A IPT-A meets four essential conditions that permit its inclusion as an efficacious treatment: 1. The treatment is manual-based. The sample characteristics are detailed; 3. The treatment has been tested in a randomized clinical trial and 4. At least two different investigator teams demonstrated the interventions effects (Rossello and Bernal, 1999). The initial open trial conducted by Mufson and colleagues (2004) had two phases. In the first phase, the treatment was modified to meet the needs of an adolescent population and was standardized in a treatment manual.
In the second phase, 14 depressed adolescents (ages 12-18) entered a 12-week open clinical trial of IPT-A. Subjects were assessed using a semi-structured diagnostic interview, self-report and clinician-administered instruments at six time points: evaluation week and weeks 0, 2, 4, 8 and 12. At termination, the adolescents reported a significant decrease in depressive symptomatology and an improvement in interpersonal functioning. None of the subjects met criteria for any depressive disorder at the conclusion of the study.
In a follow-up analysis conducted with 10 of the 14 adolescents one year after the initial study, the adolescents were found to have maintained their state of recovery from depression. Only one of the adolescents (10%) who participated in the follow-up study was suffering from an affective disorder at that time. The majority of the subjects reported few depressive symptoms and had maintained their improvement in social functioning.
There were no reported hospitalizations or suicide attempts since the completion of treatment and all were attending school regularly (Mufson &Fairbanks, 1996). Although this study was based on a very small sample size, it provided preliminary support for the use of IPT-A. Subsequent work has shown IPT-A to be effective in the treatment of major depressive disorders in adolescents, randomly assigned to IPT-A or clinical monitoring (10). Significantly more IPT-A patients completed treatment.
In addition, IPT-A patients reported fewer depressive symptoms, improved overall social functioning and better skills in certain areas of social problem- solving skills. Rossello and Bernal (1999), who used a different modification of the adult manual, found that 82% of the adolescents receiving IPT compared to 52% of the adolescents receiving CBT met recovery criteria by the end of treatment. Both IPT and CBT were significantly better than the waitlist condition for decreasing depression symptoms.
A recent effectiveness study has compared IPT-A to treatment as usual (TAU) in the school-based health clinics in New York City as delivered by the clinicians employed in the school-based clinics (Mufson et al. , 2004). Treatment as usual consisted of the psychological treatment the adolescents would have received had the study not been in place (generally, supportive, individual counseling). Adolescents treated with IPTA compared to TAU showed greater symptom reduction, significantly better social functioning, and greater decrease in clinical severity of depression and improvement in overall functioning.
In addition, the study demonstrated the ability to train community clinicians to deliver IPT-A effectively using a streamlined therapy training program and similarly demonstrated the transportability of IPT-A from the university lab setting to the community (Mufson et al. , 2004). Conclusions IPT-A is a focused and brief therapy for depressed adolescents. IPT-A has been found to be both efficacious and effective in several therapeutic settings. It is important to emphasize that we do not think IPT-A is the only therapy for depressed adolescents and might not even be the best one for all patients.
However, it is important for a therapist to be trained in IPT-A and to be able to use it whenever appropriate. The group adaptation (IPT-AG) may be another cost-effective option since it allows staff and clinics to meet the needs of more patients without additional personnel or more clinical hours.
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