Judy Garber, Ph.D. - US grants

The overall goal of this research is to examine the feasibility and efficacy of a psychoeducational program of cognitive-behavioral therapy (CBT) for depressed adult and adolescent inpatients. The specific aims of this proposal are: (a) to modify cognitive-behavioral therapy for use in a group format with adult and adolescent inpatients; (b) to utilize the knowledge and technology from educational and cognitive psychology in order to design a psychoeducational curriculum that will make CBT both engaging and effective with these populations; and (3) to conduct a treatment outcome study in order to test the feasibility, acceptability, and efficacy of the treatment program designed. A psychoeducational curriculum will be developed that will teach the basic principles of CBT while emphasizing the themes relevant to these particular populations. The program will incorporate eight innovations drawn from educational research including: education for the patient role, visual aids, teaching for generalization, memory enhancement strategies, didactic and structured presentations, testing of knowledge acquired in therapy, promotion of strong patient participation, and a flexible curriculum. Two separate treatment outcome studies (one with adults, the other with adolescents) will be conducted comparing the curriculum-based group CBT with standard group supportive- expressive treatment. In each study, adult and adolescent inpatients meeting DSM-III-R criteria for a non-bipolar mood disorder assessed using semistructured diagnostic interviews (e.g. SCIDS, K-SADS) will be randomly assigned to one of these two treatment groups. In addition to testing differential outcome, this study will examine potential: (a) prognostic indices (e.g., severity, subtypes), (b) mechanisms of change (e.g., patients' acquired knowledge), and (c) components of treatment (e.g., quality of therapist behavior, patient participation) in relation to outcome. A future goal of this research program will be to expand, distribute, and test the psychoeducational curriculum in other settings (e.g., schools) and with other populations, with a focus on prevention as well as treatment.

Depression in children and adolescents occurs in significant proportions, particularly among offspring of depressed parents, and is associated with suicide, academic and social difficulties, and increased risk of future depressions. The purpose of this study is to explore the parenting, cognitive, and stress factors associated with the development of depression during the early adolescent years. According to the Family Cognitive Diathesis Stress (FCDS) Model, when faced with an important negative life event, individuals who have a particular cognitive style (i.e., the propensity to make internal, stable, and global attributions and to develop negative expectations about the future) are more likely to become depressed. It is further hypothesized that this "depressogenic" cognitive style has its origins in parent-child relationships characterized by criticism, rejection, and overcontrol. This depresssogenic cognitive style is hypothesized to mediate the relation between negative family interactions and the onset and maintenance of depression. This study will examine the validity of the FCDS model for understanding individual differences in children's reactions to negative life events as well as to the normative life experience of the transition into junior high school. Using a prospective longitudinal design, 250 children will be followed over the early adolescent years (grades 5 to 8). Children will be selected as being either "high' or 'low' risk for developing depression based upon the history of depression in their parents. The primary variables to be assessed are: cognitions (e.g., attributions, expectancies), family factors (e.g., parenting style, family conflict), life events, and social support. Pubertal development, depression and other symptomatology also will be monitored. Multiple regression analyses will be used to test the primary hypotheses concerning the interaction between cognitions and stress in the prediction of depression, and the role of children's cognitive style as a potential mediator between parenting characteristics and depression in children. The study also will explore the family, stress, and cognitive factors associated with the increased rate of depression over the early adolescent years. This research has important implications for understanding the processes underlying individual differences in the development of depression particularly among "high risk" offspring, and will serve as a guide for the development of programs aimed at ameliorating and preventing the onset of depression in children and adults in the future.

DESCRIPTION (Adapted from applicant's abstract): The proposed project will study the impact of treating parental depression on children's socio-emotional adjustment. This project will interface with two newly funded NIMH treatment studies of adults diagnosed with major depressive disorder. The first is a two-site study being conducted at Vanderbilt University (PI, Steve Hollon, Ph.D.) and at the University of Pennsylvania (PI, Rob DeRubeis, Ph.D.). The second study will be at the University of Washington (PI, Neil Jacobson, Ph.D.). Across the three sites, 640 adults will receive cognitive therapy, pharmacotherapy, or placebo (plus a behavioral cell at UW). Based on preliminary data collected in the last four months, we estimate that about 25% of the patients will have children between 8 and 16 years old and will agree to participate. These preliminary data provide evidence of the feasibility and acceptability of the project, and showed that the targeted children of currently depressed parents were experiencing significant levels of symptoms and dysfunction. The proposed project will involve a comprehensive assessment of an index child with regard to psychopathology and functioning at the time the parent enters the treatment study and again at 2,4,8,12,18, and 24 months. A comparison group of children whose parents are lifetime-free of psychiatric and medical disorders also will be included. The primary aims of the study are: (a) to examine the relation between decreases in parent's depression and changes in children's functioning;(b) to explore possible mediators of these changes including the parent-child relationship, marital functioning, stressors, and cognitions; and (c) to test whether changes in child adaptation, the hypothesized mediators, and the relation between parent and child symptoms differ as a function of the type of treatment the parent received. Data analysis will involve traditional methods of repeated measures multivariate analyses of variance and a more general and innovative approach of individual growth curve modeling using covariance structure analysis. This study represents a truly unique opportunity to further our theoretical understanding of the link between parent and child psychopathology that can serve as a guide for the development of preventive interventions for high risk populations.

This proposal seeks continuation funds to train research scientists studying the development, life course, and prevention of abnormal behavior. The goals of the Vanderbilt University Developmental Psychopathology Research Training Program are to: (a) prepare trainees to become leading research scientists in the emerging interdisciplinary fields of developmental psychopathology and prevention science; (b) provide a national forum for the maturation and evolution of these fields; and (c) enhance the quality of research being conducted in these fields. During the nine years of funding thus far, this program has been successful in achieving all three goals. Ninety percent of trainees who have been funded by this program to date hold university positions in research or continue their research training. As a result of the program, the 36 current and former trainees have completed 287 articles, presentations at national conferences, and papers. A forum for the field has been established through a Visiting Scholar program that has led to discussions, joint manuscripts, and collaborative research grant proposals. The quality of research at Vanderbilt University has been enhanced, as indicated by both faculty feedback and a significant increase in research grant funds awarded to program faculty during the past five years. This research has focused on externalizing disorders, internalizing disorders, disorders of cognition and learning, and prevention. Funds are requested for two types of trainees: (a) advanced predoctoral trainees (six positions per year), and (b) postdoctoral trainees (six positions per year). The program emphasizes the interdisciplinary nature of the filed in that trainees come from diverse backgrounds and faculty are represented from clinical development, and social psychology, psychiatry, pediatrics, sociology, and education. The foundation of the program is apprenticeship-based research mentoring. All trainees participate in an ongoing weekly proseminar attended by program faculty and renowned Visiting Scholars. Individualized programs are developed for trainees through coursework, workshops, and other experiences. The program is a joint venture of the Departments of Psychology and Human development (Peabody College) and Psychology (Arts and Science), administered through the John F. Kennedy Center for Research on Human Development at Vanderbilt University.

DESCRIPTION (provided by applicant): This Developmental ICOHRTA proposal seeks three years of funding to refine and finalize the plan for our ICOHRTA Training Program. The goal of the ICOHRTA Training Program (for which we intend to seek funding after successful completion of this Developmental ICOHRTA project) is to train mental health researchers in the Socialist Republic of Viet Nam (Vietnam) to increase their abilities to (a) develop research-based treatments for mental health problems among Vietnamese children, and (b) plan, design, and conduct clinical intervention trials to empirically evaluate these treatments. In addition, it is expected that success in achieving this goal will enhance our own understanding of human behavior, through the collaborative sharing of cultural perspectives. Our initial ICOHRTA Training Program plan is that twelve trainees will be selected from across Vietnam. They first will receive classroom training in substantive and methodological areas related to the above goals, and then will participate in a mentored research program, focusing on the development and validation of culturally appropriate treatment programs for Vietnamese children. Training will last three years for each of two cohorts, with the two cohorts? training overlapping. Training in the U.S. will take place at Vanderbilt University and training in Vietnam will take place at the National Institute of Pediatrics in Hanoi. The goal of the Developmental ICOHRTA project for which the current proposal is seeking funding is to refine and finalize the plan for our ICOHRTA Training Program, (a) through in-depth discussions with our Vietnamese colleagues and potential trainees in Year I, and (b) by conducting pilot training activities in Years 2 and 3.

DESCRIPTION (provided by applicant): This is a request for an NIH Independent Scientist Award (K02) to enhance the Pl's ability to contribute to the understanding of the processes underlying the development of depressive disorders in children and adolescents and to develop and test interventions aimed at preventing depression in youth. The Pl's research program has evolved from studying psychosocial risk factors that predict depression in children and adolescents, to examining the role of these risk factors as mediators of the link between parent and child psychopathology, to testing a prevention program that targets several of the risk factors identified in the earlier studies. This proposal describes three research programs involving five different but related studies. The first program includes two separate longitudinal studies that examine the contribution of varbus psychosocial factors (e.g., family dysfunction, social feedback, stress) to the development of negative cognitions and depressive disorders in children and adolescents. The second program is comprised of two different investigations of whether decreases in parents' depression as a result of treatment (cognitive-behavioral and/or pharmacotherapy) are associated with changes in their children's psychopathology and functioning, and whether these changes are mediated by improvements in parent-child relationships, negative cognitions, and/or decreases in stressful life events. The last project uses knowledge about risk factors learned from the first two research programs to test a cognitive-behavioral intervention for preventing depression in adolescents at risk for mood disorders due to their having a parent in treatment for depression, and themselves having either a past depressive ecandidatesode or current subsyndromal depressive symptoms. The goal of the career development plan is to expand the candidate's skills in two areas: quantitative methods and prevention science. Because most of the candidate's research is longitudinal, learning state-of-the-art statistical methods (e.g. latent growth curve, linear and non-linear mixed effects models, survival analysis, structural equations modeling) will broaden the kinds of research questions that can be addressed with both existing and new data. In addition, she will update and expand her knowledge of preventive interventions, particularly cognitive-behavioral approaches, with the aim of further developing and testing the efficacy of programs for preventing depression in high-risk adolescents. This K award will allow the candidate to bridge emcandidaterical research with practice by using basic knowledge about etiology to address the practical problem of preventing the onset and recurrence of the serious public health condition of depression, particularly among those at greatest risk for the disorder.

[unreadable] DESCRIPTION (provided by applicant): This application is one of four interlocking R01's to assess the impact of a group cognitive behavioral program (CBP) on the prevention of depression in adolescents at risk for depression. Eligible teens must have a parent with active depression; teens themselves must have either a past depressive episode or current subsyndromal depressive symptoms. In this 5-year study, 320 at-risk adolescents (80 at each site) drawn from managed care organizations will be randomized to either CBP or usual care (UC) and followed for 32 months post intake to determine the impact of CBP vs. UC on onset of depressive disorders and symptoms, level of functioning, and medical and mental health care utilization. We hypothesize that participants in the CBP intervention will have a significantly lower prospective incidence of first and repeated episodes of depressive disorders and symptoms compared to adolescents in the usual care group. In addition, we will explore whether participants in CBP have a reduced prospective incidence of non-affective symptoms and disorders, and will show improved global functioning relative to the comparison group. Analyses also will focus on the incremental cost-effectiveness of providing the CBP over usual care from the health care perspective. This study builds on previous work by the Portland site (Clarke et al., 2001) showing a nearly six-fold reduction in the incidence of depression in CBP vs. UC, and extends this work in two ways - first, by testing whether the program can be replicated at several different sites, thereby greatly increasing the generalizability of the original findings; and second, by changing the timing and spacing of the intervention to provide continuation sessions to prolong the duration of the effect of CBP. This program of research is significant for several reasons: (1) depression is a chronic, prevalent, and impairing condition in adolescence that is often undetected, and which is more difficult to treat as chronicity increases; (2) there have been no large-scale studies of the prevention of depression in adolescence; and (3) by basing this study in managed care organizations, it will be possible to ascertain the costs and benefits of incorporating this intervention into "best practice" in real world settings. This application is based in Nashville (Judy Garber, PI), and interlocks with applications from Boston (William Beardslee, PI), Pittsburgh (David Brent, PI), and Portland (Greg Clarke, PI).

DESCRIPTION (provided by applicant): This proposal is in response to Challenge Area (06): Enabling Technologies and Specific Challenge Topic, 06-OD(OBSSR)-101* Using new technologies to improve or measure adherence. The primary aim of this research is to develop and test a method for increasing adherence to treatment recommendations for mothers of children with emotional or behavior problems. Parental psychopathology is a serious risk factor for psychiatric problems in children, yet most parents of children receiving mental health services do not get treatment for their own problems. Such parental psychopathology, particularly maternal depression, places a burden on society through lost wages, increased marital strain, and serious maladjustment in their offspring. The specific aim of the proposed research is to increase depressed mothers'adherence to recommendations for treatment. Participants will be 200 mothers of children (7-17 years old) receiving psychiatric treatment in a community mental health center. Mothers will be randomly assigned to either the Enhanced Motivation Intervention (EMI) or an information only control group. The EMI is a modified version of the program developed by Swartz, Zuckoff, and colleagues who combined motivational and ethnographic interviewing into a brief intervention that (a) elicits the mother's "story" and her understanding of her central problems;(b) provides psychoeducation about their disorder;(c) describes the effects of depression on children and the potential link between improvements in mothers'and children's symptoms;(d) obtains their prior treatment history, hopes, and concerns about the recommended treatment;(e) identifies potential practical (e.g., child care) and psychological (e.g., stigma) barriers to treatment seeking;and (f) elicits a commitment to take the next step (i.e., make an appointment). Evaluations at baseline and 8-weeks and 6-months post intervention, will assess mothers'psychiatric disorders, symptoms, functioning, and service utilization. Children's symptoms, disorders, and functioning also will be measured. We hypothesize that adherence to treatment recommendations will be significantly greater for mothers in the EM intervention group compared to mothers in the information only control group. The impact of the EM intervention on changes in mothers'and children's psychopathology also will be examined. The public health implications of this research are that more individuals in need of mental health services will receive and adhere to them, possibly resulting in a positive effect on their children's adjustment. Consistent with the goals of the Recovery Act, the project would immediately create three new full-time jobs. If the intervention is successful, then a longer-term benefit could be an increase in the demand for the services of mental health care providers, thereby expanding the work force.

DESCRIPTION (provided by applicant): This A1competitive renewal is one of four collaborative, linked R01s that proposes to examine the long-term effects of a Cognitive Behavioral Program (CBP) for preventing depression provided when adolescents were 13-17 years old. The sample is at high risk by virtue of familial (parental depression) and individual factors (past history of depression and/or current subsyndromal depressive symptoms). In the original study, we successfully enrolled 99% (N=316) of our proposed target recruitment of 320 adolescents, with equal recruitment across the 4 sites. Participants were randomized into either CBP or treatment as usual (TAU), with equally high retention (92%) in both conditions. Results through the 8-month follow-up indicated a significant prevention effect of CBP with regard to depressive episodes (HR=.60, 95% CI, .38-.96;effect size, d=.25), thus replicating and extending the earlier, single site study by Clarke et al., (2001). The aims of the current proposal are to (a) study the longer term impact of CBP on preventing depression during the critical developmental transition to early adulthood, a period of multiple new life challenges and stressors;(b) assess potential biological (e.g., genetic) and psychosocial (e.g., childhood abuse, stressful life events) moderators of response to the intervention;(c) examine the broader impact of the CBP program on sequelae of depression including other mental and medical health problems, health risk behaviors, and impairment in the attainment of developmental competencies;and (d) assess the long-term cost-efficacy of CBP, identify markers of the impact of CBP on key economic outcomes (e.g., workplace productivity), and examine the longer-term economic benefits of preventing or delaying the onset of mood disorders in adolescents with CBP. We will explore the potential role of adolescent depression in mediating these outcomes in young adulthood. These aims are consistent with the areas of highest priority for the NIMH Division of Services and Intervention Research (DSIR) insofar as this project will evaluate the durability and broader effects as well as cost-efficacy of an innovative prevention strategy, will potentially reduce the burden of suicidality by increasing depression-free days, and will both aid in the personalization of the intervention and the identification of new prevention targets through our study of biological and psychosocial moderators of treatment effects. Knowledge gained from this study will be used to identify individuals who are most and least likely to benefit from this prevention program, and will provide an empirical foundation for novel and innovative strategies for the prevention of depression. In our original study, we found that we can prevent depression among at-risk youth, but we do not yet know if this prevention lasts and whether it improves youths'schooling, employment, and relationships with others. The proposed study will be the first to examine whether depression continues to be prevented as these teens become young adults. This study also will identify youth who are most likely to benefit from this program, and will inform us about how to create future prevention programs that help those youth who did not benefit. Public Health Relevance: In our original study, we found that we can prevent depression among at-risk youth, but we do not yet know if this prevention lasts and whether it improves youths'schooling, employment, and relationships with others. The proposed study will be the first to examine whether depression continues to be prevented as these teens become young adults. This study also will identify youth who are most likely to benefit from this program, and will inform us about how to create future prevention programs that help those youth who did not benefit.

DESCRIPTION (provided by applicant): This proposal seeks continuation funds to train research scientists studying the development and treatment/prevention of psychopathology in children, adolescents, and adults. The primary goals of this training program are to produce research scientists who will contribute to the state of knowledge about (a) the psychosocial and neurobiological processes in the development and maintenance of psychopathology, and (b) the translation of this basic knowledge into empirically supported interventions for treating and preventing psychopathology. Method: (a) The foundation of the program is apprenticeship-based research mentoring in which trainees receive direct guidance by at least two primary faculty mentors. Individualized programs are developed for trainees through courses and workshops, (b) All trainees participate in an ongoing weekly proseminar attended by program directors and faculty. This proseminar provides a foundation in the biopsychosocial mechanisms underlying different types of psychopathology, the translation of this basic knowledge into intervention strategies, development of normal and abnormal behavior, research design and quantitative methods, minority and cross-cultural issues, the responsible conduct of research, and professional development, (c) A Visiting Scholars series involves intensive two-day meetings with different world-class scholars to discuss the visitor's research and for trainees to receive consultation on their own work. These visits have led to highly stimulating and mutually beneficial discussions and collaborations. Results: During the twenty years of funding thus far, this program has been successful in achieving its goals. Seventy-seven percent of the 46 trainees funded by this program in the last decade currently hold research and/or teaching positions in universities and medical schools or continue their research training. Trainees have authored over 300 peer reviewed articles and 500 conference presentations, have received several prestigious awards, and 48% have been funded as the PI or co-PI of grants from the Federal or State government, Foundations, or University funds. The quality of research at Vanderbilt has been enhanced, as indicated by faculty feedback and an increase in research grant funds awarded to program faculty during the past five years. Plan: Funds are requested for two types of trainees: (a) advanced predoctoral trainees (four positions per year) and (b) postdoctoral trainees (three positions per year). The program emphasizes the interdisciplinary nature of the field in that trainees come from diverse backgrounds and faculty represent clinical, developmental, social, cognitive, and quantitative psychology, neuroscience, psychiatry, pediatrics, pharmacology, sociology, and education. The program is a joint venture of the Departments of Psychology and Human Development (Peabody College) and Psychology (Arts and Science), administered through the John F. Kennedy Center for Research on Human Development at Vanderbilt University. PUBLIC HEALTH RELEVANCE: Consistent with the mission of NIMH, this research training program aims to produce scientific experts who can (a) produce, integrate, and disseminate new knowledge about fundamental neurobiological and psychosocial mechanisms underlying a range of psychiatric conditions, and (b) translate this basic research into interventions for treating and preventing psychopathology in children, adolescents, and adults.

DESCRIPTION (provided by applicant): Depression is a major public health problem affecting over 15 million U.S. adults annually and is especially prevalent in those of parenting age. Offspring of depressed parents are at increased risk of depression and therefore are a critical target for preventive interventions. Informed in part by the investigators' prior work, the field i now poised to make significant advances toward reducing the rate of depression by adopting an innovative, family-based approach to simultaneously preventing depression in at-risk children and in their affected parents. The rationale for this approach is based on (a) our conceptual model that integrates parenting processes, stressors (particularly those associated with parental depression), and children's self-regulatory skills in the face of stress, (b) strong evidence of th familial nature of depression, (c) promising results from family- and child-focused depression prevention programs, (d) evidence that in adults, cognitive-behavioral therapy (CBT) reduces both depressive episodes and their recurrence, and (e) growing consensus among scientists, clinicians, and policymakers on the need for family-based models of healthcare. The proposed 5- year, two-site randomized controlled trial will test a Family Depression Prevention (FDP) program for children (ages 9-15) and their parents with depressive disorders (past or current). This dual prevention approach is a novel synthesis of existing evidence-based intervention techniques drawn from child prevention and adult treatment models. Participating families (N=300) will be randomized to either FDP (12 weekly + 3 monthly sessions) or a written information control (WI) condition. Parents and children will be evaluated at pre-, mid-, and immediately post-intervention, and at 6-, 12-, 18-, and 24-months from baseline. This single integrated intervention aims to prevent depressive symptoms and episodes in both children and parents, reduce associated disorders, and improve functioning (Aim 1). We also will assess the cost-effectiveness (CE) of FDP relative to the WI control and benchmarked against the CE of landmark studies in child prevention and adult depression treatment (Aim 1). Additionally, we will examine mediators (e.g., parenting behaviors; parents' cognitions; children's coping) and evaluate bidirectional effects between child and parent processes and outcomes (Aim 2). Finally, we will explore moderators [e.g., parental depression severity (Aim 3)] of the intervention-outcome relation.

? DESCRIPTION: This application is for a 5-year renewal of the T32 Training Program in the Development of Psychopathology: From Brain and Behavior to Intervention. Mental and substance abuse disorders are more likely to arise early in life...[and] are, in fact, the predominant noncommunicable disorders of young people (Insel, 2014; p. 1727). Therefore, early identification of risk processes and early intervention are crucial. As the field has been shifting from a behavioral to a neurodevelopmental focus, this training program also has been evolving to reflect important advances in human brain development. The major thrust of this interdisciplinary program is to produce scientists who will (1) contribute to the state of knowledge about neurobiological and psychosocial mechanisms underlying the development and maintenance of psychopathology, and (2) translate findings from basic research to the development of empirically-based interventions for the prevention and amelioration of psychopathology and for the promotion of mental health. The training program provides individual mentoring in multidisciplinary science complemented by didactic activities. A personalized training plan is developed for each fellow and re-evaluated each semester. In the last five years, we have explicitly shifted our focus to increasing training on multidisciplinary research on neurobiological, psychophysiological, genetic, and psychosocial mechanisms underlying psychiatric illness. Since the last renewal in 2010, three of the 11 (27%) predoctoral trainees and two of the five postdocs (40%) have come from neuroscience programs. In the last decade, over 75% of our 24 pre- and 12 post-doctoral trainees have continued to contribute to the field through scholarly research and teaching. A quarter of trainees represent diverse ethnic minority groups and 67% have been female. Four predocs continue in training on this T32; 3 other former predoc trainees are working on their dissertations; 3 are doing their required clinical internship. All 14 remaining former predoc trainees have completed their PhDs; 6 are researchers in faculty positions in academic psychology departments; 2 are postdoctoral fellows; 4 do a combination of clinical service, consulting, teaching, and supervision, and 2 are doing clinical work. Of the 12 postdoctoral fellows, 3 continue in training; 7 of the 9 former postdocs are still actively involved in research and teaching. Other important indicators of the training program's success are trainees' publication records [predocs: 141 papers, mean=5.9; median=5; postdocs: 157 papers, mean=13.08; median =13] and their acquisition of research funding from individual career development awards (F30, F31, K01, K99), R-type grants (e.g., R34, R21, R00), and foundations (e.g., Brain Behavior Research Fund). This renewal application proposes to again support 4 predoctoral trainees and 3 postdoctoral fellows annually. Our primary goals for the next five years are to continue to develop research scientists who can discover and translate basic knowledge from clinical neuroscience into interventions for reducing psychopathology. We will especially focus on the Research Domain Criteria (RDoC), grant writing, and professional development.

PROJECT SUMMARY Depression in youth is a recurrent and impairing disorder. Although some treatments have shown modest effects in children and adolescents [e.g., cognitive behavior therapy (CBT)], there remains a critical need to improve upon these therapies in order to reach even more youths with depression. One variable hypothesized to affect children?s interpersonal relationships, as well as how well they learn the skills taught in CBT, is their level of social cognitive development on abilities particularly relevant to social functioning and to CBT (e.g., social perspective taking, theory of mind). The first phase (R61) of the proposed project will test whether a novel intervention that aims to increase children?s social cognitive (SC) abilities (the ?target?) will improve children?s SC skills, and also their uptake of the strategies taught in CBT (e.g., cognitive reappraisal), with the goal of reducing levels of depression. Youths (ages 12-17; N=42) with depression diagnoses or clinical levels of depressive symptoms (CESD > 20) and a deficit in the targeted SC skills will be randomly assigned to either the social cognitive training enhanced CBT (SCT-CBT) or to a usual care (UC) comparison condition. Pre- and post- treatment evaluations will assess the target (e.g., social cognitions) and depression. ?Target? engagement will be defined as a medium effect size (>.40) in the comparison of SCT-CBT vs. UC on the target SC measure at post-test, controlling for pre-test level of SC. We also will assess the target after sessions 3 and 6 to examine dose (i.e., at what point the target is reached). In the second phase (R33), we will conduct a replication trial with a new sample of 82 youths (ages 12-17) again randomized to either SCT-CBT or usual care. Youth will be evaluated with regard to the target SC abilities, as well as their knowledge of CBT skills, level of depressive symptoms, and social functioning at baseline and post-intervention (R61 and R33), and at a 4-month follow-up (R33). All analyses will control for age, sex, and IQ. Finally, in the R33 we will test for mediation ? that increases in SC abilities partially account for the relation between Condition (SCT-CBT vs. UC) and decreases in depressive symptoms, and also between Condition and increases in CBT skills. If the SCT-CBT intervention significantly improves children?s SC abilities, increases their capacity to uptake CBT strategies, decreases their depressive symptoms, and improves their social functioning, then this will provide therapists with a more efficient and personalized treatment of depression, and thereby substantially improve clinical care.

PROJECT SUMMARY Rates of anxiety and depression in youth are substantial, causing a major unmet need for effective interventions. Although some progress has been made in preventing these internalizing problems in adolescents, further research is needed that specifically targets theoretically and empirically supported risk processes. An important and salient risk factor found to increase the likelihood of anxiety and depression is negative affectivity ? a partially heritable trait propensity to experience and express more frequent, intense, and enduring aversive emotional states. The proposed randomized controlled prevention trial builds on our finding from our longitudinal study that elevated levels of negative affectivity during adolescence prospectively predicted internalizing disorders in early adulthood (Zinbarg et al., 2016); moreover, this relation was mediated by changes in momentary negative affect (mNA) measured with ecological momentary assessment (EMA) (Adam et al., 2018). The first phase (R61) of the proposed selective prevention trial will test whether an app-based, coach-supported mindfulness intervention as compared to an assessment-only control reduces momentary negative affect, measured with ecological momentary assessment (EMA), in 120 adolescents (age 12-16) at- risk based on their having high levels of trait negative affectivity. EMA will be used to measure average daily mood, (the ?Target?) collected six times a day across three days at pre-, mid-, and post- intervention. ?Target? engagement will be defined as a medium effect size (>.40) in the comparison of youth randomized to MBI versus control on the target ? momentary negative affect ? at post-test, adjusting for pre-test levels. We also will assess the dose-response relation by testing the association between number of sessions and exercises completed with changes in momentary negative affect and weekly mood ratings. In the second phase (R33), we will conduct a replication trial with a new sample of 360 at-risk (i.e., high trait negative affectivity) youths (ages 12-16) randomized to one of three conditions ? MBI, a nonspecific control, or an assessment-only control. Youth will be evaluated with regard to the target (i.e., mNA), internalizing symptoms and disorders, and functioning (e.g., social, academic) at baseline and post-intervention (R61 and R33), and at a 6-month follow-up (R33). Finally, in the R33 we will test if significant reductions in momentary negative affect are associated with improvements (or less worsening) in internalizing symptoms and fewer onsets of internalizing disorders.