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Transdiagnostic modular CBT improves mental health in youth

JAMA Psychiatry
Reuters Health - 04/01/2021 - A transdiagnostic modular cognitive-behavioral therapy (CBT) intervention is more effective than management as usual (MAU) for young people with emotional and behavioral problems, a new randomized trial shows.

About 73% of youth randomized to the Mind My Mind (MMM) intervention responded to treatment, versus about 47% of those who received MAU, with a number needed to treat of four, Dr. Pia Jeppesen of Mental Health Services-Capital Region of Denmark, in Hellerup, and colleagues found.

"Our greatest hope is that doctors, psychologists and decision makers will use the transdiagnostic approach to 'speed up' the dissemination of an evidence-based practice for youths with mental-health problems," Dr. Jeppesen told Reuters Health by email.

CBT is effective for treating and preventing depression, anxiety and behavioral problems in children, she and her colleagues note in JAMA Psychiatry. "Nevertheless, access to evidence-based prevention and treatment interventions is limited, because those interventions available are rarely used routinely in clinical practice," they add.

Dr. Jeppesen and her team developed the MMM and found it was acceptable and feasible in a previous trial. In the current study, they randomized 396 youths aged 6 to 16 who were seeking help for anxiety, depression and/or behavioral problems to MMM or MAU. The MMM group received nine to 13 weekly sessions of "manualized" CBT adapted for the individual and delivered by local psychologists. MAU included two care-coordination visits.

At 18 weeks, primary outcome data was available for 177 youths in the MMM group and 167 in the MAU group. Strengths and Difficulties Questionnaire (SDQ) Impact scale scores, which can range from 0 to 10, declined by 2.34 points, from 4.12 at baseline, with MMM. With MAU, SDQ Impact scores declined by 1.23 from a baseline of 4.21, for a 1.10-point between-group difference (P<0.001; effect size, 0.60).

The percentage of responders, defined as those with at least a one-point reduction in SDQ Impact score, was 73.1% with MMM and 46.7% with MAU, a statistically significant difference.

There were also statistically significant improvements in parent reports of anxiety, depressive symptoms, daily functioning and school attendance, as well as the child's primary complaint. All of these improvements persisted at 26 weeks, except for school attendance.

Based on these positive results, the Danish Mental Health Foundation, a non-governmental organization, will advocate for broad implementation of the MMM program, Dr. Jeppesen said. She and her colleagues have also received funding for a three-year follow-up study, which will also address cost-effectiveness and cost-utility.

"It is important to acknowledge that the transdiagnostic modular approach can be challenging for the therapists," she noted. "The therapist must continuously make clinical and measurement-based decisions about what to do in terms of the dosing and sequencing of modules. The MMM manual guides the therapist to explore and solve problems in a collaborative process with the child and parent beginning with the formulation of a top-problem, followed by case formulation and goal setting. This is a challenging job."

Dr. Jeppesen continued: "The beneficial effects of the transdiagnostic approach in MMM may very well depend on the implementation model. We developed an infrastructure with web-based real-time measurements to handle self-referrals, visitation and clinical staging, monitoring of the delivery of therapy, user feedback for personalized treatment, video-recorded sessions, and online supervision. This shared infrastructure was probably of paramount importance for the delivery of a quite complex care model."

She concluded: "It is our vision that the Mind My Mind program becomes the new standard of school-based mental-health care in all municipalities in Denmark - in line with our free child dental care. The children and their families must be able to get effective care before the problems cause severe distress and long-lasting impairments that threaten the child's development and health."

SOURCE: https://bit.ly/3hu7lVP JAMA Psychiatry, online December 23, 2020.

By Anne Harding

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