CBT Impactful for Young People with Mental Health Disorders

Pia Jeppesen, MD, PhD

While behavioral therapy and cognitive-behavioral therapy are effective, they have not been widely implemented to target a single class of problems in the younger population with common mental health issues.

A team, led by Pia Jeppesen, MD, PhD, Child and Adolescent Mental Health Centre, Mental Health Services–Capital Region of Denmark, compared the effectiveness of a new transdiagnostic CBT program dubbed Mind My Mind (MMM) with management as usual in young patients with emotional and behavioral problems below the threshold for referral to mental health care.

In the pragmatic, multisite, randomized clinical trial, the investigators examined 8 weeks of postintervention follow-up for 396 patients in 4 municipalities in Denmark between September 7, 2017 and August 28, 2019.

Patients included in the trial were between 6-16 years old with anxiety, depressive symptoms, and/or behavioral disturbances as a primary problem. The mean age of the patient population was 10.3 years old, with 206 patients being males.

The patients were equally randomized to either the MMM group (n = 197), which consisted of 9-13 weekly, individually adapted sessions of manualized CBT delivered by local psychologists or management as usual (n = 199), which included 2 care coordination visits to enhance usual care.

Primary Outcomes

The investigators sought primary outcomes of the 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).

The researchers assessed primary and secondary outcomes in the intention-to-treat population at week 18 and assessed maintenance effects at week 26. Data from the primary outcome was available for 177 (89.8%) individuals in the MMM group and 167 (83.9%) in the management as usual group at week 18.

Results

Ultimately, the SDQ Impact score decreased 2.34 points in the MMM group from the initial score of 4.12 and 1.23 points in the management as usual group from the initial score of 4.21 (between-group difference, 1.10; 95% CI, 0.75-1.45; P <0 .001; Cohen d = 0.60).

In addition, the number of responders (≥1-point reduction in SDQ Impact score) was greater with MMM than with management as usual (n = 144 [73.1%] vs n = 93 [46.7%]; number needed to treat, 4; 95% CI, 3-6].

The investigators found secondary outcomes showed statistically significant benefits in parent-reported changes of anxiety, depressive symptoms, daily functioning, school attendance, and the principal problem.

Conclusions

Overall, the benefits besides school attendance were maintained at week 26.

“In this randomized clinical trial, the scalable transdiagnostic cognitive-behavioral intervention MMM outperformed [management as usual] in a community setting on multiple, clinically relevant domains in youth with emotional and behavioral problems,” the authors wrote.

Mental health disorders represent the largest disease burden among children and adolescents, with 50% of mental disorders beginning prior to the age of 14.

Young people with mild to moderate symptoms of anxiety, depression, or behavioral disturbances generally have an increased risk of adverse adult outcomes.

The advent of CBT could help younger patients help with their mental health disorders at a young age before adulthood.

The study, “Effectiveness of Transdiagnostic Cognitive-Behavioral Psychotherapy Compared With Management as Usual for Youth With Common Mental Health Problems,” was published online in JAMA Psychiatry.