Intervention: The Adolescent Coping with Depression Course (CWD-A)
Theoretical Approach: Cognitive-Behavioral Theory
Modality of Intervention: Group and Family, Tertiary Prevention
Setting: School
The Adolescent Coping with Depression Course (CWD-A) is a psycho-educational, cognitive-behavioral intervention for adolescent depression (Clarke, Lewinsohn, & Hops, 1990). Cognitive-behavioral interventions like this one typically use treatment approaches that target the depressed individual’s specific maladaptive thought and behavior patterns in a structured and timely manner. This course intervention is normally used as a group treatment (groups of 4-8) for youth suffering from a depressive disorder or mood state. This includes adolescents with a diagnosable DSM affective disorder, such as major depressive disorder. Often, there is co-morbidity between this diagnosis with anxiety, conduct disorders, and/or substance use, so it is effective for students dealing with multiple issues. Participants must also be 14 to 18 years of age, or in grades 9 through 12 (Clarke et al., 1990). The course is used as an after-school program and consists of sixteen 2-hour sessions conducted over an 8-week period. The treatment sessions are conducted as a class in which a group leader teaches adolescents skills for controlling depression. The areas covered include relaxation, pleasant events, negative thoughts, social skills, communication, and problem solving. Each adolescent is provided with a Student Workbook that contains readings, structured learning tasks, self-monitoring forms, homework assignments, and short quizzes, which are all closely integrated with course discussions and group activities (Clarke et al., 1990).
The parents of the adolescents are also encouraged to participate in the program to help foster and maintain positive changes in the adolescents' moods. Clarke et al. (1990) explains that the course for parents consists of nine 2-hour sessions that are held once each week on one of the same nights as the adolescent group. During these sessions, parents are given an overview of the same skills and techniques that are taught to their adolescents. This promotes parental acceptance and reinforcement of the positive changes in their teenagers. Most of the sessions for parents and adolescents are separate, with the exception of two sessions in which they practice problem-solving and negotiation skills as a family (Clarke et al, 1990). The CWD-A course is a cost-effective, community-oriented approach that can successfully reach those depressed adolescents who typically do not make use of the services of school counselors, therapists, and other mental health professionals.
Each session is presented with full directions, worksheets, required materials, agendas, activities, and quizzes, and is provided on the links below. http://www.kpchr.org/research/public/common/getdocpublic.aspx?docid=53468A11-CDDF-4E20-A98F-9EEA4DE94C39 - therapist manual
http://www.kpchr.org/research/public/common/getdocpublic.aspx?docid=F95F9077-225F-4F9D-BDAC-6745926F4A6B - student workbook
Theoretical Approach: Cognitive-Behavioral Theory
Modality of Intervention: Group and Family, Tertiary Prevention
Setting: School
The Adolescent Coping with Depression Course (CWD-A) is a psycho-educational, cognitive-behavioral intervention for adolescent depression (Clarke, Lewinsohn, & Hops, 1990). Cognitive-behavioral interventions like this one typically use treatment approaches that target the depressed individual’s specific maladaptive thought and behavior patterns in a structured and timely manner. This course intervention is normally used as a group treatment (groups of 4-8) for youth suffering from a depressive disorder or mood state. This includes adolescents with a diagnosable DSM affective disorder, such as major depressive disorder. Often, there is co-morbidity between this diagnosis with anxiety, conduct disorders, and/or substance use, so it is effective for students dealing with multiple issues. Participants must also be 14 to 18 years of age, or in grades 9 through 12 (Clarke et al., 1990). The course is used as an after-school program and consists of sixteen 2-hour sessions conducted over an 8-week period. The treatment sessions are conducted as a class in which a group leader teaches adolescents skills for controlling depression. The areas covered include relaxation, pleasant events, negative thoughts, social skills, communication, and problem solving. Each adolescent is provided with a Student Workbook that contains readings, structured learning tasks, self-monitoring forms, homework assignments, and short quizzes, which are all closely integrated with course discussions and group activities (Clarke et al., 1990).
The parents of the adolescents are also encouraged to participate in the program to help foster and maintain positive changes in the adolescents' moods. Clarke et al. (1990) explains that the course for parents consists of nine 2-hour sessions that are held once each week on one of the same nights as the adolescent group. During these sessions, parents are given an overview of the same skills and techniques that are taught to their adolescents. This promotes parental acceptance and reinforcement of the positive changes in their teenagers. Most of the sessions for parents and adolescents are separate, with the exception of two sessions in which they practice problem-solving and negotiation skills as a family (Clarke et al, 1990). The CWD-A course is a cost-effective, community-oriented approach that can successfully reach those depressed adolescents who typically do not make use of the services of school counselors, therapists, and other mental health professionals.
Each session is presented with full directions, worksheets, required materials, agendas, activities, and quizzes, and is provided on the links below. http://www.kpchr.org/research/public/common/getdocpublic.aspx?docid=53468A11-CDDF-4E20-A98F-9EEA4DE94C39 - therapist manual
http://www.kpchr.org/research/public/common/getdocpublic.aspx?docid=F95F9077-225F-4F9D-BDAC-6745926F4A6B - student workbook
For this site, descriptions of what the different topics presented in sessions entail will be discussed here as well. For instance, different techniques are used throughout those sessions dedicated specifically to relaxation methods. Relaxation training is important because of the high evidence of correlation and co-morbidity between depression and anxiety. Many depressed adolescents report experiencing tension and anxiety during social events and in other stressful situations. This anxiety often interferes with effective interpersonal functioning and reduces the pleasure derived from potentially enjoyable activities. Teaching depressed adolescents to relax in situations that are typically stressful enables them to implement the social skills they learn during the course and enjoy pleasant activities more. Early in the course, the Jacobsen method is introduced, in which participants learn how to alternately tense and relax major muscle groups throughout their body until they are fully relaxed. This is relatively easy to learn and it provides the adolescents with an initial success experience in the beginning stages of the course in order to enhance their sense of perceived self-efficacy. The Benson method is then introduced about mid-way through the course, in which students sit comfortably in a quiet place and repeat a word or phrase.
There are also sessions that focus on pleasant activities due to certain behavioral theories based on depression, which hypothesize that low rates of response-contingent positive reinforcement, such as positive social interactions and pleasant activities, may be critical precursors for the occurrence of depression. It is therefore important to help depressed individuals increase their levels of pleasant activities, while also decreasing their levels of negative or punishing events. During these sessions, the students learn several self-change skills that include monitoring specific behaviors targeted for change, establishing a baseline, setting realistic goals, and developing a plan and contract for making changes in their behavior. Activities for each adolescent to increase are identified through the use of the Pleasant Events Schedule (PES). The PES contains a list of 320 potentially pleasant activities, such as taking a walk and reading a book. To fill out the schedule, each adolescent must go through the list twice. First, the adolescent rates each event according to how often it occurred during the past 30 days. Then, the second time through the list, each event is rated for its actual or potential enjoyability. When the PES is scored, an individualized list of pleasant activities is generated for each adolescent.
The cognitive therapy sessions address the negative and irrational thoughts known to be associated with depression in adolescents. Some elements of the interventions include cartoon strips with popular characters that are employed to illustrate negative thinking and the use of positive counter-thoughts to dispute irrational beliefs. Through a series of more advanced exercises, adolescents learn how to apply cognitive techniques to their own personal thoughts.
There are also sessions that focus on pleasant activities due to certain behavioral theories based on depression, which hypothesize that low rates of response-contingent positive reinforcement, such as positive social interactions and pleasant activities, may be critical precursors for the occurrence of depression. It is therefore important to help depressed individuals increase their levels of pleasant activities, while also decreasing their levels of negative or punishing events. During these sessions, the students learn several self-change skills that include monitoring specific behaviors targeted for change, establishing a baseline, setting realistic goals, and developing a plan and contract for making changes in their behavior. Activities for each adolescent to increase are identified through the use of the Pleasant Events Schedule (PES). The PES contains a list of 320 potentially pleasant activities, such as taking a walk and reading a book. To fill out the schedule, each adolescent must go through the list twice. First, the adolescent rates each event according to how often it occurred during the past 30 days. Then, the second time through the list, each event is rated for its actual or potential enjoyability. When the PES is scored, an individualized list of pleasant activities is generated for each adolescent.
The cognitive therapy sessions address the negative and irrational thoughts known to be associated with depression in adolescents. Some elements of the interventions include cartoon strips with popular characters that are employed to illustrate negative thinking and the use of positive counter-thoughts to dispute irrational beliefs. Through a series of more advanced exercises, adolescents learn how to apply cognitive techniques to their own personal thoughts.
There are also several sessions (sessions 9-14) focused on basic communication, negotiation, and problem-solving skills. The rationale for including these techniques in the course is due to the escalation of familial conflict during adolescence and the related inability to resolve these issues, which may contribute to or maintain the adolescent’s depression. The problem-solving sessions use a four-step model approach:
1) define the problem concisely and without accusations
2) brainstorm alternative solutions
3) decide on a mutually satisfactory solution through a structured negotiation process
4) specify the details for implementing the agreement
The communication training involves feedback, modeling, and behavior rehearsal to correct negative behaviors, such as accusations, interruptions, partial listening, lectures, and put-downs. These are replaced with positive behaviors such as paraphrasing, active listening, “I” messages, good eye contact, and appropriate body language.
Several studies have demonstrated that depression is highly associated with poor social functioning in adolescents. This lack of social skills may contribute to the onset of depressive episodes, and may also be involved in maintaining and prolonging them. Therefore, included throughout the course are the social skills sessions centered on giving adolescents opportunities to learn and practice a variety of techniques, such as active listening, planning social activities, and strategies for making friends.
Finally, the last 2 sessions focus on integrating the skills learned, anticipating future problems, maintaining therapy gains, developing a life plan and goals, and preventing relapses. Participants also identify the skills that they have found to be most effective for controlling their moods, as well as steps they can take to prevent depression in the future.
1) define the problem concisely and without accusations
2) brainstorm alternative solutions
3) decide on a mutually satisfactory solution through a structured negotiation process
4) specify the details for implementing the agreement
The communication training involves feedback, modeling, and behavior rehearsal to correct negative behaviors, such as accusations, interruptions, partial listening, lectures, and put-downs. These are replaced with positive behaviors such as paraphrasing, active listening, “I” messages, good eye contact, and appropriate body language.
Several studies have demonstrated that depression is highly associated with poor social functioning in adolescents. This lack of social skills may contribute to the onset of depressive episodes, and may also be involved in maintaining and prolonging them. Therefore, included throughout the course are the social skills sessions centered on giving adolescents opportunities to learn and practice a variety of techniques, such as active listening, planning social activities, and strategies for making friends.
Finally, the last 2 sessions focus on integrating the skills learned, anticipating future problems, maintaining therapy gains, developing a life plan and goals, and preventing relapses. Participants also identify the skills that they have found to be most effective for controlling their moods, as well as steps they can take to prevent depression in the future.
*Multicultural Considerations: Because of the fact that this intervention is given as an
after school program, some students may have difficulties fully participating.
Due to socioeconomic status, community, and culture, some students may not be
able to stay after school as often as is required for the sessions. Also, some
parents may not be able to participate in the sessions because of work,
transportation issues, and/or language barriers. These should be taken into
consideration and possible time and translation accommodations may be made.
*Developmental Considerations: The course is specifically designed for high school students, so activities are age appropriate. It should be noted that some modules of the course could be modified for adolescents who are developmentally delayed or learning disabled. For example, reading level may be an issue for some of these students, so the group leader could instead read the workbook material out loud and have the students respond orally while doing exercises.
*Modification/Accommodation: In the case of delivering this intervention to a student with a hearing impairment, certain modifications and accommodations should be made, including providing an assistive device. The counselor can use a radio frequency transmission FM system device by wearing a microphone during sessions. Additionally, the sessions should be delivered in a classroom located near relatively less noisy areas and in a room with better acoustics if possible. Also, the student can be seated close to the counselor provided with a swivel chair, which makes it easier for them to turn to face whoever is speaking, so that they can more easily see facial expressions and read lips. The counselor may also provide a copy of their notes for the lesson to the student in case they miss something.
ASCA NATIONAL STANDARDS:
Academic Standard A: Students will acquire the attitudes, knowledge and skills that contribute to effective learning in school and across the life span.
Competencies: A:A1 Improve Academic Self-concept
A:A1.3 Take pride in work and achievement
A:A1.4 Accept mistakes as essential to the learning process
A:A1.5 Identify attitudes and behaviors that lead to successful learning
A:A2 Acquire Skills for Improving Learning
A:A2.2 Demonstrate how effort and persistence positively affect learning
A:A2.4 Apply knowledge and learning styles to positively influence school performance
A:A3 Achieve School Success
A:A3.1 Take responsibility for their actions
A:A3.2 Demonstrate the ability to work independently, as well as the ability to work cooperatively with other students
A:A3.4 Demonstrate dependability, productivity and initiative
Standard B: Students will complete school with the academic preparation essential to choose from a wide range of substantial post-secondary options, including college.
Competencies: A:B1 Improve Learning
A:B1.1 Demonstrate the motivation to achieve individual potential
A:B1.2 Learn and apply critical-thinking skills
A:B2 Plan to Achieve Goals
A:B2.5 Use problem-solving and decision-making skills to assess progress toward educational goals
Standard C: Students will understand the relationship of academics to the world of work and to life at home and in the community.
Competencies: A:C1 Relate School to Life Experiences
A:C1.4 Demonstrate an understanding of the value of lifelong learning as essential to seeking, obtaining and maintaining life goals
Career Standard A: Students will acquire the skills to investigate the world of work in relation to knowledge of self and to make informed career decisions.
Competencies: C:A1 Develop Career Awareness
C:A1.3. Develop an awareness of personal abilities, skills, interests and motivations
C:A1.4 Learn how to interact and work cooperatively in teams
C:A1.5 Learn to make decisions
C:A1.6 Learn how to set goals
Standard C: Students will understand the relationship between personal qualities, education, training and the world of work.
Competencies: C:C2 Apply Skills to Achieve Career Goals
C:C2.1 Demonstrate how interests, abilities and achievement relate to achieving personal, social, educational and career goals
C:C2.2 Learn how to use conflict management skills with peers and adults
C:C2.3 Learn to work cooperatively with others as a team member
Personal/Social Standard A: Students will acquire the knowledge, attitudes and interpersonal skills to help them understand and respect self and others.
Competencies: PS:A1 Acquire Self-knowledge
PS:A1.1 Develop positive attitudes toward self as a unique and worthy person
PS:A1.2 Identify values, attitudes and beliefs
PS:A1.3 Learn the goal-setting process
PS:A1.4 Understand change is a part of growth
PS:A1.5 Identify and express feelings
PS:A1.6 Distinguish between appropriate and inappropriate behavior
PS:A1.9 Demonstrate cooperative behavior in groups
PS:A1.10 Identify personal strengths and assets
PS:A2 Acquire Interpersonal Skills
PS:A2.6 Use effective communications skills
PS:A2.7 Know that communication involves speaking, listening and nonverbal behavior
PS:A2.8 Learn how to make and keep friends
*Developmental Considerations: The course is specifically designed for high school students, so activities are age appropriate. It should be noted that some modules of the course could be modified for adolescents who are developmentally delayed or learning disabled. For example, reading level may be an issue for some of these students, so the group leader could instead read the workbook material out loud and have the students respond orally while doing exercises.
*Modification/Accommodation: In the case of delivering this intervention to a student with a hearing impairment, certain modifications and accommodations should be made, including providing an assistive device. The counselor can use a radio frequency transmission FM system device by wearing a microphone during sessions. Additionally, the sessions should be delivered in a classroom located near relatively less noisy areas and in a room with better acoustics if possible. Also, the student can be seated close to the counselor provided with a swivel chair, which makes it easier for them to turn to face whoever is speaking, so that they can more easily see facial expressions and read lips. The counselor may also provide a copy of their notes for the lesson to the student in case they miss something.
ASCA NATIONAL STANDARDS:
Academic Standard A: Students will acquire the attitudes, knowledge and skills that contribute to effective learning in school and across the life span.
Competencies: A:A1 Improve Academic Self-concept
A:A1.3 Take pride in work and achievement
A:A1.4 Accept mistakes as essential to the learning process
A:A1.5 Identify attitudes and behaviors that lead to successful learning
A:A2 Acquire Skills for Improving Learning
A:A2.2 Demonstrate how effort and persistence positively affect learning
A:A2.4 Apply knowledge and learning styles to positively influence school performance
A:A3 Achieve School Success
A:A3.1 Take responsibility for their actions
A:A3.2 Demonstrate the ability to work independently, as well as the ability to work cooperatively with other students
A:A3.4 Demonstrate dependability, productivity and initiative
Standard B: Students will complete school with the academic preparation essential to choose from a wide range of substantial post-secondary options, including college.
Competencies: A:B1 Improve Learning
A:B1.1 Demonstrate the motivation to achieve individual potential
A:B1.2 Learn and apply critical-thinking skills
A:B2 Plan to Achieve Goals
A:B2.5 Use problem-solving and decision-making skills to assess progress toward educational goals
Standard C: Students will understand the relationship of academics to the world of work and to life at home and in the community.
Competencies: A:C1 Relate School to Life Experiences
A:C1.4 Demonstrate an understanding of the value of lifelong learning as essential to seeking, obtaining and maintaining life goals
Career Standard A: Students will acquire the skills to investigate the world of work in relation to knowledge of self and to make informed career decisions.
Competencies: C:A1 Develop Career Awareness
C:A1.3. Develop an awareness of personal abilities, skills, interests and motivations
C:A1.4 Learn how to interact and work cooperatively in teams
C:A1.5 Learn to make decisions
C:A1.6 Learn how to set goals
Standard C: Students will understand the relationship between personal qualities, education, training and the world of work.
Competencies: C:C2 Apply Skills to Achieve Career Goals
C:C2.1 Demonstrate how interests, abilities and achievement relate to achieving personal, social, educational and career goals
C:C2.2 Learn how to use conflict management skills with peers and adults
C:C2.3 Learn to work cooperatively with others as a team member
Personal/Social Standard A: Students will acquire the knowledge, attitudes and interpersonal skills to help them understand and respect self and others.
Competencies: PS:A1 Acquire Self-knowledge
PS:A1.1 Develop positive attitudes toward self as a unique and worthy person
PS:A1.2 Identify values, attitudes and beliefs
PS:A1.3 Learn the goal-setting process
PS:A1.4 Understand change is a part of growth
PS:A1.5 Identify and express feelings
PS:A1.6 Distinguish between appropriate and inappropriate behavior
PS:A1.9 Demonstrate cooperative behavior in groups
PS:A1.10 Identify personal strengths and assets
PS:A2 Acquire Interpersonal Skills
PS:A2.6 Use effective communications skills
PS:A2.7 Know that communication involves speaking, listening and nonverbal behavior
PS:A2.8 Learn how to make and keep friends
References
American School Counselor Association. (2004). ASCA National Standards for Students. Alexandria, VA: Author.
Clarke, G., Lewinsohn, P., & Hops, H. (1990). Leader’s manual for adolescent groups: Adolescent coping with depression course [PDF document]. Retrieved from
http://www.kpchr.org/research/public/common/getdocpublic.aspx?docid=53468A11-CDDF-4E20-A98F-9EEA4DE94C39