Effectiveness of Transdiagnostic Cognitive-Behavioral Psychotherapy Compared With Management as Usual for Youth With Common Mental Health Problems: A Randomized Clinical Trial | Adolescent Medicine | JAMA Psychiatry | JAMA Network
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    Original Investigation
    December 23, 2020

    Effectiveness of Transdiagnostic Cognitive-Behavioral Psychotherapy Compared With Management as Usual for Youth With Common Mental Health Problems: A Randomized Clinical Trial

    Author Affiliations
    • 1Child and Adolescent Mental Health Centre, Mental Health Services–Capital Region of Denmark, Copenhagen, Denmark
    • 2Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
    • 3Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense
    • 4Musculoskeletal Statistics Unit, Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
    • 5Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
    • 6Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
    • 7Department for Child and Adolescent Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
    • 8Department of Clinical Research, University of Southern Denmark, Odense, Denmark
    • 9Research Center at the Department for Child- and Adolescent Psychiatry, Aarhus University Hospital, Skejby, Denmark
    • 10Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
    • 11Centre for the Psychological Treatment of Children and Adolescents, Department of Psychology and Behavioural Sciences, Aarhus School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
    • 12Centre for Child and Adolescent Mental Health, Oslo, Norway
    • 13Centre for Child and Youth Mental Health and Child Welfare, The Arctic University of Norway, North Norway (RKBU North), Tromsø, Denmark
    • 14Anxiety and Mood Disorders Program, Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut
    • 15Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, New York
    • 16Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York
    • 17Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York
    • 18Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
    JAMA Psychiatry. 2021;78(3):250-260. doi:10.1001/jamapsychiatry.2020.4045
    Key Points

    Question  Can a transdiagnostic modular cognitive-behavioral therapy (CBT) program outperform management as usual for youth with emotional and behavioral problems?

    Findings  In this randomized clinical trial of 396 youths aged 6 to 16 years, the parent-reported functional impairment was significantly reduced for youth allocated to transdiagnostic modular CBT compared with management as usual. Key secondary outcomes also indicated a broad range of benefits.

    Meaning  This pragmatic study adds to the growing evidence that the wide-scale implementation of transdiagnostic modular CBT in nonspecialist care settings provides timely indicated prevention and quality care for help-seeking youth.

    Abstract

    Importance  Behavioral therapy and cognitive-behavioral therapy (CBT) programs targeting a single class of problems have not been widely implemented. The population of youths with common mental health problems is markedly undertreated.

    Objective  To determine the effectiveness of a new transdiagnostic CBT program (Mind My Mind [MMM]) compared with management as usual (MAU) in youths with emotional and behavioral problems below the threshold for referral to mental health care.

    Design, Setting, and Participants  This pragmatic, multisite, randomized clinical trial of MMM vs MAU was conducted from September 7, 2017, to August 28, 2019, including 8 weeks of postintervention follow-up, in 4 municipalities in Denmark. Consecutive help-seeking youths were randomized (1:1) to the MMM or the MAU group. Main inclusion criteria were age 6 to 16 years and anxiety, depressive symptoms, and/or behavioral disturbances as a primary problem. Data were analyzed from August 12 to October 25, 2019.

    Interventions  The MMM intervention consisted of 9 to 13 weekly, individually adapted sessions of manualized CBT delivered by local psychologists. The MAU group received 2 care coordination visits to enhance usual care.

    Main Outcomes and Measures  The primary outcome was change in mental health problems reported by parents at week 18, using the Strengths and Difficulties Questionnaire (SDQ) Impact scale (range, 0-10 points, with higher scores indicating greater severity of distress and impairment). Primary and secondary outcomes were assessed in the intention-to-treat population at week 18. Maintenance effects were assessed at week 26.

    Results  A total of 396 youths (mean [SD] age, 10.3 [2.4] years; 206 [52.0%] boys) were randomized to MMM (n = 197) or MAU (n = 199), with primary outcome data available in 177 (89.8%) and 167 (83.9%), respectively, at 18 weeks. The SDQ Impact score decreased by 2.34 points with MMM and 1.23 with MAU, from initial scores of 4.12 and 4.21, respectively (between-group difference, 1.10 [95% CI, 0.75-1.45]; P < .001; Cohen d = 0.60). Number of responders (≥1-point reduction in SDQ Impact score) was greater with MMM than with MAU (144 of 197 [73.1%] vs 93 of 199 [46.7%]; number needed to treat, 4 [95% CI, 3-6]). Secondary outcomes indicated statistically significant benefits in parent-reported changes of anxiety, depressive symptoms, daily functioning, school attendance, and the principal problem. All benefits were maintained at week 26 except for school attendance.

    Conclusions and Relevance  In this randomized clinical trial, the scalable transdiagnostic cognitive-behavioral intervention MMM outperformed MAU in a community setting on multiple, clinically relevant domains in youth with emotional and behavioral problems.

    Trial Registration  ClinicalTrials.gov Identifier: NCT03535805

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