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Effectiveness of outpatient cognitive-behavioral therapy for adolescents under routine care conditions on behavioral and emotional problems rated by parents and patients: an observational study

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Abstract

Few studies have examined the effectiveness of outpatient cognitive-behavioral therapy (CBT) delivered in routine care settings for children and adolescents with mental disorders. This observational study examined changes in behavioral and emotional problems of adolescents with mental disorders during routine outpatient CBT delivered at a university outpatient clinic and compared them with a historical control group of youths who received academic tutoring of comparable length and intensity. Assessments were made at the start and end of treatment (pre- and post-assessment) using parent ratings of the German versions of the Child Behavior Checklist (CBCL) and self-ratings of the Youth Self-Report (YSR) scale. For the main analysis, 677 adolescents aged 11‒21 years had complete data. Changes from pre- to post-assessment showed significant reductions in mental health problems on both parent- and self-ratings. Pre- to post-effect sizes (Cohen’s d) were small-to-medium for the total sample (d = 0.23 to d = 0.62) and medium-to-large for those adolescents rated in the clinical range on each (sub)scale at the start of treatment (d = 0.65 to d = 1.48). We obtained medium net effect sizes (d = 0.69) for the CBCL and YSR total scores when patients in the clinical range were compared to historical controls. However, a substantial part of the sample remained in the clinical range at treatment end. The results suggest that CBT is effective for adolescents with mental disorders when administered under routine care conditions but must be interpreted conservatively due to the lack of a direct control condition.

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Authors and Affiliations

  1. Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the University of Cologne, Robert-Koch-Str. 10, 50931, Cologne, Germany

    Daniel Walter, Christiane Rademacher, Stephanie Schuermann, Tanja Wolff Metternich-Kaizman & Manfred Doepfner

  2. School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Medical Faculty of the University of Cologne, Robert-Koch-Str. 10, 50931, Cologne, Germany

    Daniel Walter, Lydia Dachs, Martin Faber, Hildegard Goletz, Anja Goertz-Dorten, Christopher Hautmann, Claudia Kinnen, Tanja Wolff Metternich-Kaizman & Manfred Doepfner

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  1. Daniel Walter
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  2. Lydia Dachs
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  3. Martin Faber
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  4. Hildegard Goletz
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  11. Manfred Doepfner
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Correspondence to Daniel Walter.

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This study has been approved by the ethics committee at the University of Cologne and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.

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Walter, D., Dachs, L., Faber, M. et al. Effectiveness of outpatient cognitive-behavioral therapy for adolescents under routine care conditions on behavioral and emotional problems rated by parents and patients: an observational study. Eur Child Adolesc Psychiatry 27, 65–77 (2018). https://doi.org/10.1007/s00787-017-1021-z

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