4 - (SYM 19) "it's Not Fun, but It Works": Lessons Learned from Adapting and Evaluating Transdiagnostic CBT for Intensive Treatment Settings

Introduction: Intensive treatment programs (e.g., partial hospitalization [PHPs] and intensive outpatient programs [IOPs]) are a growing segment of the youth mental health services landscape.  Transdiagnostic, exposure-based CBT may be ideal for addressing the clinical heterogeneity of youth in these programs, but few treatments have been systematically adapted and evaluated. Our aims are to: 1) present results evaluating an adaptation of the Unified Protocols for Children and Adolescents (UP-C/A; Ehrenreich-May et al., 2018) in a PHP, and 2) summarize ongoing work in further adapting the intervention for self-injurious thoughts and behaviors (SITBs) and other clinical areas.

Methods: We completed a hybrid effectiveness-implementation trial in a hospital PHP for youth ages 6-17. Youth received the adapted UP-C/A, which maintained core intervention functions while tailoring forms (e.g., worksheets, activities). Data on change in symptoms, functioning, and transdiagnostic risk factors was collected from 152 youth (M age 13, 63% female) at baseline, weekly, post-treatment, and follow-up. Additionally, 14 youth and 17 clinicians provided qualitative feedback. Quantitative data were analyzed using latent growth curve modeling, and qualitative data were analyzed using an iterative, mixed inductive-deductive approach.

Results: Youth experienced significant improvements in depression, anxiety, emotional reactivity, and impairment that were maintained at follow-up. Improvements in youth distress tolerance and parental self-efficacy and accommodation were associated with symptom change. 90% of youth and caregivers were satisfied or highly satisfied, and clinicians acceptability, appropriateness, and feasibility was high (M = 4.5/5.0). In qualitative responses, clinicians and youth identified exposures, emotion tracking, and thinking traps as most effective. Suggested adaptations highlight opportunities and challenges of tailoring a unified transdiagnostic framework for complex needs. Youth and clinicians suggested adaptations for SITBs and other clinical areas (e.g., anger, autism). Other suggestions included enhancing interactive components and increasing practice opportunities to support generalization.

Discussion: Results support the potential for effective translation of transdiagnostic CBT to intensive treatment settings. We discuss ongoing efforts to tailor UP-C/A intervention forms for presenting problems in these settings (e.g., SITBs), while maintaining consistency with core functions.