Young people with mental health problems often suffer from comorbidity, i.e. a complex mix of different conditions like depression, anxiety and conduct problems.
Clinical research very often investigates specific treatments (e.g. CBT) for single disorders (e.g. depression) and guidelines and manuals are then developed for clinicians to help them treat these individual conditions. The problem is, many patients don’t have single conditions, but are affected by a complex combination of problems in the real world.
Some researchers are trying to bridge this gap between clinical research and the real world by conducting reliable randomised trials in the community. One such study is an RCT published in the Archives of General Psychiatry that investigates whether modular psychotherapy is more effective than standard psychotherapy or usual care for depression, anxiety and conduct problems in youths.
The researchers recruited 203 youths aged 7-13 with anxiety, depression or disruptive conduct disorders from 10 outpatient services across Massachusetts and Hawaii.
The 84 community clinicians treating these patients were randomly assigned to 1 of 3 treatments:
- Standard psychotherapy – traditional evidence-based treatments for depression, anxiety and conduct problems (CBT for depression, CBT for anxiety, and behavioural parent training for conduct problems)
- The MATCH-ADTC (Modular Approach to Therapy with Children) modular treatment programme
- Usual care
The MATCH-ADTC is a psychosocial treatment package designed for use with families of children aged 8-13, who are experiencing problems with anxiety, depression, traumatic stress, or disruptive behaviour. It has been developed by John Weisz from Harvard and Bruce Chorpita from UCLA (the authors of this study).
The package consists of a guiding protocol for each primary problem and 33 practice modules. Each practice module includes a procedural guide for therapists along with worksheets, handouts, and assessment records for youth and their families.
Outcomes were measured using weekly youth and parent assessments, plus standardised diagnostic assessment before and after the treatment.
Here’s what they found:
- The modular MATCH-ADTC approach produced significantly faster improvement than standard psychotherapy and usual care against the youth-rated and parent-rated measures (Brief Problem Checklist and Top Problems Assessment)
- Patients receiving the MATCH-ADTC treatment had significantly fewer diagnoses than those receiving usual care after treatment
- The outcomes seen in the standard psychotherapy group did not differ significantly from the outcomes in the usual care group, which may be a reflection of the difficulties that clinicians often have in learning and applying multiple manual approaches for different conditions
The authors concluded:
The modular approach outperformed usual care and standard evidence-based treatments on multiple clinical outcome measures. The modular approach may be a promising way to build on the strengths of evidence-based treatments, improving their utility and effectiveness with referred youths in clinical practice settings.
Weisz JR, Chorpita BF, Palinkas LA, et al. The Research Network on Youth Mental Health. Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: a randomized effectiveness trial. Arch Gen Psychiatry 2012;69:274–82. [Abstract]
(Note: The full-text of this paper is not freely available, but there is an audio interview (13 mins) with the lead author on the journal website, which is well worth listening to).