Using an adapted stress-reduction intervention called the CEDARS, the investigators will pilot the intervention in adolescents (N=40) to determine the feasibility and acceptability of CEDARS implementation and to investigate adolescent stress reduction. As an exploratory aim, the investigators will explore the influence of the CEDARS on CMH-related behaviors and CMH. The investigators expect that those adolescents who undergo the intervention will have the greatest improvement in mental health symptoms than their waitlisted counterparts. Our secondary hypothesis is that those who report more adversity will also report greater improvement in mental health symptoms than their peers.
This intervention has been adapted based on feedback from previous focus groups with adolescents, clinical staff, community stakeholders, and a CEDARS workgroup. Participants will be divided into two groups - 20 in the intervention group and 20 in the waitlisted group. Adolescents in the intervention group will participate in 7 weekly, 1-hour sessions. This online intervention will feature positive affect and stress reduction skills delivered via self-paced and self-guided modules. The skills are taught through brief didactic and semi-interactive videos followed by invitations and opportunities for practice within the session and at home. Participants will complete a baseline, mid-point, and post-intervention survey to determine the influence of the intervention. There will be one follow-up survey with participants after the intervention. The survey will take place 1 month after the program has concluded.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
36
This intervention is intended to help adolescents cope with stress and improve positive affect.
Ann & Robert H. Lurie Children's Hospital of Chicago
Chicago, Illinois, United States
Feasibility: Percentage of Recruitment Target Enrollment Met
This measurement reflects the number of participants recruited compared to the recruitment target goal.
Time frame: Baseline
Feasibility:4 of 7 Intervention Modules Completed
Feasibility was defined as the proportion of participants who completed at least 4 of the 7 core intervention modules during the study period.
Time frame: Endpoint (8 Weeks after intervention start)
Feasibility: Mean Intervention Module Completion
Intervention module completion was defined as the mean number of modules the intervention participants completed during the study period.
Time frame: Endpoint (8 Weeks after intervention start)
Acceptability: Participant Satisfaction Score ≥8 of 10
Acceptability was defined as participant satisfaction with the intervention, measured using a 1-10 satisfaction scale, with scores ≥8 indicating intervention acceptability.
Time frame: Endpoint (8 Weeks after intervention start)
Acceptability: Mean Participant Satisfaction
Acceptability was defined as participant satisfaction with the intervention measured using a 1-10 satisfaction scale, with scores ≥8 indicating positive acceptability.
Time frame: Endpoint (8 Weeks after intervention start)
Depressive Symptoms
The PHQ-9 is a self-administered depression module of the Patient Health Questionnaire (PHQ). It contains 9 questions that help identify patients with clinically meaningful symptoms of depression. Patient responses are scored 0-3 with 0 representing "not at all" and 3 indicating "nearly every day;" thus, the PHQ-9 contains a total score range of 0-27. Higher scores indicate more severe depressive symptoms. No specific administration time could be found, but a reasonable administration time is approximately 5-10 minutes for cognitively intact patients. PHQ-9 questions are straightforward and pertain to depressive symptoms experienced over the past 2 weeks that include anhedonia, dysphoria, sleep disturbances, fatigue, changes in eating, low self-esteem, concentration difficulties, hypo-or-hyper-active behaviors, and thoughts of suicide or homicide.
Time frame: Baseline, Midpoint (Week 4), Endpoint (Week 8), and 1-month follow-up
Anxiety Symptoms
The GAD-7 is a 7-item self-report questionnaire used to measure the severity of generalized anxiety disorder, with total scores ranging from 0 to 21 based on a 4-point scale (0-3). Scores of 5, 10, and 15 represent cut-points for mild, moderate, and severe anxiety, respectively. A score of 10 or higher is the recommended threshold for identifying probable cases of GAD.
Time frame: Baseline, Midpoint (4 weeks), Endpoint (8 weeks), 1 month post intervention
Positive Affect
PANAS-C SF Scale: In this 10-item scale, the 5 positive affect (PA) items are summed to obtain a PA score, and the 5 negative affect (NA) items are summed to obtain an NA score. Each question is scored 1- "not much or not at all" to 5- "a lot. Higher scores on each scale indicate higher levels of engagement within that particular affect, although there is no cutoff threshold.
Time frame: Baseline, Midpoint (4 weeks), Endpoint (8 weeks), 1 month post intervention
Perceived Stress
The Perceived Stress Scale (PSS) is a widely used, self-report psychological instrument designed to measure the degree to which individuals appraise situations in their lives as uncontrollable, unpredictable, and overwhelming. The general scoring guidelines are 0-13: Low stress, 14-26: Moderate stress, 27-40: High perceived stress.
Time frame: Baseline, Midpoint (4 weeks), Endpoint (8 weeks), 1 month post intervention
Flourishing
The Flourishing Scale (FS; Diener et al., 2010) is a brief 8-item summary measure of the respondent's self-perceived success in important areas such as relationships, self-esteem, purpose, and optimism. It was designed to measure social-psychological prosperity and to complement existing measures of subjective well-being. The FS provides a single psychological well-being score. All items are rated on a 7-point Likert-type scale where 1 = strongly disagree and 7 = strongly agree. All items are phrased in a positive direction. Scores can range from 8 (Strong Disagreement with all items) to 56 (Strong Agreement with all items). Higher scores indicate greater flourshing.
Time frame: Baseline, Midpoint (4 weeks), Endpoint (8 weeks), 1 month post intervention
Negative Affect
PANAS-C SF Scale: In this 10-item scale, the 5 positive affect (PA) items are summed to obtain a PA score, and the 5 negative affect (NA) items are summed to obtain an NA score. Each question is scored 1- "not much or not at all" to 5- "a lot. Higher scores on each scale indicate higher levels of engagement within that particular affect, although there is no cutoff threshold.
Time frame: Baseline, Midpoint (4 weeks), Endpoint (8 weeks), 1 month post intervention
Resilient Coping
The Brief Resilient Coping Scale captures tendencies to cope with stress adaptively. The scale focuses on the tendency to effectively use coping strategies in flexible, committed ways to actively solve problems despite stressful circumstances. Total score: Total sum scores range from 4 to 20. Scores of 4-13 indicate low resilient coping, 14-16 indicate medium resilient coping and 17-20 indicate high resilient coping.
Time frame: Baseline, Midpoint, Endpoint. 1 Month Post-Intervention
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