Potential Mediators of Cognitive-Behavioral Therapy for Adolescents With Comorbid Major Depression and Conduct Disorder

Several possible mediators of a group cognitive-behavioral therapy (CBT) for depressed adolescents were examined. Six measures specific to CBT (e.g., negative cognitions, engagement in pleasurable activities) and 2 nonspecific measures (therapeutic alliance, group cohesion) were examined in 93 adolescents with comorbid major depressive disorder and conduct disorder who were randomly assigned to the Adolescent Coping With Depression (CWD-A) course or a life skills control condition. Change on the Automatic Thoughts Questionnaire ( S. D. Hollon & P. C. Kendall, 1980 ) appeared to mediate treatment effects on depressive symptoms. Therapeutic alliance by the 3rd session was higher among the CWD-A participants but did not predict reductions in depressive symptoms. Findings suggest that reducing negative thinking may be the primary mechanism through which the CWD-A intervention reduces depression.