CBM-I interventions
Two studies (Table
2) delivered multisession CBM-I training to young people with clinical depression [
33,
34], reporting small-to-moderate symptom reduction changes in the intervention group (Cohen’s d = 0.02/0.51). There were also small differences post-intervention with the control condition (Cohen’s d = 0.10/0.32). No studies delivered multi-session CBM-I training to young people meeting diagnostic criteria for an anxiety disorder.
Table 2
Promoting helpful interpretation patterns in participants with clinical symptoms (in bold) and high symptom scores (not bold). Where studies do not give separate demographic information for each group, these are combined in a single cell. Where effect sizes were not reported or could not be calculated, these are labelled as Not Reported (NR). Green highlighted rows reflect studies showing large within group symptom reduction and at least medium sized between group effects. Orange highlighted rows reflect studies showing near large within group symptom reduction and small sized or non-reported between group effects
Six studies applied CBM-I to young people with high symptom scores (Table
2). Only one reported large symptom improvement in the CBM-I group, and equally large differences compared to a control condition, with expected changes in interpretational style [
35]. Three studies of general anxiety [
18], social anxiety [
36] and dysphoria [
38] showed medium-sized symptom reduction in the CBM-I group (Cohen’s d = 0.59–0.79) and small between-group differences with various comparison conditions post-intervention (Cohen’s d = 0.12–0.22). Finally, two studies targeting social anxiety [
37] or anxiety/depression [
17] reported small within-group symptom reduction and small post-intervention differences with the comparison condition. However, for one, CBM-I training effects on symptoms were more apparent at 10-weeks (Cohen’s d = 1.60) [
37], with expected changes in positive interpretation.
CR interventions
Seven studies assessed CR techniques within CBT in young people with clinical anxiety and/or depression, as the primary condition or co-morbid with PTSD (Table
2). Three were case series [
39,
43,
81], where no data on symptom measures was reported, or were based on fewer than 5 participants. Two studies targeting anxiety disorders (social anxiety [
41], panic [
40]) showed large reductions in symptoms from pre-to-post intervention in the CR condition. Micco and colleagues [
40] recorded session-to-session change on anxiety, and noted a therapeutic gain following the first session of CR. However, in both studies, there was either no data reported from the (wait-list) control group, or the control group was another active intervention (behavioural activation [
41]), in which case the between-group difference at post-intervention on anxiety symptoms was small. Using CR to target depression, two studies revealed large within-group symptom reduction effects [
42,
44], but only one employed a comparison condition (comprising monitoring and non-specific counselling), and reported a moderate sized post-intervention difference in depressive symptoms [
42].
Nine studies employed CR (within CBT) in young people with high symptom levels. Two assessed CR effects on anxiety symptoms with one finding weak [
45], and the other strong [
46], within-group reduction effects. The study reporting the stronger within-group changes noted a reduction in negative self-statements [
46]. A case series aiming to reduce anxiety symptoms in young people with a chronic health condition [
47] did not report whole-sample mean changes but all 6 participants improved across treatment. For the 6 studies assessing depression symptoms (with one targeting depression in a sample at-risk for a chronic health condition [
27]), 4 reported large within-intervention-group pre-to-post symptom reduction effects and medium-to-large between-group differences with a comparison condition (treatment as usual or attention support) at post-intervention [
42,
48‐
50]. The two other studies reported weak or medium-sized symptom reduction effects [
27,
51]; the one reporting smaller-sized changes assessed this at 4 months [
51] so improvements may have become weak with time.
Nine studies examined standalone CR interventions in young people with high general anxiety/depression symptoms or with specific test, speech or performance anxiety (Table
2). Three noted significant reductions in anxiety measures from pre-to-post-intervention in the CR condition but did not report enough data to calculate effect sizes [
58,
60,
61]. Where effect sizes were reported, within-group symptom reduction were medium to large (Cohen’s d = 0.72–2.43). Two studies that reported large effect sizes also found expected changes in automatic negative thoughts and negative/positive self-statements in the CR group [
52,
62]. Comparisons with waitlist/no-intervention conditions across studies showed weak to large between-group differences at post-intervention. One study noted that individuals with
lower purposeful engagement (the reduced tendency to attend/engage with unpleasant thoughts) benefited more from CR techniques than those receiving the comparison condition [
44].