Treating Self-criticism in Adolescents: a Study With Single-case Experimental Design

Study Overview
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Brief Summary
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In this pilot study, the effect of a group intervention targeting self-criticism in adolescents in a clinical child- and adolescent psychiatric outpatient setting will be examined using a single-case experimental design (AB). Participants will be randomized to multiple baseline with weekly measures. Our primary outcomes, measured weekly, are self-criticism, nonsuicidal self-injury and symptoms of depression and anxiety, as well as an individually chosen behavior driven by self-criticism. Secondary outcomes are self-compassion, psychological flexibility, quality of life and functioning. In addition to the weekly administered questionnaires, before and after measures, and 3- and 6-month follow-up will be collected. After the treatment, participants will also be interviewed about their experiences of targeting self-criticism.

Official Title
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Treating Self-criticism in Adolescents: a Study With Single-case Experimental Design

Conditions
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Adolescent - Emotional Problem, Adolescent Problem Behavior, Nonsuicidal Self Injury, Depressive Symptoms, Anxiety, Self-Criticism

Intervention / Treatment
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* Behavioral: Treating self-criticism


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient at the child- and adolescent psychiatric clinic in Linköping, Sweden. 15 to 18 years an adequate understanding of the Swedish language cognitively capable of giving informed consent scoring 26 or above on subscale Inadequate self and 8.5 or above on subscale Hated Self on questionnaire Forms of Self-Criticism and Self-Reassuring Scale (FSCRS) the treatment is transdiagnostic so all diagnoses are included (See exclusion criteria for exceptions). Exclusion Criteria: severe anorexia, BMI ≤ 16 ongoing substance abuse diagnosed intellectual disability needing interpreter for translation of Swedish language participants who cannot give informed consent

Ages Eligible for Study
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Minimum Age: 15 Years
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: Single-case experimental design
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Treating self-criticism<br>8-session group intervention targeting self-criticism given 2-hrs/week with booster session after 3-months. | Behavioral: Treating self-criticism<br>* A psychological treatment given i a group format targeting self-criticism. The treatment is based on treatment principles from Cognitive behavior therapy, Self-compassion, Acceptance and Commitment Therapy and also contains psychoeducation. The group treatment consists of 8 sessions delivered once a week for 2 hrs during 8 weeks in a child- and adolescent psychiatric outpatient setting.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Self-criticism | Forms of Self-Criticism and Self-Reassuring Scale (FSCRS; Gilbert et al., 2004) | Change from baseline (phase A) at intervention (phase B) 8 weeks, and at 3- and 6- months | 
| Symptoms of depression | Montgomery Åsberg Depression Rating Scale, self-report version (MADRS-S; Montgomery et al., 1979). | Change from baseline (phase A) at intervention (phase B) 8 weeks, and at 3- and 6- months | 
| Symptoms of anxiety | Liebowitz Social Anxiety Scale, self-report (LSAS; Liebowitz, 1987) | Change from baseline (phase A) at intervention (phase B) 8 weeks, and at 3- and 6- months | 
| Nonsuicidal self-injury | Selected items from Self-Injurious Thoughts and Behaviors interview (SITBI; Nock et al., 2007), Deliberate self-harm inventory (DSHI; Gratz et al., 2001) och Clinician Administered Nonsuicidal self-injury Disorder Interview (CANDI; Gratz et al., 2015) | Change from baseline (phase A) at intervention (phase B) 8 weeks, and at 3- and 6- months | 
| Individually chosen behavior | A behavior driven by self-criticism | Change from baseline (phase A) at intervention (phase B) 8 weeks, and at 3- and 6- months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Self-Compassion | Self-Compassion Scale, short form (SCS; Raes et al., 2011) | Change from before to after intervention, and at 3- and 6- month follow-up | 
| Psychological flexibility | Avoidance and Fusion Questionnaire for Youth (AFQ-Y8; Greco et al., 2008). | Change from before to after intervention, and at 3- and 6- month follow-up | 
| Quality of life and functioning | The Work and Social Adjustment Scale, youth version (WSAS-Y; Mundt et al., 2002). | Change from before to after intervention, and at 3- and 6- month follow-up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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adolescents, self-criticism, group intervention, single-case experimental design