Unfolding the Wisdom Within: CFT for Adolescents in Residential Care (CFT_RYC)

University of Coimbra

Status: Enrolling

Conditions: Adolescent - Emotional Problem; Adolescent Behavior

Treatments: Behavioral: The Wise Adolescent

Study type: Interventional

Funder types: Other

Identifiers

NCT06219057

2020.05840.BD

Details and patient eligibility

About

Residential care youth show extensive mental health intervention needs due to history of maltreatment and embedded characteristics of residential placement, leading to harmful and cumulative effects throughout development, linked to internalizing and externalizing difficulties. However, existing interventions show limited suitability and poor randomized effectiveness evaluation.

To overcome these shortcomings, a new compassion-based program for adolescents in residential care will be developed. A non-randomized trial will be run, testing the program´s effects over adolescents' psychological functioning and investigating whether changes in compassion are associated with changes over time in mental health difficulties. The moderator effect of age, gender and maltreatment history will be investigated.

Findings intend to: improve mental-health of youth in residential care, provide an evidence-based intervention to be delivered in residential care settings, increase empirical support of compassion-based interventions, amplifying its scope of delivery.

Full description

Youth in residential care (YRC) are considered a vulnerable population, presenting higher levels of emotional and behavioural problems than normative peers. YRC exhibit a higher pooled prevalence for any mental disorder (49%) than the general children and adolescent population (13.4%). In Portugal, around 6118 youth are placed in residential care (55% of whom are adolescents), 89% due to history of maltreatment (HM) (neglect and psychological, physical and sexual abuse).

Residential care commonly occurs after a HM which, per se, plays an important role in predicting internalizing (e.g. anxiety, depression), externalizing (e.g. poor impulse control, aggression), and emotion regulation difficulties. HM also contributes to high levels of shame (the affective experience of feeling defective, undesirable) and self-criticism (negative self-evaluations which comprise condemning, attacking and judgemental thoughts directed to the self). Furthermore, although residential care is an attempt to provide protection and care, it frequently represents the loss of attachment figures, repeated moving placements, a less home-like environment and less individualized caregiving. Thus, it is essential that YRC receive interventions that counteract these vulnerabilities. Existing programs address mostly behavioural and cognitive domains, however: a) they are aimed primarily at fostering parental skills of caregivers, not fully meeting adolescents' developmental needs, b) they have limited randomized effectiveness evaluation, and c) findings do not show positive effects on attachment security or placement disruption.

Compassion-based interventions have been gaining growing empirical support in treating several mental health problems and have been shown to be suitable for children, adolescents, and adults. Previous research also demonstrated the benefits of targeting compassion related variables in the treatment of childhood maltreatment survivors, mitigating the association between childhood maltreatment and later emotion regulation difficulties.

Compassion is a motivation comprising a deep awareness regarding the suffering of one-self and others, tied to a wish and effort to relieve it. It is linked to healthy psychological functioning and quality of life. Additionally, compassion negatively predicts emotion regulation difficulties shame and self-criticism, as well as psychopathological problems.

The majority of available findings relates to adult samples, but empirical evidence suggests that compassionate mind training may also be well-timed for adolescents. Within adolescents' studies, compassion has been identified as revealing a buffering effect against psychological distress, partially mediating the relationship between victimization and psychological maladjustment. Differences on gender and age seem to be significant, with males and high school students reporting greater levels of compassion. Intervention studies have also provided support for compassion as a protective factor. Compassion training with adolescents in the community predicted reduction in negative affect, perceived stress, and depressive and anxiety symptoms.

In sum, YRC show wide mental health intervention needs that demand tailored interventions. Since the existing interventions showed limited randomized clinical effectiveness and considering the promising results of compassion based-interventions, the present research aims to broaden the spectrum of therapeutic care, developing and assessing the efficacy of a compassionate-based intervention specifically designed to address the needs from YRC.

Enrollment: 30 estimated patients

Sex: All

Ages: 14 to 18 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Being placed in residential care at least for 1-month (allowing for an adjustment period)

Exclusion criteria

1. Cognitive impairment (assessed through a clinical interview; MINI-KID);
2. Presence of psychotic symptoms or suicidal ideation (according to the MINI-KID).

Trial design

Primary purpose: Treatment

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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30 participants in 2 patient groups

Intervention

Experimental group

Description:

Group of adolescents living in residential youth care. Participants selection will take as inclusion criteria: age (between 14 and 18 years old) and being placed in residential care at least for 1-month (allowing for an adjustment period); as exclusion criteria: a) cognitive impairment; b) psychotic symptoms; d) remaining in residential care less than 9-months, considering the study's length. They will be asked to fill in the self-report protocol at 3 different time points (baseline, post-test and 6-month follow-up). Intervention comprises the psychological intervention program "The Wise Adolescent", twenty individual psychotherapeutic sessions based on Compassion Focused Therapy.

Treatment:

Behavioral: The Wise Adolescent

Care as Usual

No Intervention group

Description:

Group of adolescents living in residential youth care. Participants selection will take as inclusion criteria: age (between 14 and 18 years old) and being placed in residential care at least for 1-month (allowing for an adjustment period); as exclusion criteria: a) cognitive impairment; b) psychotic symptoms; d) remaining in residential care less than 9-months, considering the study's length. They will be asked to fill in the self-report protocol at 3 different time points (baseline, post-test and 6-month follow-up). Participants in the control group will receive care as usual (TAU). There will be no restrictions on the care that can be provided and it may comprise no treatment or, instead, referral to a variety of health care professionals (e.g. psychologist, psychiatrist) with diverse dosage. TAU will be recorded in terms of timing and nature of any intervention received.