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December 23, 2020
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Transdiagnostic CBT intervention effective for youth with mental health problems

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A scalable transdiagnostic cognitive-behavioral intervention outperformed management as usual for youth with common mental health problems, according to results of a randomized clinical trial published in JAMA Psychiatry.

“Evidence suggests that cognitive-behavioral therapies are effective for the indicated prevention and treatment of childhood anxiety, depression and behavioral difficulties,” Pia Jeppesen, MD, PhD, of the Child and Adolescent Mental Health Center at Gentofte Hospital in Denmark, and colleagues wrote. “Nevertheless, access to evidence-based prevention and treatment interventions is limited because those interventions available are rarely used routinely in clinical practice. This knowledge-practice gap requires bridging by pragmatic trials testing the real-world implementation of scalable interventions for common mental health problems among youths.”

The investigators developed Mind My Mind (MMM), a new transdiagnostic CBT program for indicated prevention and early treatment of youth problems that do not meet the threshold for psychiatric referral, vs. management as usual. They aimed to assess its effectiveness vs. that of management as usual among youth in this patient population. They randomly assigned 197 youth to MMM and 199 to management as usual, with main inclusion criteria including being age 6 to 16 years and having anxiety, depressive symptoms and/or behavioral disturbances as a primary problem. Those in the MMM intervention received nine to 13 weekly individualized adapted manualized CBT sessions, which local psychologists delivered. The management as usual group received two care coordination visits for enhancement of usual care. Change in parent-reported mental health problems at week 18 according to the Strengths and Difficulties Questionnaire (SDQ) Impact scale served as the primary outcome. The investigators assessed primary and secondary outcomes among the intention-to-treat population at week 18, with maintenance effects assessed at week 26.

Results showed a decrease in SDQ Impact score of 2.34 points in the MMM group and 1.23 points in the management as usual group. MMM was associated with a greater number of responders vs. management as usual. The researchers noted statistically significant benefits according to secondary outcomes, including parent-reported changes of anxiety, depressive symptoms, school attendance, daily functioning and the principal problem. At wee 26, all benefit were maintained aside from school attendance.

“Future research should establish medium- and long-term benefits and costs of the MMM model and include clinician observations,” Jeppesen and colleagues wrote.