2000 — 2001 |
Shirk, Stephen R |
R03Activity Code Description: To provide research support specifically limited in time and amount for studies in categorical program areas. Small grants provide flexibility for initiating studies which are generally for preliminary short-term projects and are non-renewable. |
Attachment Processes and Adolescent Depressive Symptoms
DESCRIPTION(adapted from Investigator's abstract): This application describes a study that seeks to explore pathogenic mechanisms underlying associations between attachment insecurity and risk for adolescent depression. The primary aim of the proposed research is to evaluate a mediational model linking maternal representations to the development of depressive symptoms among middle adolescents. It is hypothesized that internalization of a negative maternal representation is linked to maladaptive strategies for securing self worth, which in turn sensitizes adolescents to stressful events; and that negative maternal representations undermine the use of social support. It is proposed that the combination of heightened stress reactivity and the under-utilization of support increases adolescents' vulnerability to depressive symptoms, particularly in the context of stressful events. This model is examined prospectively using transition to high school as a normative adolescent stressor. The contributions of multiple pathogenic mechanisms to the development of adolescent depressive symptoms are evaluated using this model, including psychosocial stress, stress reactivity, maladaptive cognitions and coping strategies, and schematic representations. The relative contributions of two mediational pathways (cognitions about self and others) would be examined in relation to variation in depressive symptomatology. The predictive specificity of the model for depressive versus externalizing symptoms would also be examined. Data for testing the model would be obtained from following a community sample of 165 adolescents across the transition from middle to high school. Multi-source and multi-method measures and structural equation modeling would be used to evaluate the proposed model. This is a revised submission of an application for an R03 small grant to a newer, less experienced investigator.
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2002 — 2004 |
Shirk, Stephen R |
R21Activity Code Description: To encourage the development of new research activities in categorical program areas. (Support generally is restricted in level of support and in time.) |
Engagement and Alliance in Cbt For Depressed Adolescents
DESCRIPTION (provided by applicant): A major threat to treatment efficacy is the dilution of treatment strength through early drop out, sporadic attendance, and marginal participation. This problem represents a significant public health concern given the high rates of attrition and sporadic attendance in child clinic settings. As a result, children and adolescents who do not receive adequate exposure to active treatment components are unlikely to benefit from empirically supported treatments. We propose that the therapeutic alliance and therapist behaviors that facilitate alliance formation are critical for reducing drop out, promoting regular attendance, and maximizing active participation in sessions. Thus, empirically supported treatments should be complemented with empirically based engagement interventions that contribute to alliance formation, and to evaluate the contribution of engagement interventions and alliance to treatment completion, regular attendance, active participation, and treatment outcome in an open trial of CBT for adolescent depression. The proposal involves two studies. The first involves the development and evaluation of observational measures of therapist engagement interventions, therapy alliance, and treatment participation from audio recordings of completed, controlled trial of CBT for depressed and suicidal adolescents. The second study involves the evaluation of associations among engagement interventions, alliance, participation, treatment continuation/attendance, and outcome in an open trial of an empirically supported treatment, cognitive-behavioral therapy, for adolescent depression. An explicit mediational model of therapy process will be evaluated. The identification of effective engagement interventions into manualized treatments for adolescent depression, specifically, and potentially into manuals for a range of adolescent disorders. It is expected that empirically based guidelines for treatment engagement will be essential for the transportation of empirically supported treatments from research to clinical settings.
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2008 — 2010 |
Shirk, Stephen R |
R34Activity Code Description: To provide support for the initial development of a clinical trial or research project, including the establishment of the research team; the development of tools for data management and oversight of the research; the development of a trial design or experimental research designs and other essential elements of the study or project, such as the protocol, recruitment strategies, procedure manuals and collection of feasibility data. |
Deployment-Focused Development of Depression Treatment For Victimized Youth
[unreadable] DESCRIPTION (provided by applicant): This primary goal of this revised R34 application is to develop and conduct an initial evaluation of a modified cognitive-behavioral treatment (m-CBT) for depressed adolescents with histories of interpersonal trauma. A substantial number of adolescents retain their diagnoses or remain symptomatic following psychosocial or pharmacotherapy for depression. Notably, depressed adolescents with histories of trauma have been found to be less responsive to cognitive-behavioral therapy (CBT) for depression than non-exposed adolescents. Interpersonal trauma has been identified as a prominent developmental pathway to major depressive disorder and is prevalent among referrals to community clinics; thus, addressing the needs of this "treatment resistant" group is a high public health priority. In order to address the needs of this "treatment resistant" group, we propose to modify a cognitive-behavioral protocol that has been shown to be efficacious in prior clinical trials. Treatment modifications are based on the hypothesis that standard CBT does not address two factors central to depression in trauma-exposed youth: 1.) deficits in executive function; and 2.) trauma-related cognitions. First, deficits in executive functioning (e.g., attention, interference control, set shifting) found among traumatized youth are hypothesized to interfere with skill acquisition in CBT. To this end, the usual CBT modules will be modified to include empirically-supported interventions targeting executive function (e.g., attention control training, mindfulness-based cognitive interventions). Second, trauma-exposed individuals have been shown to endorse specific trauma-related maladaptive cognitions that are not typically targeted by CBT. To this end, the treatment will target both depressive automatic thoughts and trauma-related cognitions. Because a history of interpersonal trauma is prevalent among depressed adolescents in community clinics, this project uses a deployment-focused model of treatment development in order to create a "clinic-ready" intervention. To this end, the treatment will be developed and tested in a community mental health center with community clinicians and referred adolescents. The study involves two phases; the first involves pilot testing of the treatment manual with 8 referred adolescents. Acceptability, satisfaction, treatment adherence, and pre- post change in depressive symptoms will be examined. Following manual refinement, a randomized controlled trial under clinically-representative conditions will be conducted with a referred sample of 60 adolescents with a primary depression diagnosis and a history of interpersonal trauma. Adolescents will be randomized to the new intervention (m-CBT) or to an eclectic treatment-as-usual condition. Changes in depressive symptoms, global functioning, and cognitive processes (executive functions and trauma-related cognitions) will be evaluated between pre and post-treatment, and at 3-month follow-up. Linear mixed models with repeated measures will be used to evaluate the effects of treatment. Major depression affects approximately 1 in 6 adolescents during the teen years and results in increased risk for suicide, substance abuse, early childbearing, and school failure. Child interpersonal trauma is a well- documented pathway to major depression. Because youth exposed to interpersonal trauma are less likely to respond favorably to existing depression treatments, this project will develop and evaluate a new treatment for depressed adolescents with interpersonal trauma histories. [unreadable] [unreadable] [unreadable] [unreadable]
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