty). This study is registered on ClinicalTrials.gov as NCT01220635. We thank the participating schools, parents, and students for their valuable contributions to science.

Notes

Note: Annual household income was not reported for two subjects.

^a n = 62.

^b n = 58.

Note: Standard deviations and sample sizes are in parentheses. PTA = Positive Thoughts and Actions; ISP = Individual Support Program; ES = effect size (Cohen's d) Between groups (+) = PTA>ISP (better than); (–) = PTA <ISP (worse than); CI = confidence interval; BASC–2 = Behavior Assessment Scale for Children–Second Edition.

Note: Standard deviations and ns are in parentheses (SD, n). PTA = Positive Thoughts and Actions; ISP = Individual Support Program; Cohen's d (+) = PTA>ISP (better than); (–) = PTA <ISP (worse than); CI = confidence interval; BASC–2 = Behavior Assessment Scale for Children–Second Edition; PCC = Parent-Child Communication.

*p < .05.