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- Klinische proef NCT06566235
Culturele aanpassing en implementatie van DBT voor adolescenten met emotionele stoornissen
Culturele aanpassing en implementatie van trainingsgroep voor vaardigheden in dialectische gedragstherapie voor adolescenten met emotionele stoornissen: een haalbaarheidsstudie en een gerandomiseerde gecontroleerde studie
Het doel van deze studie is om te leren of Dialectische gedragstherapie vaardigheden bezit
Training voor Adolescenten (DBT-A-ST) werkt aan emotionele stoornissen bij adolescenten. De belangrijkste vragen die het wil beantwoorden zijn:
Leidt DBT-A-ST tot snellere verbeteringen (d.w.z. steilere hellingen), vergeleken met ASG, op de primaire en secundaire uitkomstmaten tijdens de behandeling en de follow-up van drie maanden?
Leidt DBT-A-ST tot grotere verbeteringen, vergeleken met ASG, op de primaire en secundaire uitkomstmaten?
Deelnemers zullen:
Willekeurig toegewezen aan (a) een cultureel aangepaste DBT-A-ST of (b) op activiteiten gebaseerde steungroep (ASG).
Kreeg vijf beoordelingen vóór de start van de proef (T1), na 4, 8 sessies (T2, T3), na de interventie (T4) en na drie maanden follow-up (T5).
Studie Overzicht
Toestand
Conditie
Interventie / Behandeling
Gedetailleerde beschrijving
Er zal een gerandomiseerd gecontroleerd onderzoek worden uitgevoerd op de afdeling kinderpsychiatrie van een medisch centrum. Deelnemers van 12 tot 17 jaar met huidige depressieve of angststoornissen zoals gediagnosticeerd met behulp van de K-SADS-E zullen worden gerekruteerd en willekeurig toegewezen in een verhouding van 1:1 aan een van de twee onderzoeksarmen: a) cultureel aangepaste DBT-A-ST-groep, b) Op activiteiten gebaseerde steungroep. Beide interventies zijn in groepsvorm en omvatten 15 wekelijkse sessies, 120 min/elke sessie. Op basis van de powerberekening zal een beoogde steekproefomvang van 160 jongeren worden opgenomen. Beoordelingen zullen plaatsvinden voordat de proef begint, tijdens de vierde en achtste behandelingssessie, aan het einde en tijdens de follow-up na drie maanden.
Primaire uitkomsten zijn de ernst van depressie en angst, beoordeeld door blinde beoordelaars. Secundaire uitkomsten zijn onder meer algemene psychopathologie, aantal DSM-5-stoornissen, kwaliteit van leven en zelfgerapporteerde metingen. Ook de behandelingsmechanismen en implementatieprocessen zullen worden onderzocht.
Studietype
Inschrijving (Geschat)
Fase
- Niet toepasbaar
Contacten en locaties
Studiecontact
- Naam: Hui-Chun Huang, Ph.D
- Telefoonnummer: 3055 886-2-28094661
- E-mail: aihch@mmh.org.tw
Studie Locaties
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Taipei, Taiwan
- Werving
- Mackay Memorial Hospital
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Contact:
- Dr.Hui-Chun Huang
- Telefoonnummer: 3055 886 2 28094661
- E-mail: aihch@mmh.org.tw
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Taipei, Taiwan
- Actief, niet wervend
- Mackay Memorial Hospital
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
- Kind
- Volwassen
Accepteert gezonde vrijwilligers
Beschrijving
Inclusiecriteria:
- 12-17 jaar oud,
- er wordt geïnformeerde toestemming gegeven door de jongere en een van de ouders,
- Mandarijn-Chinese taalvaardigheid voldoende om de onderzoeksvragenlijst in te vullen,
- een totaalscore van ofwel de PHQ-9 ≥ 10 ofwel de GAD-7 ≥ 10,
- een huidige diagnose van een depressie of angststoornis uit een K-SADS-E-interview, inclusief depressie (F32-33); aanhoudende stemmingsstoornis (F34), fobische angststoornis (F40), andere angststoornis (F41) en aanpassingsstoornissen (F43.2).
Individuen met comorbide diagnoses van verschillende emotionele stoornissen worden ook ingeschreven. Comorbiditeiten zullen niet worden gestratificeerd omdat dit de complexiteit van het ontwerp aanzienlijk zal vergroten (dat wil zeggen dat sommige patiënten meerdere comorbide diagnoses kunnen hebben).
Uitsluitingscriteria:
- diagnoses van een verstandelijke beperking, schizofrenie, pervasieve ontwikkelingsstoornis, anorexia nervosa en middelenmisbruikstoornis in de afgelopen 3 maanden,
- actieve zelfmoordgedachten met een plan of een geschiedenis van frequent of recent zelfmoordrisico in de afgelopen 3 maanden,
- ADHD zonder verhogingen op het gebied van angst, depressie of stressproblemen op de CBCL,
- recente (afgelopen 4 weken) verandering in psychiatrische medicatie of onwil om een stabiele dosering medicatie te handhaven tijdens deelname aan het onderzoek,
- in het verleden vijf of meer sessies CGT hebben gehad of niet bereid zijn gelijktijdige psychotherapie te stoppen,
- elke mentale of fysieke aandoening die ziekenhuisopname vereist,
- ernstige medische aandoening.
Omdat we ook streven naar een naturalistische setting, sluiten we geen patiënten uit die tijdens de studie medicatieveranderingen ondergaan als de behandelend arts dit noodzakelijk of klinisch belangrijk acht.
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Enkel
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
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Experimenteel: Cultureel aangepaste DBT-A-ST-groep
De cultureel aangepaste DBT-A-ST bestaat uit 15 wekelijkse groepssessies van elk 120 minuten, inclusief een pauze van 10 minuten. Het handhaaft de kernelementen van de standaard DGT-A, inclusief de filosofische basis en behandelstrategieën. Therapeuten richten zich op het aanleren van DGT-vaardigheden via verschillende methoden, zoals modellering, gestructureerde gedragsrepetities en feedback. Elke sessie begint met een mindfulness-oefening van 40 minuten en een huiswerkbeoordeling, gevolgd door 60 minuten gewijd aan vaardigheidsspecifieke didactiek en ervaringsgerichte activiteiten, en afgesloten met een huiswerkopdracht van 10 minuten. Twee groepsleiders faciliteren de sessies, en deelnemers houden dagelijks hun vaardighedengebruik bij met dagboekkaarten, die wekelijks worden beoordeeld. |
De cultureel aangepaste DBT-A-ST bestaat uit 15 wekelijkse groepssessies van elk 120 minuten, inclusief een pauze van 10 minuten. Het handhaaft de kernelementen van de standaard DGT-A, inclusief de filosofische basis en behandelstrategieën. Therapeuten richten zich op het aanleren van DGT-vaardigheden via verschillende methoden, zoals modellering, gestructureerde gedragsrepetities en feedback. Elke sessie begint met een mindfulness-oefening van 40 minuten en een huiswerkbeoordeling, gevolgd door 60 minuten gewijd aan vaardigheidsspecifieke didactiek en ervaringsgerichte activiteiten, en afgesloten met een huiswerkopdracht van 10 minuten. Twee groepsleiders faciliteren de sessies, en deelnemers houden dagelijks hun vaardighedengebruik bij met dagboekkaarten, die wekelijks worden beoordeeld. |
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Placebo-vergelijker: Satir-based group (SBG)
SBG, grounded in Satir's Iceberg Theory, aims to enhance self-awareness and communication by exploring participants' deeper emotions and beliefs.
Sessions include emotional sharing, communication skills training, and role-play exercises.
The program spans 15 weekly sessions (2 hours each): 12 for adolescents and 3 involving both adolescents and their parents.
Activities focus on practicing communication stances, reflection, and group discussion to foster personal growth and improved relationships.
The inclusion of parents is designed to help teens build supportive, resilient connections.
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SBG, grounded in Satir's Iceberg Theory, aims to enhance self-awareness and communication by exploring participants' deeper emotions and beliefs.
Sessions include emotional sharing, communication skills training, and role-play exercises.
The program spans 15 weekly sessions (2 hours each): 12 for adolescents and 3 involving both adolescents and their parents.
Activities focus on practicing communication stances, reflection, and group discussion to foster personal growth and improved relationships.
The inclusion of parents is designed to help teens build supportive, resilient connections.
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Youth Self Report (YSR)
Tijdsspanne: at baseline, at 15 weeks, and at 3 months after completion of the intervention
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The Youth Self Report (YSR) is a self-reported measure assessing emotional and behavioral problems in adolescents. Each item is rated on a 3-point scale (0 = not true, 1 = sometimes true, 2 = mostly or completely true). The scale includes internalizing problems (withdrawal, anxiety/depression, and somatic complaints) and externalizing problems (rule-breaking and aggressive behaviors). Raw scores are converted to standardized T-scores based on normative data, with higher scores indicating more severe emotional and behavioral problems. T scores range approximately from 50 to 100, with scores above 70 indicating the clinical range. |
at baseline, at 15 weeks, and at 3 months after completion of the intervention
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Child Behavior Checklist about their adolescents (CBCL)
Tijdsspanne: at baseline, at 15 weeks, and at 3 months after completion of the intervention
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The Child Behavior Checklist (CBCL) is used to assess behavioral and emotional problems in children and adolescents. Each item is rated on a 3-point Likert scale (0-2). Raw scores are converted to standardized T-scores based on age- and gender-specific norms, with higher scores indicating more severe behavioral and emotional problems. T scores of ≤59 indicate nonclinical symptoms, scores of 60-64 suggest a risk for problem behaviors, and scores ≥65 indicate clinically significant symptoms. |
at baseline, at 15 weeks, and at 3 months after completion of the intervention
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Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Hamilton Depression Scale-17 item (HAMD-17)
Tijdsspanne: at baseline, at 15 weeks, and at 3 months after completion of the intervention
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HDRS-17 is a clinician-rated measure of depressive symptoms that consists of 17 items rated using a semi-structured interview.
Eight of the 17 HDRS-17 items are rated on a 5-point scale (0=absent; 1=doubtful or mild; 2=mild to moderate; 3=moderate to severe; 4=very severe), while the remaining 9 items are rated on a 3-point scale (0=absent; 1=doubtful or mild; 2=clearly present), yielding a minimum total score of 0 (least severe) and a maximum score of 52 (most severe).
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at baseline, at 15 weeks, and at 3 months after completion of the intervention
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Hamilton Anxiety Scale (HAM-A)
Tijdsspanne: at baseline, at 15 weeks, and at 3 months after completion of the intervention
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The Hamilton Anxiety Scale (HAM-A) comprises 14 items.
Each item is scored on a scale of 0 (not present) to 4 (severe), with a total score range of 0-56, where <17 indicates mild severity, 18-24 indicates mild to moderate severity, and 25-30 indicates moderate to severe severity.
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at baseline, at 15 weeks, and at 3 months after completion of the intervention
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Clinical Global Impressions-Severity (CGI-S)
Tijdsspanne: at baseline, at 15 weeks, and at 3 months after completion of the intervention
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Clinical Global Impressions-Severity (CGI-S) is a standardized assessment tool used by clinicians to rate illness severity, monitor changes over time, and evaluate medication efficacy.
It is rated on a seven-point scale: 1=normal, not at all ill; 2=borderline mentally ill; 3=mildly ill; 4=moderately ill; 5=markedly ill; 6=severely ill; 7=among the most extremely ill patients.
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at baseline, at 15 weeks, and at 3 months after completion of the intervention
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Clinical Global Impressions-Improvement (CGI-I)
Tijdsspanne: at 15 weeks, and at 3 months after completion of the intervention
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The Clinical Global Impression-Improvement (CGI-I) is a 7-point scale that measures the extent to which the patient's illness has improved or worsened relative to baseline at the start of treatment.
It is rated on a scale from 1 to 7: 1 = very much improved since the beginning of treatment; 2 = much improved; 3 = minimally improved; 4 = no change from baseline (the start of treatment); 5 = minimally worse; 6 = much worse; 7 = very much worse since the start of treatment.
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at 15 weeks, and at 3 months after completion of the intervention
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Andere uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Patient Health Questionnaire-9 item (PHQ-9)
Tijdsspanne: at baseline, at 4, 8, and 15 weeks, and at 3 months after completion of the intervention
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It consists of nine items evaluating the presence of the nine DSM-5 criteria of major depression in the past 2 weeks.
Each item is scored 0-3.
Total scores indicate: 0-4 (None/Minimal), 5-9 (Mild), 10-14 (Moderate), 15-19 (Moderately Severe), and 20-27 (Severe).
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at baseline, at 4, 8, and 15 weeks, and at 3 months after completion of the intervention
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Generalized Anxiety Disorder Scale-7 item (GAD-7)
Tijdsspanne: at baseline, at 4, 8, and 15 weeks, and at 3 months after completion of the intervention
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It is a self-report 7-item scale to measure the severity of anxiety and has been validated in Chinese adolescent populations.
The total scores of the GAD-7 range from 0 to 21, with the higher scores indicating higher severity of anxiety disorders.
For the cutoff points of the GAD-7 scores, in general, the scores of 5, 10, and 15 match categorization of none/normal (0-4), mild anxiety (5-9), moderate anxiety (10-14), and severe anxiety (15-21), respectively.
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at baseline, at 4, 8, and 15 weeks, and at 3 months after completion of the intervention
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The number of the DSM-5 diagnoses
Tijdsspanne: at baseline, at 15weeks, and at 3 months after completion of the intervention
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The number of DSM-5 diagnoses is assessed using the Mandarin version of the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Epidemiologic version (K-SADS-E), modified to align with DSM-5 criteria.
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at baseline, at 15weeks, and at 3 months after completion of the intervention
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The Strengths and Difficulties Questionnaire (SDQ)
Tijdsspanne: Baseline
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It aims to evaluate emotional and behavioral challenges in children and adolescents, covering four problem areas: emotional symptoms, conduct issues, hyperactivity/inattention, and peer relationship difficulties.
All items are rated on a three-point scale (0=not true, 1=somewhat true, and 2=certainly true).
Five positively worded items from different SDQ difficulty scales are reverse-coded.
High scores on the difficulties scales indicate a high degree of difficulty; a high score on the prosocial scale indicates a high degree of prosocial behavior.
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Baseline
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10-item Positive and Negative Affect Schedule- Child/Parent (PANAS-C/P)
Tijdsspanne: at baseline, at 15 weeks, and at 3 months after completion of the intervention
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The 10-item Positive and Negative Affect Schedule for Children/Parents (PANAS-C/P) is used to assess positive and negative emotional states in youth, based on self-report or parent-report of recent emotional experiences.
The measure yields two subscale scores: Positive Affect (range 10-50; higher scores indicate greater positive affect) and Negative Affect (range 10-50; lower scores indicate less negative affect).
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at baseline, at 15 weeks, and at 3 months after completion of the intervention
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Perceived Stress Scale (PSS-10)
Tijdsspanne: at baseline, at 15 weeks, and at 3 months after completion of the intervention
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The Perceived Stress Scale (PSS) is a self-reported measure used to assess the degree to which individuals appraise situations in their lives as stressful.
Each item is rated on a 5-point Likert scale (0 = never to 4 = very often).
Total scores range from 0 to 40, with higher scores indicating greater perceived stress.
Scores of 0-13 indicate low stress, 14-26 indicate moderate stress, and 27-40 indicate high perceived stress.
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at baseline, at 15 weeks, and at 3 months after completion of the intervention
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World Health Organization Quality of Life Scale, Brief Version (WHOQOL-BREF)
Tijdsspanne: at baseline, at 15 weeks, and at 3 months after completion of the intervention
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The WHOQOL-BREF assesses quality of life across physical, psychological, social, and environmental domains.
Each item is rated on a 1-5 scale.
Domain scores are transformed to a 0-100 scale, with higher scores indicating better quality of life.
Interpretation is based on comparisons across domains, changes over time, and reference to population norms; lower scores (e.g., below the 30th percentile) may indicate areas requiring clinical attention.
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at baseline, at 15 weeks, and at 3 months after completion of the intervention
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The Adult Self-Report (ASR)
Tijdsspanne: at baseline, at 15 weeks, and at 3 months after completion of the intervention
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The Adult Self-Report is a self-report instrument assessing behavioral, emotional, and social functioning over the past 6 months.
Items are rated on a 3-point scale (0 = not true, 1 = somewhat true, 2 = very true).
A Total Problems score is calculated by summing all problem items, with higher scores indicating greater overall difficulties.
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at baseline, at 15 weeks, and at 3 months after completion of the intervention
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Academic Pressure subscale of Inventory of Influencing Factors of Trait Anxiety
Tijdsspanne: at baseline, at 15 weeks, and at 3 months after completion of the intervention
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It includes 10 items that describe daily events related to students' academic pressure.
Each item is rated on a 5-point Likert scale ranging from 1 = never to 5 = always.
The items are averaged to calculate scale scores; the higher the average score, the higher the level of self-reported academic pressure.
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at baseline, at 15 weeks, and at 3 months after completion of the intervention
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Chinese Adolescent Life Event Scale checklist
Tijdsspanne: at baseline, at 15 weeks, and at 3 months after completion of the intervention
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The Stressful Life Events Scale assesses the occurrence of stressful life events.
In this study, only eight items related to controllable negative events are included.
Each item is rated as 0 = no, 1 = yes, and a Total Score is calculated by summing all items, ranging from 0 to 8, with higher scores indicating a greater number of stressful life events.
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at baseline, at 15 weeks, and at 3 months after completion of the intervention
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The Treatment History Interview (THI)
Tijdsspanne: Baseline
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The Treatment History Questionnaire assesses the types and amounts of previous medical and psychological treatments received.
Items include self-reported hospital admissions, days in hospital, emergency department visits, medications, and outpatient psychosocial treatments.
Each item is rated 0 = no, 1 = yes, and a Total Score is calculated by summing all items, with higher scores indicating greater use of treatment resources.
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Baseline
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Emotion Regulation Questionnaire, Child and Adolescent Form (ERQ-C/A)
Tijdsspanne: at baseline, at 8 and 15 weeks, and at 3 months after completion of the intervention
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The Emotion Regulation Questionnaire for Children and Adolescents is a 10-item self-report measure assessing emotion regulation strategies, including cognitive reappraisal and emotion suppression.
Items are rated on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree).
Subscale scores range from 6-30 for cognitive reappraisal and 4-20 for emotion suppression.
Higher scores indicate greater emotion dysregulation.
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at baseline, at 8 and 15 weeks, and at 3 months after completion of the intervention
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The Distress tolerance Scale-Short Form (DTS-SF)
Tijdsspanne: at baseline, at 4, 8, and 15 weeks, and at 3 months after completion of the intervention
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The DTS-SF is a modification of the DTS and contains the highest-loading item from each subscale, forming a single DT factor.
As with the DTS, items are rated on a 5-point Likert scale (1 = strongly agree, 5 = strongly disagree), with lower scores indicating poorer ability to withstand and tolerate distress.
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at baseline, at 4, 8, and 15 weeks, and at 3 months after completion of the intervention
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DBT skills subscale (DSS) of the DBT Ways of Coping Checklist
Tijdsspanne: at baseline, at 15 weeks, and at 3 months after completion of the intervention
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The Dialectical Behavior Therapy Skills Use Scale is a 38-item self-report measure assessing the frequency of DBT skills use over the past month.
Participants rate how often they used specific skills when facing stressors on a 4-point scale (0 = never to 3 = regularly).
A Total Score (range: 0-114) is calculated by summing item scores, with higher scores indicating more frequent use of DBT skills.
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at baseline, at 15 weeks, and at 3 months after completion of the intervention
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Mindful Attention Awareness Scale-Children
Tijdsspanne: at baseline, at 8 and 15 weeks, and at 3 months after completion of the intervention
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The Mindful Attention Awareness Scale is a 15-item self-report measure assessing mindfulness across cognitive, emotional, physical, interpersonal, and general domains.
Items are rated on a 6-point scale (1 = almost always to 6 = almost never), reverse-scored, and averaged to yield a total score.
Higher scores indicate greater mindfulness.
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at baseline, at 8 and 15 weeks, and at 3 months after completion of the intervention
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Group Climate Questionnaire-Short Form (GCQ-S)
Tijdsspanne: at 4, 8, and 15 weeks
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It is a 12-item self-report instrument used to measure youths' perceptions of the atmosphere in therapy groups.
It contains 12 items rated on a 7-point Likert scale, indicating the extent of agreement, ranging from "not at all" (0) to "extremely" (6).
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at 4, 8, and 15 weeks
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Therapy Alliance Scale for Adolescence
Tijdsspanne: Completed by adolescents: at 4, 8, and 15 weeks Completed by therapists: at 8 and 15 weeks
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It is widely used to measure therapeutic alliance in research with adolescent populations.
The higher the score, the better the therapeutic alliance.
Items are rated on a 4-point Likert scale ranging from 1 (Strongly Disagree) to 4 (Strongly Agree) and summed to create a single Total score with a maximum of 48.
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Completed by adolescents: at 4, 8, and 15 weeks Completed by therapists: at 8 and 15 weeks
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Client Satisfaction Questionnaire (CSQ-8)
Tijdsspanne: at 15 weeks
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It consists of eight questions (quality of service, kind of service, whether needs were met, likelihood to recommend to a friend, amount of help received, handling of problems, overall satisfaction, and likelihood to return), each rated on a 4-point Likert scale (1-4).
Total scores range from 8 to 32, with higher scores indicating greater satisfaction.
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at 15 weeks
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Satisfaction of each session
Tijdsspanne: From the first group session to the final (15th) group session, satisfaction for each session was assessed immediately after each session.
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This 4-item, content-specific scale is completed by patients after each session using a 5-point Likert scale (1 = very unsatisfied to 5 = excellent).
Total scores range from 4 to 20, with higher scores indicating better session evaluation.
It is designed to facilitate collaborative adjustments to therapy, including the therapeutic alliance, session content, and relevance.
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From the first group session to the final (15th) group session, satisfaction for each session was assessed immediately after each session.
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The Adolescent Dialectical Behavior Therapy Group Skills Learning Experience Scale (ADBT-SLES)
Tijdsspanne: at 15 weeks
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The ADBT-SLES is a 12-item questionnaire assessing adolescents' perceived helpfulness of DBT group skills, rated on a 5-point Likert scale (1 = not helpful at all, 5 = extremely helpful).
It also includes four open-ended questions exploring participants' learning experiences in the group.
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at 15 weeks
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A short drop-out questionnaire
Tijdsspanne: at the time of participant withdrawal during the 15-session group treatment program (up to 15 sessions)
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It contains 6 questions (i.e., reason for drop-out, date of drop-out, number of sessions attended, person who initiated the stop of treatment) to gather information about drop-outs, which is filled in by adolescents.
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at the time of participant withdrawal during the 15-session group treatment program (up to 15 sessions)
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Medewerkers en onderzoekers
Sponsor
Onderzoekers
- Hoofdonderzoeker: Shen-Ing Liu, Ph.D, Mackay Memorial Hospital
Studie record data
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Primaire voltooiing (Geschat)
Studie voltooiing (Geschat)
Studieregistratiedata
Eerst ingediend
Eerst ingediend dat voldeed aan de QC-criteria
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Updates van studierecords
Laatste update geplaatst (Werkelijk)
Laatste update ingediend die voldeed aan QC-criteria
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Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
Andere studie-ID-nummers
- NSTC 113-2314-B-195 -012 -MY3
Plan Individuele Deelnemersgegevens (IPD)
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