Coping With Adolescent Peer Victimization and Reducing Anxious/Depressed Symptoms
| Status: | Completed |
|---|---|
| Conditions: | Anxiety, Depression, Depression, Healthy Studies |
| Therapuetic Areas: | Psychiatry / Psychology, Other |
| Healthy: | No |
| Age Range: | 13 - 18 |
| Updated: | 4/21/2016 |
| Start Date: | June 2012 |
| End Date: | June 2015 |
Among adolescents, SAD and depression are prevalent, highly comorbid, and can be chronic and
impairing. Interpersonal peer victimization (IPV) is a key stressor that contributes to both
social anxiety and depression in adolescents; it includes relational (e.g., social
exclusion) and reputational (e.g., spreading rumors) forms of peer victimization. Currently,
there are no preventive interventions for adolescent SAD. Also, effective preventive
interventions for adolescents have not yet integrated a focus on both social anxiety and
depression or targeted specific peer risk factors. Interventions for depression and for
bullying have not addressed IPV, which is less observable than overt victimization (e.g.,
threats, physical acts).
Thus, the Peers Emotions and Relationships (PEERS/UTalk) intervention, will take an
integrated approach to reducing risk for SAD and depression by modifying and adapting an
evidence-based intervention for depression, Interpersonal Psychotherapy- Adolescents Skills
Training (IPT-AST), that focuses on improving interpersonal skills and managing conflict. We
will add a) elements of anxiety-based treatments (e.g., exposures) and b) strategies for
handling challenging peer experiences. PEERS/UTalk will have a positive focus and will
target adolescents who report elevated symptoms of social anxiety and/or depression and high
levels of IPV.
Following are the aims and hypotheses of the Pilot-Randomized Controlled Trial:
Aim: Evaluate PEERS/UTalk. We will screen adolescents and conduct a pilot randomized trial
of PEERS (U Talk) versus an Education/Support (ES) condition with up to 60 "high-risk"
adolescents.
Hypothesis 1: Both PEERS/UTalk and ES conditions will demonstrate: (a) feasibility via rates
of participation and study completion, (b) intervention credibility via adolescents' ratings
of acceptability and satisfaction, and (c) high rates of clinician fidelity to the
respective manuals.
Hypothesis 2: Adolescents randomized to PEERS/UTalk will show improvements in primary
outcomes (less IPV, fewer symptoms of social anxiety and depression, improved clinician
ratings) relative to those in the ES condition.
Hypothesis 3: The benefits of PEERS/UTalk over ES will be apparent on the secondary outcomes
of increased quality of close friendships, increased peer support.
Exploratory Aims: We will examine: (1) the durability and persistence of PEERS/UTalk
intervention effects versus ES on primary outcomes at 6-month follow-up and (2) potential
moderators of response to the PEERS/UTalk intervention, recognizing that there are power
limitations in doing so.
impairing. Interpersonal peer victimization (IPV) is a key stressor that contributes to both
social anxiety and depression in adolescents; it includes relational (e.g., social
exclusion) and reputational (e.g., spreading rumors) forms of peer victimization. Currently,
there are no preventive interventions for adolescent SAD. Also, effective preventive
interventions for adolescents have not yet integrated a focus on both social anxiety and
depression or targeted specific peer risk factors. Interventions for depression and for
bullying have not addressed IPV, which is less observable than overt victimization (e.g.,
threats, physical acts).
Thus, the Peers Emotions and Relationships (PEERS/UTalk) intervention, will take an
integrated approach to reducing risk for SAD and depression by modifying and adapting an
evidence-based intervention for depression, Interpersonal Psychotherapy- Adolescents Skills
Training (IPT-AST), that focuses on improving interpersonal skills and managing conflict. We
will add a) elements of anxiety-based treatments (e.g., exposures) and b) strategies for
handling challenging peer experiences. PEERS/UTalk will have a positive focus and will
target adolescents who report elevated symptoms of social anxiety and/or depression and high
levels of IPV.
Following are the aims and hypotheses of the Pilot-Randomized Controlled Trial:
Aim: Evaluate PEERS/UTalk. We will screen adolescents and conduct a pilot randomized trial
of PEERS (U Talk) versus an Education/Support (ES) condition with up to 60 "high-risk"
adolescents.
Hypothesis 1: Both PEERS/UTalk and ES conditions will demonstrate: (a) feasibility via rates
of participation and study completion, (b) intervention credibility via adolescents' ratings
of acceptability and satisfaction, and (c) high rates of clinician fidelity to the
respective manuals.
Hypothesis 2: Adolescents randomized to PEERS/UTalk will show improvements in primary
outcomes (less IPV, fewer symptoms of social anxiety and depression, improved clinician
ratings) relative to those in the ES condition.
Hypothesis 3: The benefits of PEERS/UTalk over ES will be apparent on the secondary outcomes
of increased quality of close friendships, increased peer support.
Exploratory Aims: We will examine: (1) the durability and persistence of PEERS/UTalk
intervention effects versus ES on primary outcomes at 6-month follow-up and (2) potential
moderators of response to the PEERS/UTalk intervention, recognizing that there are power
limitations in doing so.
Participants in the Pilot-Randomized Controlled Trial (P-RCT) will be provided with
PEERS/UTalk or an Education/Support (ES) control condition, and will receive up to 3
individual and up to 10 group sessions of either. Clinicians will be clinical postdoctoral
trainee or doctoral students in clinical psychology with specialized training in
evidence-based treatments for youth and experience working with child populations; all
clinicians will receive intensive training on the PEERS/UTalk intervention prior to the
P-RCT. The research-specific intervention is conceptualized as a preventive intervention,
with the possibility of altering the length of the program as needed. The intent is to
develop PEERS/UTalk so that it fits within a 60-90 minute period that meets about once a
week, during one school semester, or could potentially be conducted as an after-school
"club." As is typical of adolescent school-based prevention programs, the groups will be
co-ed.
The PEERS/UTalk intervention will consist of the following: The first 2 sessions will be
conducted individually, during school, and be modeled on procedures used in Interpersonal
Psychotherapy - Adolescent Skills Training (IPT-AST), which are further modified to address
issues of social anxiety and of IPV. The first 2 sessions are about 45-60 minutes long; a
clinician meets with each adolescent to assess PV experiences and socially anxious and
depressive symptoms, provides a framework for the group, and conducts an abbreviated
interpersonal inventory. The interpersonal inventory is a clinical interview in which the
clinician and adolescent review significant peer and other relationships looking for
strengths as well as problems and patterns of communication and problem-solving; we have
adapted this interview to incorporate IPV experiences and how they influence the
adolescent's feelings of social anxiety or depressive symptoms. Together the adolescent and
clinician identify interpersonal goals for the group. An inventory of IPV experiences that
are challenging for adolescents will also be obtained. The next sessions (up to 10) will be
group-sessions (up to 8 adolescents per group) and will incorporate key elements of IPT-AST
(modified to integrate strategies for social anxiety, taken from the Unified Protocol for
the Treatment of Emotional Disorders in Youth [UP-Y]); these treatment elements will be
adapted to include examples of IPV experiences and strategies for handling them. We plan to
build on the IPT-AST intervention model because of its focus on improving interpersonal
relations and enhancing social skills and supportive relationships. However, we also plan to
incorporate strategies from the UP-Y to help teens manage social anxiety; and for all
sessions we will cover both social anxiety and depressive feelings and adjust the examples,
exercises, and homework assignments so that they incorporate strategies for handling IPV
experiences. We also will review the Miami-Dade County Public Schools bullying policy so
adolescents know how to handle more serious events, should they arise. Specifically, the
first group session will educate members about the symptoms of social anxiety and
depression, outline interpersonal problem areas and IPV experiences, and discuss the
relationship between feelings and interpersonal interactions. During session 2, discussion
and activities help adolescents understand the impact of their words and actions on others,
and the feelings that result from a given interaction, including IPV experiences. In session
3, adolescents are introduced to different communication and interpersonal strategies (using
"I feel statements", finding the right time to have a conversation) and practice these
skills by role-playing hypothetical situations, including ones that involve IPV (e.g.,
social exclusion, handling an embarrassing situation). In sessions 4-6, group members apply
the interpersonal strategies to different relationships in their lives, particularly peer
relationships that are linked to IPV experiences and to socially anxious and depressive
symptoms. The group also discusses how these techniques can help the adolescents develop new
relationships. Adolescents try these techniques outside of group and report back about how
the interactions went. Session 7 is devoted to practicing exposure to social situations that
are associated with uncomfortable feelings, particularly those occurring in an interpersonal
context. Adolescents learn about positive friendship qualities and discuss how to identify
these characteristics in others. In session 8, adolescents discuss peer and cyber
victimization, as well as how to handle challenging peer situations. During group sessions
9-10, the group reviews the strategies learned and changes that have occurred in the
adolescents' relationships and symptoms. Group members are encouraged to continue the
interpersonal work on their own.
PEERS/UTalk or an Education/Support (ES) control condition, and will receive up to 3
individual and up to 10 group sessions of either. Clinicians will be clinical postdoctoral
trainee or doctoral students in clinical psychology with specialized training in
evidence-based treatments for youth and experience working with child populations; all
clinicians will receive intensive training on the PEERS/UTalk intervention prior to the
P-RCT. The research-specific intervention is conceptualized as a preventive intervention,
with the possibility of altering the length of the program as needed. The intent is to
develop PEERS/UTalk so that it fits within a 60-90 minute period that meets about once a
week, during one school semester, or could potentially be conducted as an after-school
"club." As is typical of adolescent school-based prevention programs, the groups will be
co-ed.
The PEERS/UTalk intervention will consist of the following: The first 2 sessions will be
conducted individually, during school, and be modeled on procedures used in Interpersonal
Psychotherapy - Adolescent Skills Training (IPT-AST), which are further modified to address
issues of social anxiety and of IPV. The first 2 sessions are about 45-60 minutes long; a
clinician meets with each adolescent to assess PV experiences and socially anxious and
depressive symptoms, provides a framework for the group, and conducts an abbreviated
interpersonal inventory. The interpersonal inventory is a clinical interview in which the
clinician and adolescent review significant peer and other relationships looking for
strengths as well as problems and patterns of communication and problem-solving; we have
adapted this interview to incorporate IPV experiences and how they influence the
adolescent's feelings of social anxiety or depressive symptoms. Together the adolescent and
clinician identify interpersonal goals for the group. An inventory of IPV experiences that
are challenging for adolescents will also be obtained. The next sessions (up to 10) will be
group-sessions (up to 8 adolescents per group) and will incorporate key elements of IPT-AST
(modified to integrate strategies for social anxiety, taken from the Unified Protocol for
the Treatment of Emotional Disorders in Youth [UP-Y]); these treatment elements will be
adapted to include examples of IPV experiences and strategies for handling them. We plan to
build on the IPT-AST intervention model because of its focus on improving interpersonal
relations and enhancing social skills and supportive relationships. However, we also plan to
incorporate strategies from the UP-Y to help teens manage social anxiety; and for all
sessions we will cover both social anxiety and depressive feelings and adjust the examples,
exercises, and homework assignments so that they incorporate strategies for handling IPV
experiences. We also will review the Miami-Dade County Public Schools bullying policy so
adolescents know how to handle more serious events, should they arise. Specifically, the
first group session will educate members about the symptoms of social anxiety and
depression, outline interpersonal problem areas and IPV experiences, and discuss the
relationship between feelings and interpersonal interactions. During session 2, discussion
and activities help adolescents understand the impact of their words and actions on others,
and the feelings that result from a given interaction, including IPV experiences. In session
3, adolescents are introduced to different communication and interpersonal strategies (using
"I feel statements", finding the right time to have a conversation) and practice these
skills by role-playing hypothetical situations, including ones that involve IPV (e.g.,
social exclusion, handling an embarrassing situation). In sessions 4-6, group members apply
the interpersonal strategies to different relationships in their lives, particularly peer
relationships that are linked to IPV experiences and to socially anxious and depressive
symptoms. The group also discusses how these techniques can help the adolescents develop new
relationships. Adolescents try these techniques outside of group and report back about how
the interactions went. Session 7 is devoted to practicing exposure to social situations that
are associated with uncomfortable feelings, particularly those occurring in an interpersonal
context. Adolescents learn about positive friendship qualities and discuss how to identify
these characteristics in others. In session 8, adolescents discuss peer and cyber
victimization, as well as how to handle challenging peer situations. During group sessions
9-10, the group reviews the strategies learned and changes that have occurred in the
adolescents' relationships and symptoms. Group members are encouraged to continue the
interpersonal work on their own.
Inclusion Criteria:
- Male and female adolescents, ages 13-18 years (inclusive) and in grades 9, 10, or 11.
- Participants must be sufficiently fluent in English (by their own self-report) to
complete measures and intervention programs in this language.
- Participants must report elevated levels of relational PV and/or reputational PV on
screening measures (R-PEQ); i.e., adolescents must obtain a total score > or = to 6
on the relational and/or reputational subscales of the R-PEQ.
- Participants must report symptoms of social anxiety and/or depression that exceed
clinical cutoffs on the Social Anxiety Scale for Adolescents (SAS-A > or = to 50) or
the Center for Epidemiologic Studies-Depression Scale (CES-D > or = to 16).
Exclusion Criteria:
- Enrollment in special education services (e.g., for learning disabilities, mental
retardation, pervasive developmental disorder).
- Adolescents must not exceed clinical cutoffs (t score > 63) on the Aggression
Subscale of the Youth Self Report (YSR).
- Adolescents must not report elevated levels (score >6) on the overt peer
victimization scale of the R-PEQ.
- Adolescents must not currently meet diagnostic criteria for a social anxiety or
depressive disorder as determined by the Anxiety Disorders Schedule for Children
(ADIS-IV-C).
- Adolescents must not currently meet criteria for PTSD, bipolar disorder, psychosis,
or an eating, substance use, or conduct disorder on the ADIS-IV-C.
- Adolescents must not endorse active suicidal items on the Columbia Suicide Severity
Rating Scale (C-SSRS).
- Adolescents must not be currently receiving treatment for social anxiety or
depressive disorder.
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