Op Volle Kracht: An intervention to increase emotional resilience among youth in residential treatment centers

Adolescents admitted to residential treatment in youth care and youth mental
health care often show complex combinations of internalizing (anxiety,
depression, somatization) and externalizing problems (agression, oppositional
behaviour, substance abuse etc), and there is some evidence that internalizing
problems play a causal role in the development of externalizing problems. A
systematic approach to internalizing problems in residential youth welfare
system and youth mental health care is expected to improve treatment outcomes
and adolescents' developmental perspective (Granic, 2012). Currently, such a
systematic approach is lacking and internalizing problems are often
underrecognized and undertreated.
The aim of this study is to test the effectiveness of a CBT-based group program
aimed to increase adolescents' emotional resilience by training them in using
positive cognitive styles and attributions, and to prevent development of
clinical levels of anxiety and depression on a long-term perspective. The
program will be delivered by trained social workers and nurses and treatment
will be integrated within the therapeutic climate on the treatment group.

Main:
1. To investigate whether a short term CBT-based group program is more
effective in reducing symptoms of depression and anxiety than treatment as
usual (TAU), among adolescents aged 10-16 within residential treatment settings
in the youth welfare system and youth mental health care.
Secondary:
2. To investigate whether a short term CBT-based group prevention program is
more effective in changing adolescents cognitive- and response styles than
treatment as usual (TAU), among adolescents aged 12-16 within residential
treatment settings in the youth welfare system and youth mental health care.
3. To investigate the effects of the intervention on the treatments group
therapeutic climate
4. To investigate the role of possible mediators (e.g. cognitive styles, coping
styles) and moderators (e.g. setting, intelligence, gender) .

Open matched-pair cluster randomised study with blinded raters

Explanation:
Within the residential treatment settings in the Netherlands, adolescents
usually reside in treatment groups of 8-10 clients each. Randomization is based
on these natural treatment groups: each of the 20 groups is matched to another
group with a similar population (MID/ non-MID, age, sex), within the same
setting (youth mental health care, the youth welfare system, care for youth
with MID). Within each pair one group will be randomly assigned to the
intervention condition, and one group will be assigned to the TAU-condition.

84 subjects receive 8 sessions of the program *Op Volle Kracht* (*At Full
strength*; an adapted version of the Penn Resiliency Program), 84 subjects
receive treatment as usual (TAU).

Description intervention program (Op Volle Kracht):
Adolescents will receive eight 45-minute group-sessions of the OVK-program
within a period of 10 weeks. Within the sessions, adolescents are trained in
the following cognitive-behavioural skills:
-to recognize and describe their feelings and thoughts
- to detect inaccurate thoughts
- to evaluate the accuracy of inaccurate thoughts
- to challenge inaccurate thoughts by considering alternative interpretations.
The sessions include group talks, individual- and group exercises, and video
fragments. After each session, adolescents are assigned a homework task that
takes approximately 15 minutes.

Within the residential treatment settings in the Netherlands, adolescents
usually reside in treatment groups of 8-10 clients each, and treatment is
delivered by a permanent team of nurses and social workers.
Adolescents will receive the OVK-program wihtin these natural treatment groups
and the program will be delivered by trained nurses and social workers from the
team.

The burden for the subjects consists of three assessments (pre- and
post-treatment, follow up) and the intervention itself consisting of 8 sessions
for 45 minutes, and weekly homework tasks that take approximately 15 minutes.
Adolescents and their parents are asked to report depressive symptoms and
suicidal ideation; they run the risk to be faced with unexpected adverse
results based on these assessments (e.g. evidence for clinical depression or
anxiety, the presence of suicidal ideation). Risks and side effects of the
intervention itself are not expected.

The benefit involves of the a priori chance of positive effect of the OVK
intervention on symtoms of anxiety and depression, to increase adolescents
emotional resilience and to prevent clinical levels of anxiety and depression.
Because research shows that strategies to alter cognitive styles and to prevent
depression are most effective in young adolescents, adolescent aged 12-16 years
will form the target population of this study.
Adolescents with mild intellectual disability are included because they are at
higher risk to develop clinical levels of internalizing problems as compared to
their non-disabled peers.