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Child & Youth Care Forum

, Volume 48, Issue 1, pp 29–53 | Cite as

An Open Trial Applying the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) Adapted as a School-Based Prevention Program

  • Julia García-Escalera
  • Paloma ChorotEmail author
  • Bonifacio Sandín
  • Jill Ehrenreich-May
  • Antonio Prieto
  • Rosa M. Valiente
Original Paper
  • 125 Downloads

Abstract

Background

Anxiety and depressive disorders in adolescents have an enormous burden worldwide due to their high prevalence and disability. Despite the high comorbidity between these disorders, preventive interventions have often been developed separately for anxiety and depression.

Objective

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A; Ehrenreich-May et al. in Unified protocols for transdiagnostic treatment of emotional disorders in children and adolescents, Oxford University Press, New York, 2018), a transdiagnostic treatment that targets core dysfunctions associated with anxiety and depression within a single protocol, was adapted as a universal preventive anxiety and depression program for the purposes of this investigation. The subsequent study of this adapted protocol evaluated pre- to post-intervention changes across a range of primary and secondary outcome measures. The secondary aims of this study were to assess the acceptability and feasibility of the adapted UP-A.

Methods

Twenty-eight students (mean age = 14.67; SD = 0.87) participated in this uncontrolled trial conducted in Madrid, Spain. The program included nine weekly 55-min sessions administered in a school setting by an advanced doctoral student in clinical psychology to two groups of 15 and 13 students, respectively.

Results

Intent-to-treat analyses revealed significant declines in self-reported anxiety symptoms, interference of anxiety and depression, and top problems’ mean severity. Moderate to high participant satisfaction was indicated.

Conclusions

The initial promising findings suggest that future trials of the UP-A adapted as a school-based universal anxiety and depression prevention program using a larger sample size are warranted. However, the results of this study should be interpreted cautiously due to limitations regarding the small sample size as well as the lack of a control group and a follow-up period. Suggestions are provided as to how the intervention might be refined in content and delivery.

Keywords

Universal prevention Unified Protocol Transdiagnostic Adolescents Anxiety Depression 

Notes

Acknowledgements

The authors would like to thank the Secondary School that participated in the study (IES Jaime Vera, Madrid, Spain), it’s teachers, students, the school principal (Dimás Rodríguez Perdomo) and the school counselor (María Teresa Andreu Escaño).

Funding

This work is supported by: (1) The Spanish Ministry of Economy, Industry and Competitiveness [Ministerio de Economía, Industria y Competitividad], Grant #PSI2013-4480-P to authors BS, PC, and RMV; (2) the Spanish Ministry of Education, Culture and Sport [Ministerio de Educación, Cultura y Deporte], Grant #FPU13/03315 to author JGE and Grant #FPU13/05914 to author AP. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research Involving Human Participants

All procedures performed in the study were in accordance with national and institutional ethical standards for research with human subjects and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was granted ethical approval from the Research Ethics Committee of Universidad Nacional de Educación a Distancia, Madrid, Spain. The study is registered at Clinicaltrials.gov (NCT03123991).

Informed Consent

All parents or guardians as well as adolescent participants provided written informed consent.

References

  1. Ahlen, J., Lenhard, F., & Ghaderi, A. (2015). Universal prevention for anxiety and depressive symptoms in children: A meta-analysis of randomized and cluster-randomized trials. The Journal of Primary Prevention, 36(6), 387–403.  https://doi.org/10.1007/s10935-015-0405-4.Google Scholar
  2. Anderson, E. R., & Hope, D. A. (2008). A review of the tripartite model for understanding the link between anxiety and depression in youth. Clinical Psychology Review, 28(2), 275–287.  https://doi.org/10.1016/j.cpr.2007.05.004.Google Scholar
  3. Axelson, D. A., & Birmaher, B. (2001). Relation between anxiety and depressive disorders in childhood and adolescence. Depression and Anxiety, 14(2), 67–78.  https://doi.org/10.1002/da.1048.Google Scholar
  4. Balázs, J., Miklósi, M., Keresztény, Á., Hoven, C. W., Carli, V., Wasserman, C., et al. (2013). Adolescent subthreshold-depression and anxiety: Psychopathology, functional impairment and increased suicide risk. Journal of Child Psychology and Psychiatry, 54(6), 670–677.  https://doi.org/10.1111/jcpp.12016.Google Scholar
  5. Barlow, D. H., & Farchione, T. J. (Eds.). (2017). Applications of the unified protocol for transdiagnostic treatment of emotional disorders. New York: Oxford University Press.Google Scholar
  6. Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Murray-Latin, H., Sauer-Zavala, S., et al. (2017). The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders. A randomized controlled trial. JAMA Psychiatry, 74(9), 875–884.  https://doi.org/10.1001/jamapsychiatry.2017.2164.Google Scholar
  7. Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Allen, L. B., et al. (2011). Unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. New York: Oxford University Press.Google Scholar
  8. Bastounis, A., Callaghan, P., Lykomitrou, F., Aubeeluck, A., & Michail, M. (2017). Exploring students’ participation in universal, depression and anxiety, prevention programmes at school: A meta-aggregation. School Mental Health, 9(4), 372–385.  https://doi.org/10.1007/s12310-017-9230-7.Google Scholar
  9. Becker, K. D., Brandt, N. E., Stephan, S. H., & Chorpita, B. F. (2014). A review of educational outcomes in the children’s mental health treatment literature. Advances in School Mental Health Promotion, 7(1), 5–23.  https://doi.org/10.1080/1754730X.2013.851980.Google Scholar
  10. Becker, K. D., & Domitrovich, C. E. (2011). The conceptualization, integration, and support of evidence-based interventions in the schools. School Psychology Review, 40(4), 582–589.Google Scholar
  11. Bentley, K. H., Boettcher, H., Bullis, J. R., Carl, J. R., Conklin, L. R., Sauer-Zavala, S., et al. (2017). Development of a single-session, transdiagnostic preventive intervention for young adults at risk for emotional disorders. Behavior Modification, 41, 01–25.  https://doi.org/10.1177/0145445517734354.Google Scholar
  12. Bishop, D. C., Pankratz, M. M., Hansen, W. B., Albritton, J., Albritton, L., & Strack, J. (2014). Measuring fidelity and adaptation: Reliability of an instrument for school-based prevention programs. Evaluation and the Health Professions, 37(2), 231–257.  https://doi.org/10.1177/0163278713476882.Google Scholar
  13. Brunwasser, S. M., Gillham, J. E., & Kim, E. S. (2009). A meta-analytic review of the penn resiliency program’s effect on depressive symptoms. Journal of Consulting and Clinical Psychology, 77(6), 1042–1054.  https://doi.org/10.1037/a0017671.Google Scholar
  14. Calkins, S. D. (2010). Psychobiological models of adolescent risk: Implications for prevention and intervention. Developmental Psychobiology, 52(3), 213–215.  https://doi.org/10.1002/dev.20435.Google Scholar
  15. Chorot, P., Magaz, A., Valiente, R., & Sandín, B. (2013). Estilos de crianza y vulnerabilidad psicopatológica [Parenting styles and vulnerability to psycholopathology]. Paper presented at the Symposium Nacional de Psicología Clínica y de la Salud en Niños y Adolescentes; Elche (Spain).Google Scholar
  16. Corrieri, S., Heider, D., Conrad, I., Blume, A., Konig, H. H., & Riedel-Heller, S. G. (2014). School-based prevention programs for depression and anxiety in adolescence: A systematic review. Health Promotion International, 29(3), 427–441.  https://doi.org/10.1093/heapro/dat001.Google Scholar
  17. Crawley, S. A., Kendall, P. C., Benjamin, C. L., Brodman, D. M., Wei, C., Beidas, R. S., et al. (2013). Brief cognitive-behavioral therapy for anxious youth: Feasibility and initial outcomes. Cognitive and Behavioral Practice, 20(2), 123–133.  https://doi.org/10.1016/j.cbpra.2012.07.003.Google Scholar
  18. Currie, C., Molcho, M., Boyce, W., Holstein, B., Torsheim, T., & Richter, M. (2008). Researching health inequalities in adolescents: The development of the health behaviour in school-aged children (HBSC) family affluence scale. Social Science and Medicine, 66(6), 1429–1436.  https://doi.org/10.1016/j.socscimed.2007.11.024.Google Scholar
  19. Dozois, D. J. A., Seeds, P. M., & Collins, K. A. (2009). Transdiagnostic approaches to the prevention of depression and anxiety. Journal of Cognitive Psychotherapy, 23(1), 44–59.  https://doi.org/10.1891/0889-8391.23.1.44.Google Scholar
  20. Durlak, J. A., & DuPre, E. P. (2008). Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology, 41(3–4), 327–350.  https://doi.org/10.1007/s10464-008-9165-0.Google Scholar
  21. Durlak, J. A., Weissberg, R. P., Dymnicki, A. B., Taylor, R. D., & Schellinger, K. B. (2011). The impact of enhancing students’ social and emotional learning: A meta-analysis of school-based universal interventions. Child Development, 82(1), 405–432.  https://doi.org/10.1111/j.1467-8624.2010.01564.x.Google Scholar
  22. Ehrenreich-May, J., & Bilek, E. L. (2011). Universal prevention of anxiety and depression in a recreational camp setting: An initial open trial. Child & Youth Care Forum, 40(6), 435–455.  https://doi.org/10.1007/s10566-011-9148-4.Google Scholar
  23. Ehrenreich-May, J., Bilek, E. L., Queen, A. H., & Hernandez Rodriguez, J. (2012). A unified protocol for the group treatment of childhood anxiety and depression. Revista de Psicopatología y Psicología Clínica, 17(3), 219–236.  https://doi.org/10.5944/rppc.vol.17.num.3.2012.Google Scholar
  24. Ehrenreich-May, J., & Chu, B. C. (Eds.). (2014). Transdiagnostic treatments for children and adolescents: Principles and practice. New York: Guilford Press.Google Scholar
  25. Ehrenreich-May, J., Kennedy, S. M., Sherman, J. A., Bilek, E. L., Buzzella, B. A., Bennett, S. M., et al. (2018). Unified protocols for transdiagnostic treatment of emotional disorders in children and adolescents. New York: Oxford University Press.Google Scholar
  26. Ehrenreich-May, J., Rosenfield, D., Queen, A. H., Kennedy, S. M., Remmes, C. S., & Barlow, D. H. (2017). An initial waitlist-controlled trial of the unified protocol for the treatment of emotional disorders in adolescents. Journal of Anxiety Disorders, 46, 46–55.  https://doi.org/10.1016/j.janxdis.2016.10.006.Google Scholar
  27. Essau, C., Conradt, J., Sasagawa, S., & Ollendick, T. (2012). Prevention of anxiety symptoms in children: Results from a universal school-based trial. Behavior Therapy, 43(2), 450–464.  https://doi.org/10.1016/j.beth.2011.08.003.Google Scholar
  28. Field, A. (2013). Discovering statistics using IBM SPSS statistics. London: Sage Publications Ltd.Google Scholar
  29. Garber, J., Brunwasser, S. M., Zerr, A. A., Schwartz, K. T., Sova, K., & Weersing, V. R. (2016). Treatment and prevention of depression and anxiety in youth: Test of cross-over effects. Depression and Anxiety, 33(10), 939–959.  https://doi.org/10.1002/da.22519.Google Scholar
  30. García-Escalera, J., Chorot, P., Valiente, R. M., Reales, J. M., & Sandín, B. (2016a). Efficacy of transdiagnostic cognitive-behavioral therapy for anxiety and depression in adults, children and adolescents: A meta-analysis. Revista de Psicopatología y Psicología Clínica, 21(3), 147–175.  https://doi.org/10.5944/rppc.vol.21.num.3.2016.17811.Google Scholar
  31. García-Escalera, J., Sandín, B., Chorot, P., & Valiente, R. M. (2016b). Escala de interferencia de la depresión y ansiedad en niños [Depression and anxiety interference scale in children] (EIDAN). Unpublished questionnaire, Facultad de Psicología, Universidad Nacional de Educación a Distancia, Madrid.Google Scholar
  32. García-Escalera, J., Valiente, R. M., Chorot, P., Ehrenreich-May, J., Kennedy, S. M., & Sandín, B. (2017). The Spanish version of the unified protocol for transdiagnostic treatment of emotional disorders in adolescents (UP-A) adapted as a school-based anxiety and depression prevention program: Study protocol for a cluster randomized controlled trial. JMIR Research Protocols, 6(8), e149.  https://doi.org/10.2196/resprot.7934.Google Scholar
  33. Garmy, P., Jakobsson, U., Carlsson, K. S., Berg, A., & Clausson, E. K. (2015). Evaluation of a school-based program aimed at preventing depressive symptoms in adolescents. The Journal of School Nursing, 31(2), 117–125.  https://doi.org/10.1177/1059840514523296.Google Scholar
  34. Gondek, D., & Lereya, T. (2017). What are the challenges involved in the prevention of depression in schools? Contemporary School Psychology, 13, 1–6.  https://doi.org/10.1007/s40688-017-0136-z.Google Scholar
  35. Grill, S. S., Castañeiras, C., & Fasciglione, M. P. (2017). Aplicación grupal del protocolo unificado para el tratamiento transdiagnóstico de los trastornos emocionales en población argentina. Revista de Psicopatología y Psicología Clínica, 22(3), 171–181.  https://doi.org/10.5944/rppc.vol.22.num.3.2017.18122.Google Scholar
  36. Hedges, L. V. (2007). Effect sizes in cluster-randomized designs. Journal of Educational and Behavioral Statistics, 32(4), 341–370.  https://doi.org/10.3102/1076998606298043.Google Scholar
  37. Hetrick, S. E., Cox, G. R., Witt, K. G., Bir, J. J., & Merry, S. N. (2016). Cognitive behavioural therapy (CBT), third-wave CBT and interpersonal therapy (IPT) based interventions for preventing depression in children and adolescents. Cochrane Database of Systematic Reviews, 8, 1–329.  https://doi.org/10.1002/14651858.CD003380.pub4.Google Scholar
  38. Horowitz, J. L., & Garber, J. (2006). The prevention of depressive symptoms in children and adolescents: A meta-analytic review. Journal of Consulting and Clinical Psychology, 74(3), 401–415.  https://doi.org/10.1037/0022-006X.74.3.401.Google Scholar
  39. Horowitz, J. L., Garber, J., Ciesla, J. A., Young, J. F., & Mufson, L. (2007). Prevention of depressive symptoms in adolescents: A randomized trial of cognitive-behavioral and interpersonal prevention programs. Journal of Consulting and Clinical Psychology, 75(5), 693–706.  https://doi.org/10.1037/0022-006X.75.5.693.Google Scholar
  40. Johnson, C., Burke, C., Brinkman, S., & Wade, T. (2016). Effectiveness of a school-based mindfulness program for transdiagnostic prevention in young adolescents. Behaviour Research and Therapy, 81, 1–11.  https://doi.org/10.1016/j.brat.2016.03.002.Google Scholar
  41. Johnstone, J., Rooney, R. M., Hassan, S., & Kane, R. T. (2014). Prevention of depression and anxiety symptoms in adolescents: 42 and 54 months follow-up of the aussie optimism program-positive thinking skills. Frontiers in Psychology, 5, 1–10.  https://doi.org/10.3389/fpsyg.2014.00364.Google Scholar
  42. Kennedy, K. A., & Barlow, D. H. (2018). The unified protocol for transdiagnostic treatment of emotional disorders: An introduction. In D. H. Barlow & T. J. Farchione (Eds.), Applications of the unified protocol for transdiagnostic treatment of emotional disorders (pp. 1–16). New York: Oxford University Press.Google Scholar
  43. Kessler, R. C., Avenevoli, S., Costello, J., Green, J. G., Gruber, M. J., McLaughlin, K. A., et al. (2012). Severity of 12-month DSM-IV disorders in the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry, 69(4), 381–389.  https://doi.org/10.1001/archgenpsychiatry.2011.1603.Google Scholar
  44. Kessler, R. C., Ruscio, A., Shear, K., & Wittchen, H. (2010). Epidemiology of anxiety disorders. In M. B. Stein & T. Steckler (Eds.), Behavioral neurobiology of anxiety and its treatment (pp. 21–35). New York: Springer Science.Google Scholar
  45. La Greca, A. M., Ehrenreich-May, J., Mufson, L., & Chan, S. (2016). Preventing adolescent social anxiety and depression and reducing peer victimization: Intervention development and open trial. Child & Youth Care Forum, 45(6), 905–926.  https://doi.org/10.1007/s10566-016-9363-0.Google Scholar
  46. Lee, Y., Barendregt, J., Stockings, E., Ferrari, A., Whiteford, H., Patton, G., et al. (2017). The population cost-effectiveness of delivering universal and indicated school-based interventions to prevent the onset of major depression among youth in Australia. Epidemiology and Psychiatric Sciences, 26(5), 545–564.  https://doi.org/10.1017/S2045796016000469.Google Scholar
  47. Lemstra, M., Neudorf, C., D’arcy, C., Kunst, A., Warren, L. M., & Bennett, N. R. (2008). A systematic review of depressed mood and anxiety by SES in youth aged 10–15 years. Canadian Journal of Public Health, 99(2), 125–129.Google Scholar
  48. Lock, S., & Barrett, P. M. (2003). A longitudinal study of developmental differences in universal preventive intervention for child anxiety. Behaviour Change, 20(04), 183–199.  https://doi.org/10.1375/bech.20.4.183.29383.Google Scholar
  49. Lowry-Webster, H. M., Barrett, P. M., & Dadds, M. R. (2001). A universal prevention trial of anxiety and depressive symptomatology in childhood: Preliminary data from an Australian study. Behaviour Change, 18(1), 36–50.  https://doi.org/10.1375/bech.18.1.36.Google Scholar
  50. Macklem, G. L. (2014). Preventive mental health at school: Evidence-based services for students. New York: Springer.Google Scholar
  51. Martinsen, K. D., Kendall, P. C., Stark, K., & Neumer, S. P. (2016). Prevention of anxiety and depression in children: Acceptability and feasibility of the transdiagnostic EMOTION program. Cognitive and Behavioral Practice, 23(1), 1–13.  https://doi.org/10.1016/j.cbpra.2014.06.005.Google Scholar
  52. Morrissey, T. W., Hutchison, L., & Winsler, A. (2014). Family income, school attendance, and academic achievement in elementary school. Developmental Psychology, 50(3), 741.  https://doi.org/10.1037/a0033848.Google Scholar
  53. Mrazek, P. J., & Haggerty, R. J. (1994). Reducing risks for mental disorders: Frontiers for preventive intervention research. Washington, DC, USA: National Academies Press.Google Scholar
  54. Muris, P. (2010). Normal and abnormal fear and anxiety in children and adolescents. London: Elsevier Science Ltd.Google Scholar
  55. Nehmy, T. J. (2010). School-based prevention of depression and anxiety in Australia: Current state and future directions. Clinical Psychologist, 14(3), 74–83.  https://doi.org/10.1080/13284207.2010.524884.Google Scholar
  56. Nehmy, T. J., & Wade, T. D. (2014). Reduction in the prospective incidence of adolescent psychopathology: A review of school-based prevention approaches. Mental Health & Prevention, 2(3), 66–79.  https://doi.org/10.1016/j.mhp.2014.11.002.Google Scholar
  57. Nehmy, T. J., & Wade, T. D. (2015). Reducing the onset of negative affect in adolescents: Evaluation of a perfectionism program in a universal prevention setting. Behaviour Research and Therapy, 67, 55–63.Google Scholar
  58. Payton, J., Weissberg, R. P., Durlak, J. A., Dymnicki, A. B., Taylor, R. D., Schellinger, K. B., et al. (2008). The positive impact of social and emotional learning for kindergarten to eighth-grade students: Findings from three scientific reviews. Technical report. Chicago: Collaborative for Academic, Social, and Emotional Learning.Google Scholar
  59. Piqueras, J. A., Martin-Vivar, M., Sandín, B., San Luis, C., & Pineda, D. (2017a). The revised child anxiety and depression scale: A systematic review and reliability generalization meta-analysis. Journal of Affective Disorders, 218, 153–169.  https://doi.org/10.1016/j.jad.2017.04.022.Google Scholar
  60. Piqueras, J. A., Pineda, D., Martin-Vivar, M., & Sandín, B. (2017b). Confirmatory factor analysis and psychometric properties of the revised child anxiety and depression Scale–30 (RCADS-30) in clinical and non-clinical samples. Revista de Psicopatologia y Psicologia Clinica, 22(3), 183–196.  https://doi.org/10.5944/rppc.vol.22.num.3.2017.19332.Google Scholar
  61. Pössel, P., Horn, A. B., Groen, G., & Hautzinger, M. (2004). School-based prevention of depressive symptoms in adolescents: A 6-month follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 43(8), 1003–1010.  https://doi.org/10.1097/01.chi.0000126975.56955.98.Google Scholar
  62. Queen, A. H., Barlow, D. H., & Ehrenreich-May, J. (2014). The trajectories of adolescent anxiety and depressive symptoms over the course of a transdiagnostic treatment. Journal of Anxiety Disorders, 28(6), 511–521.  https://doi.org/10.1016/j.janxdis.2014.05.007.Google Scholar
  63. Rapee, R. M., Wignall, A., Sheffield, J., Kowalenko, N., Davis, A., McLoone, J., et al. (2006). Adolescents’ reactions to universal and indicated prevention programs for depression: Perceived stigma and consumer satisfaction. Prevention Science, 7(2), 167–177.  https://doi.org/10.1007/s11121-006-0035-4.Google Scholar
  64. Rosique, M. T., Sandín, B., Valiente, R. M., García-Escalera, J., & Chorot, P. (in press). Tratamiento transdiagnóstico de un caso clínico con elevada comorbilidad de trastornos emocionales: Aplicación del protocolo unificado. Revista Argentina de Clínica Psicológica.Google Scholar
  65. Sánchez-Hernández, Ó., Méndez, F. X., & Garber, J. (2014). Prevención de la depresión en niños y adolescentes: Revisión y reflexión. Revista de Psicopatología y Psicología Clínica, 19(1), 63–76.  https://doi.org/10.5944/rppc.vol.19.num.1.2014.Google Scholar
  66. Sandín, B. (1997). Ansiedad, miedos y fobias en niños y adolescentes. Madrid: Dykinson.Google Scholar
  67. Sandín, B., Chorot, P., & Valiente, R. M. (2012). Transdiagnóstico: Nueva frontera en psicología clínica. Revista de Psicopatología y Psicología Clínica, 17(3), 185–203.  https://doi.org/10.5944/rppc.vol.17.num.3.2012.11839.Google Scholar
  68. Sandín, B., Chorot, P., & Valiente, R. M. (2016). TCC de los trastornos de ansiedad: Innovaciones en niños y adolescentes. Madrid: Klinik.Google Scholar
  69. Sandín, B., Chorot, P., Valiente, R. M., & Chorpita, B. F. (2010). Development of a 30-item version of the revised child anxiety and depression scale. Revista de Psicopatología y Psicología Clínica, 15(3), 165–178.  https://doi.org/10.5944/rppc.vol.15.num.3.2010.Google Scholar
  70. Santesteban-Echarri, O., Hernández-Arroyo, L., Rice, S. M., Güerre-Lobera, M. J., Serrano-Villar, M., Espín-Jaime, J. C., et al. (2018). Adapting the brief coping cat for children with anxiety to a group setting in the spanish public mental health system: A hybrid effectiveness-implementation pilot study. Journal of Child and Family Studies.  https://doi.org/10.1007/s10826-018-1154-9.Google Scholar
  71. Schagen, I., & Hodgen, E. (2009). How much difference does it make? Notes on understanding, using, and calculating effect sizes for schools. Research Division, Ministry of Education and Edith Hodgen, New Zealand Council for Educational Research. Retrieved July 23, 2018, from http://www.nzcer.org.nz/system/files/16886.pdf.
  72. Tok, E. S. S. (2018). Cognitive behavioral therapy principles in children: Treatment of internalizing disorders. In O. Şenormancı (Ed.), Cognitive behavioral therapy and clinical applications (pp. 1–25). InTech. Retrieved July 23, 2018, from https://www.intechopen.com/books/cognitive-behavioral-therapy-and-clinical-applications/cognitive-behavioral-therapy-principles-in-children-treatment-of-internalizing-disorders.
  73. Weare, K., & Nind, M. (2011). Mental health promotion and problem prevention in schools: What does the evidence say? Health Promotion International, 26(S1), i29–i69.  https://doi.org/10.1093/heapro/dar075.Google Scholar
  74. Weisz, J. R., Chorpita, B. F., Frye, A., Ng, M. Y., Lau, N., Bearman, S. K., et al. (2011). Youth top problems: Using idiographic, consumer-guided assessment to identify treatment needs and to track change during psychotherapy. Journal of Consulting and Clinical Psychology, 79(3), 369–380.  https://doi.org/10.1037/a0023307.Google Scholar
  75. Werner-Seidler, A., Perry, Y., Calear, A. L., Newby, J. M., & Christensen, H. (2017). School-based depression and anxiety prevention programs for young people: A systematic review and meta-analysis. Clinical Psychology Review, 51, 30–47.  https://doi.org/10.1016/j.cpr.2016.10.005.Google Scholar

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Authors and Affiliations

  1. 1.Facultad de PsicologíaUniversidad Nacional de Educación a DistanciaMadridSpain
  2. 2.Department of PsychologyUniversity of MiamiCoral GablesUSA

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