Coping With Adolescent Peer Victimization and Reducing Anxious/Depressed Symptoms
Condition: Depression; Social Anxiety
MeSH terms: Depression
Study type: Interventional
Phase: Phase 2

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): UTalk
Intervention type(s): Behavioral
Intervention description(s): Prevention intervention delivered in group format adapted from IPT-AST, for adolescents who experience peer victimization and who are at risk for developing social anxiety and depression.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: Social Anxiety; Prevention; Peer Relations; Depression; Adolescent; High School; Interpersonal; Peer Victimization