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Transdiagnostic Approach to Mental Illness Effective in Teens

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A new transdiagnostic cognitive-behavioral therapy (CBT) program called Mind My Mind (MMM) provides significant and lasting benefits for adolescents with emotional and behavioral problems, report researchers from Denmark who developed the program.

In a randomized controlled trial, MMM provided significant and sustained reductions in anxiety and depressive symptoms, as well as improvements in daily functioning, school attendance, and quality of life, compared to usual care.

“This pragmatic study adds to the growing evidence that the wide-scale implementation of transdiagnostic modular CBT in nonspecialist care settings provides timely indicated prevention and quality care for help-seeking youth,” the study team writes.

The study was published online December 23 in JAMA Psychiatry.

“Scalable” Program Has Range of Benefits

Pia Jeppesen, MD, PhD, Child and Adolescent Mental Health Center, Gentofte Hospital, Hellerup, Denmark, and colleagues developed MMM as a scalable transdiagnostic CBT program targeting youth with emotional and behavioral problems below the threshold for psychiatric referral.

The MMM intervention includes nine to 13 weekly sessions of manual-based CBT “training” followed by a booster session after 4 weeks. “We call it training instead of therapy when we work with youth,” Jeppesen noted in a JAMA Psychiatry podcast featuring the study.

The training is provided by psychologists who receive 1 week of training on the MMM manual.

“The text is written to guide psychologists with very limited training in any kind of psychotherapy. We give instructions that are quite comprehensive, yet easy to read, and the content is organized into generic and problem-specific modules,” Jeppesen explained.

The study included 396 help-seeking youth aged 6 to 16 years for whom anxiety, depressive symptoms, and/or behavioral disturbances were a primary problem; 197 participants were randomly allocated to MMM, and 199 to management as usual (MAU).

The primary outcome was change in mental health problems reported by parents at week 18. Problems were assessed using the Strengths and Difficulties Questionnaire (SDQ) impact scale (range, 0–10 points, with higher scores indicating greater severity of distress and impairment).

The SDQ impact score fell by 2.34 points with MMM, vs 1.23 with MAU, from baseline scores of 4.12 and 4.21, respectively. There was a “clinically meaningful” between-group difference and a “medium” Cohen effect size of 0.60, the researchers report.

Response was defined as a 1-point reduction in SDQ impact score. Significantly more participants in the MMM group responded than in the MAU group (144 of 197 [73.1%], vs 93 of 199 [46.7%]; the number needed to treat was 4).

The results were robust and consistent in several prespecified sensitivity analyses.

“Secondary outcomes indicated statistically significant benefits in parent-reported changes of anxiety, depressive symptoms, daily functioning, school attendance, and the principal problem. All benefits were maintained at week 26 except for school attendance,” the researchers report.

Notably, Jeppesen said, these results were “sustained until the follow-up after half a year, and they were found across the different informants, that is, the teacher and the child self-report.”

With MMM, “the children overall feel less distressed and less impaired in many different daily situations at home, at school, and with friends,” she noted.

John Torous, MD, director of digital psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, who moderated the podcast, noted that “access to mental health, especially evidence-based psychological therapies for young people, remains limited in every country around the world.”

There is a “clear” need for transdiagnostic therapies that can be easily applied, Torous said, and the results achieved with the MMM program in this study are “exciting” and “give a lot of hope” that this type of approach is going to be “widely available and easy to implement.”

The Mind My Mind project was initiated by Psykiatrifonden and was sponsored through unrestricted grants from the Danish TrygFonden and the Lundbeckfonden. Jeppesen has received grants from the TrygFonden and Lundbeckfonden. Torous has disclosed no relevant financial relationships.

JAMA Psychiatry. Published online December 23, 2020. Full text

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