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Intervention scientists have published more than 600 randomized controlled trials (RCTs) of youth psychotherapies. Four decades of meta-analyses have been used to synthesize the RCT findings and identify scientifically and clinically significant patterns. These meta-analyses have limitations, noted herein, but they have advanced our understanding of youth psychotherapy, revealing ( a) mental health problems for which our interventions are more and less successful (e.g., anxiety and depression, respectively); ( b) the beneficial effects of single-session interventions, interventions delivered remotely, and interventions tested in low- and middle-income countries; ( c) the association of societal sexism and racism with reduced treatment benefit in majority-girl and majority-Black groups; and, importantly, ( d) the finding that average youth treatment benefit has not increased across five decades of research, suggesting that new strategies may be needed. Opportunities for the future include boosting relevance to policy and practice and using meta-analysis to identify mechanisms of change and guide personalizing of treatment.

Brief digital interventions (BDIs) may help address the mental health needs of students when realworld resource constraints limit access to in-person or longer-form care. This article describes BDIs, which are conceptualized as being at the intersection of short-term interventions, internet-delivered cognitive behavior therapy programs, and measurement-based care. We use a real-world example of a BDI which was delivered in Ontario schools as a practice example for this mode of intervention. We then identify potential clinical and ethical considerations, and we highlight some of the challenges of implementing and evaluating innovative interventions and measurement-based care initiatives in Canadian schools.

Understanding the efficacy of each module of cognitive behavioral therapy (CBT) may inform efforts to improve outcomes for youth depression, but effects of specific modules have been difficult to examine. Idiographic interrupted time series models offer a robust way to estimate module effects on an individual's symptoms. This study examined the association of specific CBT modules for depression on internalizing symptoms among depressed youths who received modular CBT in a randomized trial.Individual models were created for three youths who met study criteria. Youths completed weekly symptom reports, and clinicians completed records of modules delivered. First order auto-regressive models quantified the change in average internalizing symptom severity between pre- and post-module delivery.All youths had 1-3 modules that were significantly associated with symptom reduction and 1-3 modules associated with deterioration. The 5 modules associated with improvement in at least one youth also lacked association (engagement, relaxation, cognitive reframing), or were associated with worsening (activity selection, parent psychoeducation) in others. Seven modules showed no measurable benefit, or detriment to any youth.This study demonstrated that specific modules have measurable effects, but more work is needed to build an evidence base of specific module effects to inform treatment personalization for youth depression.

Intervention scientists have proposed a focus on empirically supported principles of change (ESPCs) in psychotherapies. We explored this proposition as applied to youth psychotherapies, focusing on five candidate ESPCs—calming, increasing motivation, changing unhelpful thoughts, solving problems, and practicing positive opposites. We synthesized 348 treatment–control comparisons from 263 randomized controlled trials (RCTs) spanning six decades, testing treatments for anxiety, depression, attention-deficit/hyperactivity disorder, and conduct problems. We found that ESPCs could be reliably identified and distinguished by independent coders and that psychotherapies most often included fewer than three ESPCs. However, across the entire study pool and the anxiety subsample, when we controlled for dose, treatments with all five ESPCs showed effects about twice as large as treatments with fewer ESPCs. The findings suggest that ESPCs are reliably identifiable, that they are associated with variations in treatment effect size, and that treatments containing more ESPCs may produce greater therapeutic benefit.

Discrepancies among the key stakeholders in youth psychotherapy (e.g., caregivers, youths) commonly present an obstacle to treatment planning, forcing clinicians to align with one perspective over another and increasing the likelihood of a treatment plan that is not fully responsive to divergent opinions. At the same time, multi-stakeholder discrepancies can also offer opportunities to build an inclusive, effective treatment plan, guided by the integration of numerous sources of domain-specific knowledge related to the concerns for which families seek clinical care.We aim to: 1) investigate the degree to which multi-stakeholder discrepancies are observed when youths and caregivers are invited to report their treatment priorities, rather than the presence and severity of youth symptoms, 2) describe the rationale for, as well as the promise and challenges of, shared decision-making (SDM)-an approach designed to facilitate multi-stakeholder collaboration during treatment planning, 3) provide a case example illustrating how a clinician, youth, and caregiver could use SDM to navigate discrepancies and identify therapy targets, and 4) propose future directions for exploring the potential value of SDM in youth psychotherapy.Different levels of multi-stakeholder agreement were observed when caregivers and youths were asked to identify their treatment priorities, compared to youth symptom presence and severity, revealing nuances in multi-stakeholder agreement in youth psychotherapy.Multi-stakeholder discrepancies can inform treatment planning processes, and SDM may be an effective approach for navigating them and building a treatment plan that integrates the perspective of all stakeholders in youth psychotherapy.

Objective Training lay providers to deliver mental health interventions is both effective and cost-effective. However, more research is needed to document training and supervision procedures and to collect lay providers’ feedback. Methods This study documents training and supervision from a randomized controlled trial of the Shamiri intervention, a four-session, school-based intervention that significantly reduced symptoms of anxiety and depression in Kenyan adolescents. We delivered a 10-hour training to 13 lay providers, M (SD)age = 21.00 (1.95), %female = 61.54. We also hosted 30-minute supervision meetings twice weekly. Training and supervision were delivered primarily by undergraduates. Independent raters coded session recordings for fidelity and quality of services, and we collected quantitative and qualitative feedback from lay providers. Results Reliability and mean ratings for all six of our fidelity and quality measures (delivering required content, adhering to specified details, thoroughness, skillfulness, clarity, and purity) were very good to excellent. Lay provider quantitative ratings of training were also overwhelmingly positive, with an overall satisfaction rating of 6.46/7.00. We identified central qualitative themes in lay provider comments: Generally, comments about training style, content, and personal interactions were overwhelmingly positive, and many lay providers reported personal growth. Comments about timing and location of training were mixed. Conclusions This study provides preliminary evidence that a very brief training delivered primarily by undergraduates can teach high school-graduate lay providers to deliver effective mental health interventions. Additionally, we discuss lessons learned and implications for future research, including the importance of considering local context when planning and of continuously collecting and addressing lay provider feedback.

OBJECTIVE: We examined whether anti-Black cultural racism moderates the efficacy of psychotherapy interventions among youth. METHOD: We analyzed a subset of studies from a previous meta-analysis of five decades of youth psychotherapy randomized controlled trials. Studies were published in English between 1963 and 2017 and identified through a systematic search. The 194 studies (N = 14,081; ages 2–19) across 34 states comprised 2,678 effect sizes (ESs) measuring mental health problems (e.g., depression) targeted by interventions. Anti-Black cultural racism was operationalized using a composite index of 31 items measuring explicit racial attitudes (obtained from publicly available sources; e.g., General Social Survey), aggregated to the state level and linked to the meta-analytic database. Analyses were conducted with samples of majority (i.e., ≥50%) Black (n = 36 studies) and majority-White (n = 158 studies) youth. RESULTS: Two-level random effects meta-regression analyses indicated that higher anti-Black cultural racism was associated with lower ESs for studies with majority-Black youth (β = −0.2, 95% CI: −0.35, −0.04, p = .02) but was unrelated to ESs for studies with majority-White youth (β = 0.0004, 95% CI: −0.03, 0.03, p = .98), controlling for relevant area-level covariates. In studies with majority-Black youth, mean ESs were significantly lower in states with the highest anti-Black cultural racism (>1 SD above the mean; g = 0.19) compared to states with the lowest racism (

Few measures of autism-related symptoms have been established as both psychometrically robust and sensitive to the effects of treatment. In the present study, a personalized measure of autism-related symptoms using the Youth Top Problems (YTP) method (Weisz et al., 2011) was evaluated. Participants included 68 children with diagnoses of autism (ages 6-13 years), and their parents, who were randomized to cognitive behavioral therapy (CBT) or enhanced standard community treatment (ESCT) addressing autism-related symptoms. At pretreatment, parents described their child's top autism-related problems (YTPs) in their own words and rated the severity of these problems on a Likert-type scale. Parents also made daily severity ratings on the child's top three YTPs for 5 days prior to treatment and 5 days following treatment while videorecording their child's behavior at home on each of these days. Trained observers coded these videorecordings, focusing on the same YTPs that the parents rated. Parents also completed standardized checklists of autism-related symptoms and general mental health symptoms. There was evidence of convergent and discriminant validity as well as good test-retest reliability for the YTP measures. YTP severity scores converged with the standardized measure of autism-related symptoms. Parent-reported YTP scores predicted observers' YTP scores at the daily level, and both parent-reported and observers' YTP scores decreased from pre- to post treatment. Observers' ratings of the videorecordings exhibited sensitivity to treatment condition. These applications of the YTP method are promising and may complement standardized symptom checklists for clinical trials focusing on autism-related symptoms. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Background Network analyses have been applied to understand the relationships between individual symptoms of depression and anxiety. However, little is known about which symptoms are most strongly associated with “positive” indicators of mental health, such as happiness. Furthermore, few studies have examined symptom networks in participants from low- and middle-income countries. Methods To address these gaps, we applied network analyses in a sample of Indian adolescents (Study 1; n=1080) and replicated these analyses in a pre-registered study with Kenyan adolescents (Study 2; n=2176). Participants from both samples completed the same measures of depressive symptoms, anxiety symptoms, and happiness. Results Feeling sad and feeling like a failure had the strongest (negative) associations with happiness items. These two symptoms, as well as worrying and feeling nervous, had the strongest associations with other symptoms of depression and anxiety. Symptoms of depression and anxiety formed a single cluster, which was distinct from a cluster of happiness items. Main findings were consistent across the two samples, suggesting a cross-culturally robust pattern. Limitations We used cross-sectional data, and we administered scales assessing a limited subset of symptoms and happiness items. Conclusions Our findings support the idea that some symptoms of depression and anxiety are more strongly associated with happiness. These findings contribute to a body of literature emphasizing the advantages of symptom-level analyses. We discuss how efforts to understand associations between individual symptoms and “positive” mental health indicators, like happiness, could have theoretical and practical implications for clinical psychological science.

Meta-analyses show that psychotherapies are effective in the treatment of depression in children and adolescents. However, these effects are usually reported in terms of effect sizes. For patients and clinicians, it is important to know whether patients achieve a clinically significant improvement or deterioration. We conducted such a meta-analysis to examine response, clinically significant change, clinically significant deterioration and recovery as outcomes. We searched four bibliographic databases and included 40 randomised trials comparing psychotherapy for youth depression against control conditions. We used a validated method to estimate outcome rates, based on means, standard deviation and N at baseline and post-test. We also calculated numbers-need-to- treat (NNT). The overall response rate in psychotherapies at 2 (±1) months after baseline was 39% (95% CI: 34–45) and 24% (95% CI: 0.19–28) in control conditions (NNT: 6.2). The difference between therapy and control was still significant at 6–12 months after baseline (NNT=7.8). Clinically significant improvement was found in 54% of youth in therapy, compared with 32% in control groups (NNT=5.3); clinically significant deterioration was 6% in therapy, 13% in controls (NNT=5.1); recovery was 58% in therapy, 36% in controls (NNT=3.3). Smaller effects were found in studies with low risk of bias. Psychotherapies for depression in youth are effective compared to control conditions, but more than 60% of youth receiving therapy do not respond. More effective treatments and treatment strategies are clearly needed. Trial registrationhttps://osf.io/84xka

Because most youth psychotherapies are developed and tested in high-income countries, relatively little is known about their effectiveness or moderators in low- and middle-income countries (LMICs). To address this gap, we conducted a meta-analysis of randomized controlled trials (RCTs) testing psychotherapies for youth with multiple psychiatric conditions in LMICs, and we tested candidate moderators.We searched nine international databases for RCTs of youth psychotherapies in LMICs published through January 2021. The RCTs targeted elevated symptoms of youth anxiety (including post-traumatic stress disorder [PTSD] and obsessive compulsive disorder [OCD]), depression, conduct, and attention problems. Using robust variance estimation, we estimated the pooled effect sizes (Hedges g) at post-treatment and follow-up for intervention versus control conditions.Of 5,145 articles identified, 34 (with 43 treatment-control comparisons and N=4176 participants) met methodological standards and were included. The overall pooled g with winsorized outliers was 1.01 (95% CI=0.72 1.29, p.001) at post-treatment and 0.68 (95% CI=0.29 1.07, p=.003) at follow-up. Interventions delivered by professional clinicians significantly outperformed those delivered by lay-providers (g=1.59 vs. 0.53). Interventions developed non-locally were more effective if not adapted to local contexts than if adapted locally (g=2.31 vs. 0.66), highlighting a need for further research on effective adaptations. Significant risk of bias was identified.Overall pooled effects of youth psychotherapies in LMICs were markedly larger than those in recent comparable non-LMIC meta-analyses, which have shown small-to-medium effects for youth psychotherapies. Findings highlight the potential benefits of youth psychotherapies in LMICs as well as a need for more RCTs and improved study quality.

Although technical (quality of delivering techniques from a specific treatment) and global (general clinical expertise) competence are believed to be important ingredients of successful psychosocial treatment with youth, there have been few empirical efforts to measure both dimensions. Efforts to understand the role that each competence dimension plays in the process and outcome of youth treatment starts with determining whether the dimensions can be measured separately. This study examined whether scores from measures designed to assess technical and global competence were distinct. Treatment sessions (N = 603) from 38 youths (M age = 9.84 years, SD = 1.65; 60.5% White; 52.6% male) treated for primary anxiety problems within a randomized effectiveness trial were coded. Four coders used observational measures designed to assess technical competence, global competence, protocol adherence, and the alliance. Mean item interrater reliability was .70 (SD = .09) for technical competence and .66 (SD = .05) for global competence. While most components of global competence were distinct from technical competence scores, two components showed redundancy (r > .70). Scores on both competence measures were empirically distinct (r < .70) from scores on measures of protocol adherence and the alliance. Although the measures did not fully distinguish between technical and global competence, our findings do indicate that some components of technical and global competence may provide unique information about competence.

Objective: Cognitive Behavioral Therapy (CBT) was dismantled into four modules of three sessions each: cognitive restructuring (Think), behavioral activation (Act), problem solving (Solve) and relaxation (Relax). We investigated the modules’ relative effectiveness in indicated depression prevention for adolescents and examined variations in sequencing of these modules. Method: We performed a pragmatic cluster-randomized microtrial with four parallel conditions: (1) Think-Act-Relax-Solve (n = 14 clusters, n = 81 participants); (2) Act-Think-Relax-Solve (n = 13, n = 69); (3) Solve-Act-Think-Relax (n = 13, n = 77); and (4) Relax-Solve-Act-Think (n = 12, n = 55). The sample consisted of 282 Dutch adolescents with elevated depressive symptoms (Mage = 13.8; 55.7% girls, 92.9% Dutch). In total 52 treatment groups were randomized as a cluster. Assessments were conducted at baseline, after each module and at 6-month follow-up with depressive symptoms as primary outcome. Results: None of the modules (Think, Act, Solve, Relax) was associated with a significant decrease in depressive symptoms after three sessions and no significant differences in effectiveness were found between the modules. All sequences of modules were associated with a significant decrease in depressive symptoms at post-intervention, except the sequence Relax-Solve-Act-Think. At 6-month follow-up, all sequences showed a significant decrease in depressive symptoms. No significant differences in effectiveness were found between the sequences at post-intervention and 6-month follow-up. Conclusions: Regardless of the CBT technique provided, one module of three sessions may not be sufficient to reduce depressive symptoms. The sequence in which the CBT components cognitive restructuring, behavioral activation, problem solving and relaxation are offered, does not appear to significantly influence outcomes at post- intervention or 6-month follow-up. Abbreviations: CDI-2:F: Children’s Depression Inventory-2 Full-length version; CDI-2:S: Children’s Depression Inventory-2 Short version; STARr: Solve, Think, Act, Relax and repeat.

We examined whether cultural sexism (county- and state-level gender attitudes) moderates the efficacy of psychotherapies by re-analyzing data from a previous meta-analysis of randomized controlled trials of youth psychotherapy for the most commonly targeted problems (depression, anxiety, conduct, attention-deficit hyperactivity disorder; 2,698 effect sizes (ESs);314 studies; N=19,739; ages 4-18). Higher cultural sexism was associated with lower ESs for studies with ³50% girls; this association became stronger as the proportion of girls in thesamples increased. Cultural sexism was unrelated to ESs for studies with >50% boys. An interaction between state- and county-level sexism revealed that psychotherapies were mostbeneficial when they were conducted in states and counties with the lowest cultural sexism. Thus, the context in which psychotherapies are delivered is associated with psychotherapy efficacy for girls.

Background: Research dedicated to youth mental health problems in low – resource countries is an urgent and critical global health priority. Prior to COVID-19, only a handful of studies had estimated the prevalence rates of youth depression and anxiety and identified the associations between these problems with socio-demographic and psychosocial variables. As COVID-19 has emerged as a stressor for youth mental health, new studies on youth mental health during and post COVID-19 may yield important research, policy, and practice implications. Here, we assessed the prevalence of depression and anxiety symptoms and their associations with psychosocial and sociodemographic variables in a large sample of school-going youths in Kenya. Method: Measures of depression (PHQ-8) and anxiety (GAD-7), social support, perseverance, optimism, perceived control, connectedness, happiness, purpose in life, and gratitude were administered to 1,498 Kenyan adolescents (55.47% male) aged 13-to-21 years (M age = 16.33) in mid-2021 when schools re-opened after the COVID–19 school closures. Results: Some 42.46% and 37.56% youths met the clinical cut-off for elevated depression and anxiety symptoms, respectively. Adolescents whose academic performance was not satisfactory endorsed higher depressive and anxiety symptoms. Female adolescents and those who lived with a single parent endorsed higher depressive and anxiety symptoms, respectively. Subjective wellbeing and perceived control were negatively associated with depressive symptoms.Conclusion: The prevalence of depression and anxiety symptoms among Kenyan adolescents has remained steady when compared to pre-pandemic studies. However, symptoms were high when compared to those of adolescents in other countries during COVID-19. This study also identified potential important risk and protective factors.

Objective Discrepancies between caregiver and youth reports of emotional and behavioral symptoms are well-documented, with cross-informant correlations often falling in the low to moderate range. Studies have shown that caregiver-youth (dis)agreement in reporting of youth symptoms is related to treatment outcomes. However, commonly used methods for exploring reporter discrepancies (e.g., difference scores) are limited by their inability to assess discrepancies across multiple symptom domains simultaneously, and thus these previous findings do not explore multiple patterns of (dis)agreement. Method We used latent profile analysis (LPA) to identify subgroups of clinically referred youths based on patterns of caregiver- and youth-reported internalizing and externalizing symptoms for 174 caregiver-youth dyads. Longitudinal multilevel models were used to examine changes in weekly caregiver- and youth-reported internalizing symptoms, externalizing symptoms, and top problems for identified subgroups. Results The LPA identified four latent subgroups: (a) Caregiver Internalizing (9%), (b) Caregiver Internalizing-Externalizing (45%), (c) Youth Internalizing (7%), and (d) Caregiver-Youth Internalizing-Externalizing (39%). Clinical outcomes varied across informants and subgroups. Significant improvements in caregiver- and youth-reported outcome measures were documented within the Caregiver Internalizing, Caregiver Internalizing-Externalizing, and Caregiver-Youth Internalizing-Externalizing subgroups. However, only youth-reported improvements were detected in the Youth Internalizing subgroup. The results show differences in treatment outcomes across caregiver-youth informant subgroups. Conclusions These findings suggest how youth and caregiver baseline data could provide guidance for clinicians in interpreting discrepant reporting and its relevance to change during treatment.

Objective: To evaluate the costs and cost-effectiveness of Shamiri-Digital, an online single-session intervention (SSI) for depression among Kenyan adolescents. Method: Data were drawn from a randomized clinical trial with n = 103 Kenyan high school students (64% female, Mage = 15.5). All students were eligible to participate, regardless of baseline depression symptomatology. We estimated delivery costs in 2020 U.S. dollars from multiple perspectives. To account for uncertainty, we performed sensitivity analyses with different cost assumptions and definitions of effectiveness. Using number needed to treat (NNT) estimates, we also evaluated the cost required to achieve a clinically meaningful reduction in depressive symptoms. Results: In the base-case (the most realistic cost estimate), it costs U.S. $3.57 per student to deliver Shamiri-Digital. Depending on the definition of clinically meaningful improvement, 7.1-9.7 students needed to receive the intervention for one student to experience a clinically meaningful improvement, which translated to a cost of U.S. $25.35 to U.S. $34.62 per student. Under a worst-case scenario (i.e., assuming the highest treatment cost and the strictest effectiveness definition), the cost to achieve clinically meaningful improvement was U.S. $92.05 per student. Conclusions:Shamiri-Digital is a low-cost intervention for reducing depression symptomatology. The public health benefit of empirically supported SSIs is especially important in low-income countries, where funding for mental health care is most limited. Future research can compare the cost-effectiveness of online SSIs to higher-cost treatments and estimate the robustness of Shamiri-Digital's effects over a longer time horizon. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

More than 50 years of randomized clinical trials for youth psychotherapies have resulted in moderate effect sizes for treatments targeting the most common mental health problems in children and adolescents (i.e., anxiety, depression, conduct problems, and attention disorders). Despite having psychotherapies that are effective for many children, there has been a dearth of progress in identifying the contextual factors that likely influence who will respond to a given psychotherapy, and under what conditions. The developmental psychopathology evidence base consistently demonstrates that psychosocial risk exposures (e.g., childhood adversities, interpersonal stressors, family dysfunction) significantly influence the onset and course of youth psychopathology. However, the developmental psychopathology framework remains to be well integrated into treatment development and psychotherapy research. We argue that advances in basic developmental psychopathology research carry promising implications for the design and content of youth psychotherapies. Research probing the effects of psychosocial risks on youth development can enrich efforts to identify contextual factors in psychotherapy effectiveness and to personalize treatment. In this article we review empirically supported and hypothesized influences of individual- and family-level risk factors on youth psychotherapy outcomes, and we propose a framework for leveraging developmental psychopathology to strengthen psychotherapies.

Introduction Studies have found that psychological treatments produce positive clinical outcomes for many problems experienced by youth. However, there is limited research on whether therapist adherence and competence in delivering these treatments are related to differential clinical outcomes. Method We examined the relationship of therapist adherence and competence to clinical outcomes in a sample of 51 youth aged 7-14 years (M age = 10.36, SD = 1.90; 86.3% white; 60.8% male) treated for anxiety disorders with a manualized individual cognitive-behavioral therapy. Adherence and competence were measured via coding of recorded treatment session content and outcomes were measured by caregiver and youth report across multiple timepoints. We used two-level mixed-effects regression models to test the degree to which adherence and competence predicted differential youth clinical outcomes. Results Across multiple caregiver- and child-reported symptom and diagnostic outcomes, we found no statistically significant relationship between adherence or competence and clinical outcomes. Discussion Although there was variability in both treatment integrity and clinical outcome, neither adherence to nor competence in youth anxiety treatment was related to clinical outcomes for youth with anxiety disorders treated with individual cognitive-behavioral treatment (CBT) in a research clinic-based efficacy trial. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Researchers strategically assess youth mental health by soliciting reports from multiple informants. Typically, these informants (e.g., parents, teachers, youth themselves) vary in the social contexts where they observe youth. Decades of research reveal that the most common data conditions produced with this approach consist of discrepancies across informants' reports (i.e.

Objective To examine the frequency of evidence-based treatment elements in popular smartphone apps for eating disorders (EDs), and to characterize the extent to which real-world users encounter different elements. Method We searched the Apple App Store and Google Play Store for apps offering treatment or support to individuals with EDs. Then, we created a codebook of 47 elements found in evidence-based treatments for EDs. We examined the presence or absence of each element within each ED app. We also acquired estimates of the monthly active users (MAU) of each app. Results The ED apps (n = 28) included a median of nine elements of empirically supported treatments (mean = 9.46, SD = 6.28). Four apps accounted for 96% of all MAU. MAU-adjusted analyses revealed that several elements are reaching more users than raw frequency tallies would suggest. For example, assessments were included in 32% of apps, but 84% of users used an app with assessments. Similar trends were found for cognitive restructuring (21% of apps, 56% of MAU), activity scheduling (39%, 57%), and self-monitoring (14%, 46%). Problem solving, exposure, and relapse prevention strategies, elements that are prominent in face-to-face empirically supported treatments, were rarely included in the apps. Discussion Evidence-based content is commonly included in ED apps, with certain elements reaching more users than others. Additionally, the top four apps are responsible for nearly all active users. We recommend that ED clinicians and researchers familiarize themselves with these apps-those that patients are most likely to encounter.

Standardized assessment tools developed in western contexts may systematically miss certain problems that are considered important in non-western cultures. In this mixed-methods study, we used an open-ended assessment tool (the Top Problem Assessment; TPA) to identify culturally relevant concerns among low-income Kenyan youth. We then (a) applied thematic analysis to identify the most frequently reported problems and (b) examined the extent to which these problems were reflected in standardized mental health measures. Using the TPA, we identified common social, academic, and economic problems facing Kenyan youths. Specifically, 61% of the sample reported a social problem, 38% an academic problem, and 35% an economic problem. By contrast, the standardized assessments revealed that worrying and difficulty concentrating were the most commonly reported symptoms. However, the emotional and behavioral problems assessed via the standardized measures were only reported as top problems by 17% of the sample. Overall, our findings are consistent with the idea that standardized measures can miss certain culturally-salient concerns that can be acquired through open-ended assessments. We discuss how brief open-ended assessment tools could complement standardized measures, inform the development of culturally relevant standardized measures, and offer rich data about the experiences of people in understudied cultural contexts.

Our understanding of child, adolescent, and caregiver mental health (MH) problems during the coronavirus pandemic, and which interventions are needed, may be advanced by consumer input. 133 general population caregivers reported top MH problems and needs for themselves and their children (Mage = 8.21; SD = 4.94), using standardized and idiographic measures. We applied linear regression models to quantitative data and thematic analysis to qualitative data. Caregivers’ COVID-era depression and anxiety symptom means fell within the clinical range, as did their children’s MH symptoms. Caregiver-reported child and adolescent symptoms were positively associated with number of children in the home. Caregiver and caregiver-reported child and adolescent symptoms were more pronounced in regions with more lenient COVID-19 restrictions. Among the kinds of help most urgently needed, MH services were ranked #1 for caregivers and adolescents, #2 for 6–12 year-olds, and #3 for 1–5 year-olds. Top problems identified for each age group highlight pressing pandemic-related intervention targets. Electronic supplementary material The online version of this article (10.1007/s10578-020-01089-z) contains supplementary material, which is available to authorized users.

We examined the acceptability, integrity, and symptom trajectories associated with FIRST, a principle-guided treatment for youth internalizing and externalizing problems designed to support efficie...

Leonard Bickman's article on the future of artificial intelligence (AI) in psychotherapy research paints an encouraging picture of the progress to be made in this field. We support his perspective, but we also offer some cautionary notes about the boost AI can provide. We suggest that AI is not likely to transform psychotherapy research or practice to the degree seen in pharmacology and medicine because the factors that contribute to treatment response in these realms differ so markedly from one another, and in ways that do not favor advances in psychotherapy. Despite this limitation, it seems likely that AI will have a beneficial impact, improving empirical analysis through data-driven model development, tools for addressing the limitations of traditional regression methods, and novel means of personalizing treatment. In addition, AI has the potential to augment the reach of the researcher and therapist by expanding our ability to gather data and deliver interventions beyond the confines of the lab or clinical office.

Objective It is difficult for individuals with eating disorders (EDs) to build and maintain motivation to recover. This challenge contributes to high rates of treatment dropout and relapse. To date, motivational interventions have been largely ineffective, and there is little research on factors that affect recovery motivation. To better understand recovery motivation and identify potential intervention targets, this study examines factors that affect recovery motivation in individuals with EDs. Method N = 13 participants completed qualitative interviews. All had been recovered from their diagnosed and treated ED for at least 1 year. We applied thematic analysis to interview transcripts in order to identify factors that had influenced recovery motivation and to classify their effects as helpful, harmful, or mixed. Results Six main themes were identified, with subthemes detailed under each: (a) important people and groups (e.g., social circle, mentor), (b) actions and attitudes of others (e.g., judgmental responses, failure to intervene), (c) treatment-related factors (e.g., therapeutic skills, therapeutic alliance), (d) influential circumstances (e.g., removing triggers, pregnancy/children), (e) personal feelings and beliefs (e.g., obligation to others, hope for the future), and (f) the role of epiphanies (i.e., sudden insights or moments of change). Discussion In this study, we identified potentially malleable factors that may affect ED recovery motivation (e.g., removing triggers, focusing on obligation to others, getting involved in meaningful causes, securing non-judgmental support, building hope for the future). These factors may be investigated as potential targets or strategies in motivational interventions for EDs.

Despite great advancements in the development of evidence-based treatments (EBTs) for youth mental health problems, few EBTs have been adopted by or successfully implemented in schools. This is of ...

Difficulty with emotion regulation is a feature of many mental health disorders, but obsessive-compulsive disorder (OCD) has received only limited attention in this regard. We addressed this gap by examining the use of three emotion regulation strategies — rumination, suppression, and reappraisal — among 176 transitional age (16–24 years) patients receiving intensive treatment for severe OCD. Weekly assessments during treatment showed significant decreases in OCD symptoms, rumination, and suppression and significant increases in reappraisal. Lower levels of OCD symptom severity during treatment were associated with lower mean levels of rumination and higher mean levels of reappraisal. Reduction in OCD symptom severity over the course of treatment was associated with lower mean levels of rumination and with higher mean levels of suppression. These findings highlight the potential relevance of emotion regulation strategy use to OCD treatment process and outcomes, suggesting that strategy use might be made an intentional focus of treatment.