Clarke Cognitive-Behavioral Prevention Intervention Program: A Promising Indicated Intervention to Prevent Depression
The Clarke Cognitive-Behavioral Prevention Intervention, a 15-session group cognitive-behavioral intervention focused on coping with stress, is modeled after an effective cognitive-behavioral treatment for depression. The first randomized trial targeted adolescents with elevated depressive symptoms and was delivered in schools. At one-year follow-up, intervention participants had a much lower incidence of major depressive disorder or dysthymia (14.5 percent) than participants in the usual care control group (25.7 percent) (Clarke, Hawkins, et al., 1995). A second trial broadened the definition of high-risk adolescents to include parental depression and subsyndromal symptoms and recruited 95 adolescents from a health maintenance organization rather than from classrooms (Clarke, Hornbrook, et al., 2001). At 15-month follow-up, participants in the experimental condition showed a much lower rate of major depressive episodes (9.3 percent) than those in the usual care condition (28.8 percent) (p = .003). These results were recently replicated in a four-site randomized trial involving 316 at-risk youths (Garber, Clarke, et al., 2007, in press). Parental depression at the beginning of the intervention significantly moderated the effect, however; thus adolescents who had a parent with current depression did not experience a significant reduction in rates of incident depression versus those receiving usual care. Further follow-up of this sample is under way.
Many of the interventions discussed in Chapter 6 have had effects on outcomes related to substance abuse. Additional intervention strategies specifically targeting prevention of substance abuse are discussed here. School-based programs with this focus emerge primarily in the middle school years, when initial risk for use is greatest.
Cuijpers (2002) reviewed three meta-analyses of classroom-based substance abuse prevention programs (Rooney and Murray, 1996; Tobler, Roona, et al., 2000; White and Pitts, 1998) and a set of studies that analyzed mediators of the effects of these programs. Their synthesis led to six conclusions about effective programs. First, programs that involve interactions among participants and encourage them to learn drug refusal skills are more effective than noninteractive programs. Second, interventions that focus on direct and indirect (e.g., media) influences on use of drugs appear to be more effective than those that do not focus on social influences.