Assessing Fit Between Evidence-Based Psychotherapies for Youth Depression and Real-Life Coping in Early Adolescence

Abstract

The modest efficacy of psychological interventions for youth depression, including evidence-based psychotherapies (EBPs), suggests a question: Do the therapy components match the coping strategies youths find helpful when dealing with depressed mood? Answering this question may help strengthen treatments. We asked 105 middle schoolers across a range of depression symptom levels to identify the coping strategies they used when they felt sad (habitual responses) and those that made them feel better (perceived-effective responses). Habitual and perceived-effective responses were coded for resemblance to EBPs, and each youth's habitual responses were coded for their match to the youth's perceived-effective responses. Most perceived-effective responses (92.6%) matched EBP components (most frequent: Behavioral Activation); however, 65.0% of the EBP components did not match any youth's habitual or perceived-effective responses. Youths at higher depression symptom levels were significantly more likely than low-symptom youths to report (a) habitual responses that did not match EBP components, (b) habitual responses that did not match their own perceived-effective responses, and (c) perceiving no effective response. The higher their depression symptom level, the less likely youths were to use strategies identified by researchers and perceived by themselves as effective, and the less likely they were to identify any perceived-effective coping strategy. The findings suggest a need to (a) determine which EBP components do in fact enhance youth coping, (b) design the most effective ways to help youths master those effective components, and (c) facilitate more frequent use of those strategies the youths already find effective.

ACKNOWLEDGMENTS

We are grateful to Angie Morssal, Heather Phipps, Carin Eisenstein, Kristen Jones, and other research assistants for their valuable help with this study, and to the children, families, and schools who have participated in and supported our research.

Notes

¹Although it is more common to base odds ratios on an increase of a one unit or one standard deviation in a continuous predictor, we based our odds ratios on an increase of an interquartile range in depression symptoms because it is more meaningful to compare the average high-symptom youth (scoring at the 75th percentile) to the average low-symptom youth (scoring at the 25th percentile), than to compare two youths who are one unit or one standard deviation apart in depression symptoms (see Babyak, 2009).

²We thank an anonymous reviewer for suggesting these analyses.