European Child & Adolescent Psychiatry

, Volume 27, Issue 1, pp 65–77 | Cite as

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

  • Daniel WalterEmail author
  • Lydia Dachs
  • Martin Faber
  • Hildegard Goletz
  • Anja Goertz-Dorten
  • Christopher Hautmann
  • Claudia Kinnen
  • Christiane Rademacher
  • Stephanie Schuermann
  • Tanja Wolff Metternich-Kaizman
  • Manfred Doepfner
Original Contribution


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.


Adolescents Mental disorders Routine treatment Cognitive-behavioral therapy Outpatient treatment Effectiveness 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical standards

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.

Supplementary material

787_2017_1021_MOESM1_ESM.docx (27 kb)
Supplementary material 1 (DOCX 26 kb)


  1. 1.
    Carr A (2009) What works with children, adolescents and adults?. A review of research on the effectiveness of Psychotherapy, RoutledgeGoogle Scholar
  2. 2.
    Weisz JR, Doss AJ, Hawley KM (2005) Youth psychotherapy outcome research: a review and critique of the evidence base. Annu Rev Psychol 56:337–363CrossRefPubMedGoogle Scholar
  3. 3.
    Weisz JR, Ugueto AM, Cheron DM, Herren J (2013) Evidence-based youth psychotherapy in the mental health ecosystem. J Clin Child Adolesc Psychol 42:274–286CrossRefPubMedGoogle Scholar
  4. 4.
    Weisz JR, Donenberg GR, Han SS, Weiss B (1995) Bridging the gap between laboratory and clinic in child and adolescent psychotherapy. J Consult Clin Psychol 63:688–701CrossRefPubMedGoogle Scholar
  5. 5.
    Doepfner M (2009) Psychotherapieforschung [Psychotherapy Research]. In: Schneider S, Magraf J (eds) Lehrbuch der Verhaltenstherapie. Störungen im Kindes- und Jugendalter, vol 3. Springer, Berlin, pp 159–183Google Scholar
  6. 6.
    Hoagwood K, Hibbs E, Brent D, Jensen P (1995) Introduction to the special section: efficacy and effectiveness in studies of child and adolescent psychotherapy. J Consult Clin Psychol 63:683–687CrossRefPubMedGoogle Scholar
  7. 7.
    Weisz JR, Donenberg GR, Han SS, Kauneckis D (1995) Child and adolescent psychotherapy outcomes in experiments versus clinics: why the disparity? J Abnorm Child Psychol 23:83–106CrossRefPubMedGoogle Scholar
  8. 8.
    Southam-Gerow M, Chorpita BF, Daleiden EL (2012) Dissemination and implementation of evidence based treatments for youth: challenges and recommendations. Prof Psychol Res Pr 43:527–534CrossRefGoogle Scholar
  9. 9.
    Weisz JR, Chorpita BF, Palinkas LA et al (2012) Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth. A randomized effectiveness trial. Arch Gen Psychiatry 69:274–282CrossRefPubMedGoogle Scholar
  10. 10.
    Gilbody S, House A, Sheldon T (2002) Outcomes research in mental health. Systematic review. Br J Psychiatry 181:8–16CrossRefPubMedGoogle Scholar
  11. 11.
    Weisz JR, Kuppens S, Eckshtain D, Ugueto AM, Hawley KM, Jensen-Doss AJ (2013) Performance of evidence-based youth psychotherapies compared with usual clinical care: a multilevel meta-analysis. JAMA Psychiatry 70:750–761CrossRefPubMedGoogle Scholar
  12. 12.
    Casey RJ, Berman JS (1985) The outcome of psychotherapy with children. Psychol Bull 98:388–400CrossRefPubMedGoogle Scholar
  13. 13.
    Weisz JR, Weiss B, Alicke MD, Klotz ML (1987) Effectiveness of psychotherapy with children and adolescents: a meta-analysis for clinicians. J Consult Clin Psychol 55:542–549CrossRefPubMedGoogle Scholar
  14. 14.
    Weisz JR, Weiss B, Han SS, Granger DA, Morton T (1995) Effects of psychotherapy with children and adolescents revisited: a meta-analysis of treatment outcome studies. Psychol Bull 117:450–468CrossRefPubMedGoogle Scholar
  15. 15.
    Kazdin AE, Bass D, Ayres WA, Rodgers A (1990) Empirical and clinical focus of child and adolescent psychotherapy research. J Consult Clin Psychol 58:729–740CrossRefPubMedGoogle Scholar
  16. 16.
    Weiss B, Catron T, Harris V, Phung TM (1999) The effectiveness of traditional child psychotherapy. J Consult Clin Psychol 67:82–94CrossRefPubMedGoogle Scholar
  17. 17.
    Weiss B, Catron T, Harris V (2000) A 2-year follow-up of the effectiveness of traditional child psychotherapy. J Consult Clin Psychol 68:1094–1101CrossRefPubMedGoogle Scholar
  18. 18.
    Weisz JR, Weiss B (1989) Assessing the effects of clinic-based psychotherapy with children and adolescents. J Consult Clin Psychol 57:741–746CrossRefPubMedGoogle Scholar
  19. 19.
    Goletz H, Yang Y-I, Suhr-Dachs L, Walter D, Doepfner M (2013) Alltagswirksamkeit kognitiver Verhaltenstherapie bei Kindern und Jugendlichen mit Angststörungen in einer Ausbildungsambulanz [Effectiveness of routine cognitive-behavioral therapy within children and adolescents with anxiety disorders in a university outpatient clinic]. Z Kinder Jug-Psych 41:247–260CrossRefGoogle Scholar
  20. 20.
    Beig I, Goletz H, Plück J, Dachs L, Kinnen C, Walter D, Doepfner M (2016) Alltagswirksamkeit kognitiver Verhaltenstherapie bei Kindern und Jugendlichen mit Zwangsstörungen in einer Ausbildungsambulanz [Effectiveness of cognitive behavioral therapy in children and adolescents with obsessive-compulsive disorders treated in an outpatient clinic]. Z Kinder Jug-Psych. doi: 10.1024/1422-4917/a000416 (Published online April 8, 2016) Google Scholar
  21. 21.
    Walter D, Dachs L, Faber M, Goletz H, Goertz-Dorten A, Kinnen C, Rademacher C, Schürmann S, Woitecki K, Wolff Metternich-Kaizman T, Plück J, Hautmann C, Ise E, Doepfner M (2015) Alltagswirksamkeit ambulanter Verhaltenstherapie von Kindern und Jugendlichen im Urteil der Eltern in einer universitären Ausbildungsambulanz [Effectiveness of cognitive behavioral therapy under routine care conditions within children and adolescents in an university outpatient clinic as rated by parents]. Zschr klin Psychol Psychiatr Psychother 44:169–180CrossRefGoogle Scholar
  22. 22.
    MacLeod K, Brownlie E (2014) Mental health and transitions from adolescence to emerging adulthood: developmental and diversity considerations. Can J Commun Ment Health 33:77–86CrossRefGoogle Scholar
  23. 23.
    Lewinsohn PM, Shankman SA, Gau JM, Klein DN (2004) The prevalence and co-morbidity of subthreshold psychiatric conditions. Psychol Med 34:613–622CrossRefPubMedGoogle Scholar
  24. 24.
    Remschmidt H, Schmidt MH, Poustka F (2012) Multiaxiales Klassifikationsschema für psychische Störungen des Kindes- und Jugendalters nach ICD-10 der WHO - Mit einem synoptischen Vergleich von ICD-10 und DSM-IV [Multiaxial classification system for mental disorders of children and adolescents according to ICD-10 - including a synoptic comparison of ICD-10 and DSM-IV]. 6 edn. Huber, BernGoogle Scholar
  25. 25.
    Doepfner M, Plueck J, Kinnen C, Arbeitsgruppe Deutsche Child Behavior Checklist (2014) Manual deutsche Schulalter-Formen der Child Behavior Checklist von Thomas M. Achenbach. Elternfragebogen über das Verhalten von Kindern und Jugendlichen (CBCL/6-18R), Lehrerfragebogen über das Verhalten von Kindern und Jugendlichen (TRF/6-18R), Fragebogen für Jugendliche (YSR/11-18R) [Manual of the German versions of the Child Behavior Checklist for school-aged children and adolescents by Thomas M. Achenbach. Child Behavior Checklist (CBCL/6-18R), Teacher Report Form (TRF/6-18R), Youth Self-Report (YSR/11-18R). Hogrefe, GöttingenGoogle Scholar
  26. 26.
    Doepfner M, Goertz-Dorten A, Lehmkuhl G (2008) DISYPS-II: Diagnostik-System für psychische Störungen im Kindes- und Jugendalter nach ICD-10 und DSM-IV [DISYPS-II: Diagnostic system for psychiatric disorders in children and adolescents], 3rd edn. Hans Huber, BernGoogle Scholar
  27. 27.
    Goertz-Dorten A, Doepfner M (2008) Diagnose-Checklisten aus dem Diagnostik-System für Psychische Störungen im Kindes- undJugendalter (DISYPS-II)—Gütekriterien und klinische Anwendung [Diagnostic-Checklists of the Diagnostic System for Mental Disorders in Childhood and Adolescence (DISYPS-II)—psychometric criteria and clinical application]. Klin Diag Eval 1:378–394Google Scholar
  28. 28.
    Doepfner M, Schmeck K, Berner W, Lehmkuhl G, Poustka F (1994) Zur Reliabilität und faktoriellen Validität der Child Behavior Checklist: Eine Analyse in einer klinischen und einer Feldstichprobe [Reliability and factorial validity of the Child Behavior Checklist: an analysis of a clinical sample and a field sample]. Z Kinder Jug-Psych 22:189–205Google Scholar
  29. 29.
    Doepfner M, Berner W, Schmeck K, Lehmkuhl G, Poustka F (1995) Internal consistencies and validity of the CBCL and the TRF in a German sample: A cross cultural comparison. In: Sergeant J (ed) Eunethydis: European approaches to hyperkinetic disorder. Egg, Zürich, Switzerland, pp 51–81Google Scholar
  30. 30.
    Schmeck K, Poustka F, Doepfner M, Plück J, Berner W, Lehmkuhl G, Fegert JM, Lenz K, Huss M, Lehmkuhl U (2001) Discriminant validity of the Child Behavior Checklist CBCL-4/18 in German samples. Eur Child Adolesc Psychiatry 10:240–247CrossRefPubMedGoogle Scholar
  31. 31.
    Doepfner M, Steinhausen HC (2012) Störungsübergreifende Verfahren zur Diagnostik psychischer Störungen [transdiagnostic instruments to assess mental health disorders]. Kinder-Diagnostik-System (KIDS) [children-diagnostic-system (KIDS)], vol 3. Hogrefe, GöttingenGoogle Scholar
  32. 32.
    Busner J, Targum SD (2007) The clinical global impressions scale: applying a research tool in clinical practice. Psychiatry 4:28–37PubMedPubMedCentralGoogle Scholar
  33. 33.
    Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Erlbaum, HillsdaleGoogle Scholar
  34. 34.
    Rubin DR (1987) Multiple imputation for nonresponse in surveys. Wiley, New YorkCrossRefGoogle Scholar
  35. 35.
    Jacobson NS, Truax P (1991) Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 59:12–19CrossRefPubMedGoogle Scholar
  36. 36.
    Doepfner M, Plueck J, Berner W, Fegert J, Huss M, Lenz K, Schmeck K, Lehmkuhl U, Poustka F, Lehmkuhl G (1997) Psychische Auffälligkeiten von Kindern und Jugendlichen in Deutschland—Ergebnisse einer repräsentativen Studie: Methodik, Alters-, Geschlechts- und Beurteilereffekte [Mental disturbances in children and adolescents in Germany. Results of a representative study: age, gender and rater effects]. Z Kinder Jug-Psych 25:218–233Google Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Daniel Walter
    • 1
    • 2
    Email author
  • Lydia Dachs
    • 2
  • Martin Faber
    • 2
  • Hildegard Goletz
    • 2
  • Anja Goertz-Dorten
    • 2
  • Christopher Hautmann
    • 2
  • Claudia Kinnen
    • 2
  • Christiane Rademacher
    • 1
  • Stephanie Schuermann
    • 1
  • Tanja Wolff Metternich-Kaizman
    • 1
    • 2
  • Manfred Doepfner
    • 1
    • 2
  1. 1.Department for Child and Adolescent Psychiatry, Psychosomatics and PsychotherapyMedical Faculty of the University of CologneCologneGermany
  2. 2.School for Child and Adolescent Cognitive Behavior Therapy (AKiP)Medical Faculty of the University of CologneCologneGermany

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