Implementation challenges to TADS cognitive-behavioral therapy

This article discusses treatment obstacles that were frequently encountered by CBT therapists in the Treatment for Adolescents With Depression Study (TADS) trial. The most common or challenging treatment obstacles and their respective solutions were distilled from the minutes of national conference calls attended by TADS CBT supervisors and therapists. Obstacles were categorized into the following 6 themes: (1) comorbid disorders (i.e., anxiety, conduct, attention problems, and learning disorders); (2) severe depressive symptoms (i.e., anhedonia and hopelessness); (3) self-harm and suicidal ideation; (4) school refusal; (5) interpersonal factors, and; (6) treatment noncompliance. Case illustrations are provided throughout to illustrate these treatment obstacles and how they were addressed within the treatment manual.