Coping with Depression course

1. Introduction

Version followed: Adolescent Coping with Depression Course (CWD-A), Leader's Manual for Adolescent Groups by Clarke, Lewinsohn and Hops (Kaiser Permanente Center for Health Research, original 1990, 2000 web edition) and its Student Workbook; the adult CWD (Lewinsohn et al., 1984) and the preventive Adolescent Coping with Stress course (CWS) are covered as variants. The session-by-session leader scripts (manual Section II, pp. 69–296) could not be read in full: the openly hosted PDF text broke off before them, so the session detail below comes from the Student Workbook (Sessions 1–12 read), the manual's introduction and leader chapters, and programme registries. Sessions 13–16 are reconstructed from the manual's overview and marked [uncertain].

The Coping with Depression course is a class-style psychoeducational CBT group. It is taught as a course rather than run as therapy. Members are "students" with a workbook, short lectures, quizzes, role-plays and homework, and leaders act more like teachers than therapists. It grew out of Lewinsohn's social-learning (behavioural) theory: depression follows and is kept going by a low rate of response-contingent positive reinforcement. That low rate comes from too few pleasant activities, weak social skills, tension, negative or irrational thinking and unresolved conflict, especially family conflict for teens. Change happens by teaching a "smorgasbord" of self-change skills: mood monitoring, pleasant activities, social skills, relaxation, cognitive restructuring, communication, negotiation and problem solving, and relapse planning. Members are taught to attribute improvement to their own growing skill, not to the leader. [source: CWD-A Leader's Manual, Introduction and background chapter; NHS Scotland EIF; CEBC]

2. Framework

Formats [source: Leader's Manual; NHS Scotland EIF; CEBC; NNED]

• CWD-A (treatment, ages about 13–18): 16 two-hour sessions held twice a week over 8 weeks, in mixed-gender groups. Recommended size is 5–8 (CEBC) to 10 (NHS Scotland). Run as an after-school programme or in an outpatient, community or school setting. You need a room with a large table and a whiteboard. Each member gets a workbook, and each session includes a 10-minute social break with snacks.
• Parent course (optional): 9 weekly two-hour sessions held on the same night as the teen group. Parents learn the same skills, especially communication and problem solving. Two sessions are joint parent–teen problem-solving sessions. In the manual these are Section III, Sessions 12–14: "Negotiation and Problem Solving, Part 2" and "Joint Parent-Adolescent Problem-Solving Session, Parts 1–2". A separate Leader's Manual for Parent Groups exists; it is not drawn on here. [uncertain]
• Booster / continuation: in Clarke et al. (1999), booster sessions after the acute course did not reduce recurrence but seemed to speed recovery in teens still depressed at the end of treatment [source: CEBC]. The booster schedule (often reported as every 4 months for up to 2 years) is [uncertain].
• Adult CWD (Lewinsohn, Antonuccio, Steinmetz & Teri, 1984): 6–10 adults with one or two leaders. Twelve two-hour sessions over 8 weeks: twice weekly in weeks 1–4, then weekly in weeks 5–8. Content covers pleasant events, relaxation, changing irrational or negative thoughts, social skills and relapse prevention. Members read chapters of Control Your Depression and use a Participant Workbook. "Class reunions" are held at 1 and 6 months after the course. [source: Leader's Manual background chapter, summarising Lewinsohn, Hoberman & Clarke, 1989]
• Adolescent Coping with Stress course (CWS, prevention): a shorter version of CWD-A focused on cognitive restructuring, for teens with subsyndromal symptoms or teens of depressed parents. Reported formats are about 15 sessions of 45–60 minutes in school or HMO groups (Clarke et al., 1995, 2001), and 8 weekly 90-minute sessions plus 6 monthly continuation sessions (Garber et al., 2009). These figures are from secondary knowledge. [uncertain]

Session sequence (CWD-A) [source: Student Workbook; Leader's Manual table of contents and Introduction]

Typical session format [source: Leader's Manual]

1. Review every member's homework, including that of members who did not do it.
2. Short lecture or rationale.
3. Discussion.
4. Structured workbook tasks, cartoons and role-plays.
5. Mid-session break.
6. Skill practice.
7. Workbook quiz.
8. Assign homework (keep daily mood and pleasant-activity tracking going all course).

Moving between phases: the course runs on a fixed calendar and does not wait for mastery. Skills build cumulatively, and each new session keeps earlier tracking going. Outside research settings, leaders may slow the pace or adjust content, though the manual warns that the effects of changes are hard to predict. Check group cohesion at the end of Sessions 3, 8 and 16. Teens at extreme suicide risk, in acute crisis, or likely to disrupt the group are screened out at intake and referred for individual or more intensive care. [source: Leader's Manual, Chapters 1–4]

Leaders: licensed mental health professionals, typically at master's level or above, with supervised experience in:

• crisis and suicide assessment
• assessing mood disorders
• CBT
• leading adolescent groups
• relaxation
• behavioural management
• adolescent development

Non-clinicians may lead only under supervision. Training is by co-leading or running a mock group, the Mastering the Coping Course DVD, or self-study of the manual, with weekly or fortnightly supervision. Fidelity is checked by a supervisor rating recorded sessions with adherence and competence scales. [source: Leader's Manual; NHS Scotland EIF; CEBC]

3. Guiding principles

[source: Leader's Manual Introduction and Chapters 1–4 unless marked]

• It is a class, not therapy. Teach, demonstrate and practise. Keep personal disclosure optional and focused on applying skills.
• Depression is learned and can be unlearned (social learning). Present every symptom as a chain of thoughts, actions and feelings that members can change. [source: Workbook Session 1]
• Reinforcement first. Raise the rate of pleasant, rewarding activities and social contact early. Most later skills serve that goal.
• Self-monitoring underpins everything. Daily mood ratings and activity counts give the data for self-change and show members their progress.
• Skills over insight; members own the credit. Give an elaborated, well-planned rationale for each skill, then attribute gains to the member's own effort and skill. [source: background chapter, citing Zeiss et al.]
• A smorgasbord of skills. Teach many skills because different teens benefit from different ones. In the last sessions each member chooses their own most effective skills.
• Small, realistic, rewarded steps. Goals must be specific and realistic, set from a baseline, written into a contract and paired with a self-chosen reward. [source: Workbook Session 4]
• Homework is voluntary but always reviewed. Never shame a member over homework. Always ask about it, and allow catch-up during the session.
• Friendly but firm; treat teens as young adults. Don't act like a teenager. Ask for their input and keep the structure.
• Cohesion matters. Use the break, snacks and pair work. Pair compatible members first, then rotate partners.
• Confidentiality with stated limits. What is said in group stays in group, except in a medical emergency or when someone is a danger to self or others. Members may keep personal details private.
• Group rules protect mood. Avoid depressive talk, share time equally, keep matters confidential and support one another. [source: Workbook Session 1]
• Families matter. Family conflict can maintain teen depression, so communication and negotiation take up a large part of the course, and parents are invited into a parallel course.
• Plan for relapse. Depression often recurs, so the course ends with a written plan for warning signs and responses.
• Follow the protocol, adapt with care. In research, follow the manual closely. In clinical use, adjust pace and content with discretion. [synthesis] Note your changes so outcomes can be interpreted.

4. Intervention inventory

The interventions are listed in the order the CWD-A teaches them. Session numbers refer to CWD-A. All worksheet descriptions are paraphrased, not reproduced. [source: CWD-A Student Workbook, Sessions 1–12; Leader's Manual Introduction and Chapters 1–4; for Sessions 13–16 see the [uncertain] notes]

4.1 Course orientation: the social-learning model and the mood spiral (Session 1)

• Purpose: give the rationale for the whole course: depression is learned and changeable, and the course teaches the skills to change it. Also build early hope and group norms.
• Steps:
  1. Leaders introduce themselves and the course format: classes, workbook, homework, quizzes and a break.
  2. Present personality as three linked parts: thoughts, actions and feelings. A change in any one shifts the others.
  3. Draw the downward mood spiral (negative thought, then withdrawal, then lower mood, and round again) and the upward spiral, which the course aims to start.
  4. Workbook exercise: members sort example statements into thoughts, actions or feelings, and into depressive or positive ones.
  5. Present and agree the class guidelines: avoid depressive talk, share time equally, keep personal matters confidential, offer support.
  6. Start the Mood Diary (4.2) and the Session Goal Record.
• Example language (illustrative): "This is a class, not a therapy group. You'll learn skills here, practise them at home, and keep the ones that work for you." "When your mood drops, what you do and what you think usually drop with it. We're going to work on all three."
• Watch for: members expecting a talking group, and members swapping stories about how bad things are. Redirect gently with the rule against depressive talk. A sign it is working: members can name a thought, an action and a feeling from their own week.

4.2 Mood Diary and graph (all sessions from Session 1)

• Purpose: daily self-monitoring. It gives the baseline and the outcome data for every later skill, and helps members see links between mood and events.
• Steps:
  1. Each evening, members rate their overall mood for the day on the workbook's 1–7 scale and plot it on the graph.
  2. Later, from Session 2, they plot pleasant-activity counts on the same graph.
  3. At every session, review the graphs one by one. Ask about the high and low days and what was happening.
  4. In Session 4, analyse the combined mood and activity graph to find patterns, such as weekday effects or mood rising with activity.
• Example language (illustrative): "Look at Tuesday, your best day. What were you doing?" "If you missed some days, fill them in now from memory. Rough is fine."
• Watch for: blank diaries. Allow members to fill in recent days afterwards during the session [source: Leader's Manual Ch. 4]. It is working when members link their own mood dips to their activities or thoughts without prompting.

4.3 Session Goal Record and workbook quizzes (every session)

• Purpose: keep members active and check understanding of each session's concepts.
• Steps: members note the session's goals or progress on the Goal Record. They complete the short true/false or multiple-choice quiz at the end of each workbook session, and leaders correct misunderstandings straight away.
• Example language (illustrative): "Quiz time. It's not graded; it just shows us what to go over again."
• Watch for: reading difficulties. Read items aloud or pair members up. [synthesis]

4.4 Social skills training (spread across Sessions 1–8)

This is a set of small skills, one per session, practised in pairs and as homework. [source: Workbook Sessions 1–3, 6, 8]

• Purpose: increase rewarding social contact and reduce behaviours that push others away.
• Components:
  • Session 1: friendly behaviours. Members answer questions about what makes someone seem friendly, then practise one friendly skill in a conversation as homework.
  • Session 2: starting conversations. Members spot good and bad times to start a conversation and good opening questions. Optional role-plays use scripted characters, such as a talker who won't stop or a shy listener. Homework: start two conversations.
  • Session 3: meeting someone new in four steps: eye contact, smile, greeting, use the person's name.
  • Session 6: positive statements. Members write positive comments about classmates and give them in group.
  • Session 8: distracting habits. Members use a checklist (for example poor eye contact, mumbling, complaining) to pick one habit to reduce.
• Steps (per skill): state the rationale, have the leader model the skill, have pairs rehearse it, give brief praise and specific coaching, and set a real-world homework target.
• Example language (illustrative): "Try it with your partner: look up, smile, say hi and use their name. Then swap."
• Watch for: social anxiety, which can block practice. Start with easier partners and smaller targets. It is working when members report real conversations started.

4.5 Pleasant activities: baseline and selection (Session 2 onwards)

• Purpose: the core behavioural lever. Raise response-contingent positive reinforcement.
• Steps:
  1. Members build a personal list of pleasant activities, drawing on the Pleasant Events Schedule approach (activities rated for how often they happened and how enjoyable they were) [source: Leader's Manual Introduction].
  2. Choose target activities using the workbook criteria: high pleasure rating, under the member's control, possible often, cheap, positive, and unlikely to cause trouble.
  3. Each day, tick which listed activities were done and plot the total alongside mood (the baseline week).
  4. Review the baseline in Session 4 before setting goals.
• Example language (illustrative): "Pick things you can do this week without anyone's permission or much money." "Don't try to change anything yet. Just count."
• Watch for: lists made of unrealistic or risky activities, and "nothing is enjoyable". In that case, ask what used to be enjoyable and include small neutral activities [synthesis]. It is working when mood and activity rise together on the graph.

4.6 Self-change plan, rewards and contracts (Session 4; reused later)

• Purpose: teach a general self-change method. It is first applied to pleasant activities, then to negative thoughts and family problems.
• Steps:
  1. Observe the target behaviour.
  2. Take a baseline (use the Session 2–3 records).
  3. Set a specific, realistic goal just above baseline, worked through with the workbook example.
  4. Choose a reward using the Reward Selection Worksheet, which covers people, places, things and activities.
  5. Write a Pleasant Activities Contract stating the target level, the time span and the reward.
  6. Monitor progress and give yourself the reward when you meet the goal.
• Example language (illustrative): "Your baseline was about three a day. What's a goal you're confident you could hit? Four? Then what will you give yourself if you do?"
• Watch for: goals set too high, and rewards that never get delivered. Coach members to lower the goal rather than drop the contract. It is working when contracts are met and members renegotiate goals themselves.

4.7 Progressive muscle relaxation, Jacobsen method (Session 3)

• Purpose: reduce tension that blocks enjoyment and social contact. This is the first relaxation skill taught.
• Steps:
  1. Members complete a tension questionnaire and a checklist of situations that cause them tension.
  2. Before practice, each member rates their tension and, as the workbook describes, measures finger temperature.
  3. The leader guides the class through tensing and then releasing each muscle group in turn, in a calm voice and at a slow pace.
  4. Afterwards, members rate tension again and compare.
  5. Homework: practise at least three times and keep the activity records going.
• Example language (illustrative): "Make a tight fist, notice the tension... hold it... and let go. Notice the difference as your hand loosens."
• Watch for: giggling or embarrassment in a teen group. Normalise it and keep going. Avoid tensing injured areas, and allow members to keep their eyes open [synthesis]. It is working when after-practice ratings drop and members use it in the situations on their checklist.

4.8 Benson relaxation and the quick Benson (Session 8)

• Purpose: a portable relaxation skill for everyday stress.
• Steps:
  1. Choose a quiet place and a comfortable position.
  2. Relax the muscles progressively.
  3. Breathe slowly and repeat a calming word on each out-breath for several minutes.
  4. Then teach the quick Benson, a shortened version for brief moments such as before a test or a hard conversation.
  5. A workbook quiz helps members choose between Jacobsen and Benson for a given situation.
  6. Homework: practise Benson four times.
• Example language (illustrative): "Pick a word that feels calm to you. Each time you breathe out, say it silently."
• Watch for: members using it only in group. Ask for one real use per week [synthesis].

4.9 Catching negative thoughts (Session 5)

• Purpose: the first cognitive step: notice thoughts and link them to the events that trigger them.
• Steps:
  1. Use the workbook checklists of common negative and positive thoughts; members tick the ones they have.
  2. Use cartoon strips to spot the negative thought and its trigger.
  3. Introduce the target of having several positive thoughts for every negative one.
  4. Start the Negative Thoughts Baseline: log each day's worst negative thought and its triggering event, carrying a 3x5 card to note them as they happen.
• Example language (illustrative): "You can't change a thought you haven't caught. This week is just about catching them."
• Watch for: members who say "I don't have thoughts, I just feel bad". Work backwards from the mood change to the event, then ask what went through their mind. It is working when members log specific thoughts with triggers.

4.10 Counter-thoughts and positive thinking (Session 6)

• Purpose: replace negative thoughts with more balanced or positive ones and start challenging irrational beliefs.
• Steps:
  1. Teach the difference between personal statements ("I feel...") and non-personal ones.
  2. Use the Counter-a-Negative-Thought worksheet: for each negative thought, write a believable counter-thought.
  3. Introduce common irrational beliefs: needing everyone's approval, demanding perfection, blaming others, catastrophising. Members write rational replacements, using cartoons that show exaggeration and unrealistic expectations.
  4. Write a Negative Thoughts Contract: replace at least one negative thought a day, with a reward.
• Example language (illustrative): "'I always mess up' — what would you say to a friend who said that? Write that down as your counter-thought."
• Watch for: counter-thoughts that are just cheerleading and that the member doesn't believe. Push for realistic ones. It is working when members say their counter-thoughts are believable and their mood ratings rise.

4.11 Disputing irrational thinking: the C-A-B / A-B-C method (Session 7; reused in Sessions 8 and 10)

• Purpose: a structured way to analyse upsetting situations and dispute irrational beliefs, adapted from Ellis and Beck [source: Leader's Manual Introduction].
• Steps:
  1. Start with the Consequence (the feeling), then find the Activating event, then the Beliefs about it. In later sessions the order is A-B-C.
  2. Check each belief against the list of irrational beliefs, which now adds jumping to conclusions and personal beliefs disguised as facts.
  3. If a belief is irrational, write counter-thoughts and name the better feeling they lead to.
  4. If the belief is rational and the event really is a problem, choose one of five ways to handle the activating event: don't respond to it, change your response, avoid it, change it, or cope with it.
  5. Practise on cartoon strips and sample situations, then on personal ones.
  6. Homework: one form a day (at least four by Session 8).
• Example language (illustrative): "Start with how you felt. What happened just before? And what were you telling yourself about it?" "Is that a fact, or a guess dressed up as a fact?"
• Watch for: members using the method to argue that real problems (abuse, bullying) are only "irrational thinking". If a belief is rational, move to action and check safety [synthesis]. It is working when forms show disputes the member generated themselves and feelings that are less intense afterwards.

4.12 Worry Time and stopping negative thinking (Session 9)

• Purpose: contain rumination.
• Steps:
  1. When a member catches themselves worrying, they tell themselves they will worry later.
  2. They set a fixed, scheduled worry period.
  3. They keep that appointment and worry only then.
• The workbook says Session 9 teaches three stop-negative-thinking techniques, but only Worry Time could be read. The other two are not named here to avoid guessing. [uncertain]
• Example language (illustrative): "When the worry shows up, tell it: 'Not now. 7:30, for fifteen minutes.' Then actually show up at 7:30."
• Watch for: worry periods set at bedtime, which can worsen sleep. Suggest an earlier slot [synthesis].

4.13 Active listening (Session 9)

• Purpose: the base communication skill for peer and family relationships and for negotiation.
• Steps:
  1. Teach the sender–listener model and how messages break down.
  2. To listen actively: restate the sender's message in your own words, begin with a feeling-reflecting lead such as "It sounds like you feel...", and show neither approval nor disapproval.
  3. Give your own view only after the sender agrees they were understood.
  4. Name listener mistakes: half-attention, rehearsing a reply, guessing at feelings the sender didn't express.
  5. Workbook exercise: tell judgmental responses apart from understanding ones.
  6. Practise in pairs.
  7. Homework: restate someone's message at least once a day and log it.
• Example language (illustrative): "Before you answer your mum, try: 'So you're upset because I came home late without texting?' Wait until she says yes."
• Watch for: parroting the words back, and sarcasm. Model a warm tone. It is working when members report fewer arguments escalating.

4.14 Expressing feelings, self-disclosure and relationship statements (Session 10)

• Purpose: state positive and negative feelings constructively.
• Steps:
  1. Teach "I feel..." statements instead of "You make me feel...".
  2. Pair the event (what happened) with the feeling it produced.
  3. Teach helpful self-disclosure: honest, paced, reciprocal, and involving some risk.
  4. Teach relationship statements, which talk about the relationship itself.
  5. Stress that the aim is to improve the situation, not to hurt or control the other person.
  6. Members classify sample statements, list three or four current problem situations, and role-play them.
  7. Use the extended A-B-C form: if the belief is rational, choose to avoid the event, not respond to it, or tell the person about the event and your feeling.
  8. Homework: one positive feeling statement a day, at least two negative feelings expressed through self-disclosure, and A-B-C forms.
• Example language (illustrative): "'When plans get cancelled at the last minute, I feel left out.' Notice: no 'you always'."
• Watch for: members choosing risky targets, such as an aggressive parent, for their first try. Start with safer people [synthesis].

4.15 Assertive imagery (Session 11)

• Purpose: rehearse assertive expression in imagination before doing it for real.
• Steps:
  1. Picture the problem situation as a still "photograph".
  2. Turn it into a "movie".
  3. In the movie, state your feelings to the person.
  4. Imagine their likely reaction and how you would respond.
• Example language (illustrative): "Freeze the scene. Now let it play. What do you say? What does he say back?"
• Watch for: imagery that turns into a catastrophic scene. Coach toward a realistic outcome.

4.16 Defining problems (Session 11)

• Purpose: the first step of the four-step problem-solving model: define the problem briefly and without accusations.
• Steps: apply the workbook's eight rules:
  1. Begin with something positive.
  2. Be specific.
  3. Describe the other person's behaviour.
  4. Avoid name-calling.
  5. Express your feelings.
  6. Admit your own part.
  7. Don't accuse.
  8. Be brief.
  Members critique sample problem statements, then write definitions of several of their own problems. They do not raise these with anyone yet.
• Example language (illustrative): "'I like it when we get along. When you check my phone without asking, I feel I'm not trusted, and I know I've lied about where I was before.'"
• Watch for: definitions that are really demands. It is working when definitions are short and blame-free.

4.17 Brainstorming and evaluating solutions (Session 12)

• Purpose: generate options before judging them, then find one most people can agree to.
• Steps:
  1. Generate many solutions without evaluating any of them.
  2. On the Problem-Solving Worksheet, each party (teen, mother, father) rates each solution plus or minus.
  3. Choose the solution that is most acceptable to everyone.
  4. Complete the sample brainstorming and evaluation exercises.
• Example language (illustrative): "No judging yet, even silly ideas count. We'll sort them after."
• Watch for: early criticism shutting down ideas. Enforce the no-evaluation rule.

4.18 Agreement contracts (Session 12)

• Purpose: turn the agreed solution into specific commitments.
• Steps:
  1. Record what each person will do, when, and for how long.
  2. Set a review date.
  3. If either side breaks the terms, the contract is cancelled and renegotiated rather than enforced by punishment.
• Example language (illustrative): "Who does what, by when, and when do we check how it's going?"
• Watch for: one-sided contracts where only the teen commits. Each side needs a commitment.

4.19 Issues Checklist (Session 12 homework)

• Purpose: identify family conflict topics to bring to negotiation practice.
• Steps: in teen-only groups, teens complete the Issues Checklist and ask each parent to complete one. Where parents attend the parallel course, families complete it there. This appears to be Robin and Foster's family conflict checklist, which is not reproduced here. [source: Workbook Session 12; attribution to Robin & Foster is inference, uncertain]
• Watch for: checklists that show a high-conflict or unsafe home. Assess before using joint sessions [synthesis].

4.20 Negotiation and problem-solving practice; joint parent–teen sessions (Sessions 13–14) [uncertain]

• Purpose: bring together the four steps: define, brainstorm, negotiate a mutually acceptable solution, specify how it will be carried out [source: Leader's Manual Introduction].
• Steps (reconstructed; the session scripts were not read): members role-play whole negotiations on real issues from the Issues Checklist, with leaders coaching each step and using active listening and feeling statements. Where a parent group runs, Sessions 13–14 are joint parent–adolescent problem-solving sessions (manual Section III) in which families negotiate live with leader coaching.
• Example language (illustrative): "Mum, can you restate what Jay just said before you reply?" "Let's write down all the options for curfew first."
• Watch for: escalation in joint sessions. Pause, split the family into separate rooms, and return to listening [synthesis].

4.21 Life goals and the life plan (Session 15) [uncertain detail]

• Purpose: link the skills to longer-term goals and maintain gains. Members develop a Life Plan with goals tied to it [source: Leader's Manual Introduction].
• Steps (reconstructed): members name valued long-term goals in areas such as school, relationships and work, break them into short-term steps using the self-change method (4.6), and note possible obstacles.
• Example language (illustrative): "Where would you like to be in a year? What's one step you could take this month?"
• Watch for: goals that are out of reach and set up hopelessness. Scale them down.

4.22 Prevention, emergency plan and ending (Session 16)

• Purpose: prevent relapse. Members identify the skills that worked best for them, anticipate future problems, and each builds a personal "emergency plan" with the leader's help [source: Leader's Manual Introduction].
• Steps:
  1. Each member reviews their mood graph across the course.
  2. Each lists the skills they found most effective.
  3. Each names likely future stressors and their own early warning signs.
  4. With the leader, each writes the steps they will take when warning signs appear (which skills to restart, whom to contact).
  5. Complete the cohesion questionnaire.
  6. End the group. [steps 2–4 detail: synthesis consistent with the manual overview]
• Example language (illustrative): "If your mood diary drops for three days running, what's the first thing on your plan?"
• Watch for: members still depressed at the end. Refer them for continued or more intensive care, or boosters (see 4.25).

4.23 Homework review routine (every session)

• Purpose: keep skills practised outside the group.
• Steps:
  1. At the start of each session, review every member's homework, including that of members who did not do it.
  2. Let members complete overdue forms early in the session, filling in recent days afterwards if needed.
  3. Praise any effort.
  4. Keep homework voluntary but always discussed. [source: Leader's Manual Ch. 4]
• Example language (illustrative): "Let's go round. Even partial is fine. What did you notice?"

4.24 Group cohesion monitoring and building

• Purpose: cohesion supports attendance and practice.
• Steps:
  1. Give the cohesion questionnaire (a modified Yalom measure) at the end of Sessions 3, 8 and 16.
  2. If scores are low, make more use of the social break and snacks, and use paired role-plays.
  3. Pair compatible members early, then rotate partners. [source: Leader's Manual Ch. 4]

4.25 Parent course, reunions and boosters

• Parent course: 9 weekly two-hour sessions. Parents learn the teen skills, especially communication and problem solving, and two sessions are joint [source: NHS Scotland EIF; CEBC]. Content beyond this was not read. [uncertain]
• Adult "class reunions": held at 1 and 6 months after the course to support maintenance and check for relapse [source: Leader's Manual background].
• Adolescent boosters: these sped recovery in teens still depressed after the course but did not prevent recurrence [source: CEBC]. The schedule was not verified. [uncertain]

4.26 Variant: Adolescent Coping with Stress course (CWS) [uncertain]

This is a preventive group for teens with elevated symptoms who do not meet criteria for depression, or for teens of depressed parents. It concentrates on the cognitive skills (4.9–4.11) in shorter sessions. Deliver those sections in condensed form, plus psychoeducation and a prevention plan. This description is from secondary knowledge of Clarke et al. (1995, 2001).

5. Handling problems

From the manual [source: Leader's Manual Chapters 1–4]

• Missed sessions: phone the teen the same evening or the next day. Arrange a short individual catch-up before or after the next session. If several sessions are missed, also phone the parents.
• Reluctant teens: ask for a trial of three sessions. If the teen still wants to stop after that, help them find other resources rather than pressing them.
• Families fading out: phone periodically and remind them that depression is likely to come back without completing this or another treatment.
• Homework not done: keep it voluntary but review it with everyone. Let members complete forms in session and fill in recent days afterwards. Never single out or shame a member.
• Low cohesion: use the break and snacks, paired role-plays, and pairing compatible members before rotating partners. Re-check at Sessions 8 and 16.
• Suicidality: probe any suicidal ideation further. Teens at extreme risk or in acute crisis are excluded at intake and referred to individual or more intensive care. Explain the limits of confidentiality (danger to self or others, medical emergency) at the start.
• Disruptive behaviour: screen out at intake teens whose behaviour would disrupt the group.
• Rapport: be friendly but firm, don't try to be a teenager, and ask for members' input.

Additional guidance [synthesis: not from the CWD sources]

• Stuck client (flat mood graph after about 4 weeks):
  • Check that the pleasant-activity targets are realistic and are actually being done.
  • Lower the contract goals and check that the reward is really being delivered.
  • Pick the one skill the member liked best and focus on it.
  • Re-assess for comorbidity (anxiety, substance use, trauma), medical causes, or a worsening home situation.
  • Arrange an individual check-in, and consider adding individual CBT, a medication review, or referral for more intensive care. The course may not be enough for severe depression.
• Resistance or "this is stupid": acknowledge the school-like feel. Invite the member to test one skill as an experiment for a week and check the mood graph together. Give sceptical members roles, such as playing the other person in a role-play.
• Overwhelm or distress in group: slow down and use a quick Benson. Offer a private word at the break and do a brief risk check after the session. Keep personal disclosure optional, as the course already does.
• Rising suicide risk mid-course:
  • Do a structured risk assessment in private the same day.
  • Make a safety plan with the teen and involve parents within the limits already explained.
  • Do lethal-means counselling: ask parents to lock away or remove medicines and firearms.
  • Step up care. The teen may continue in the group only if clinically safe.
• Rupture with a leader or member: name it, take your share of responsibility, and use the course's own skills (active listening, feeling statements). Handle peer conflict out of group first, then agree a group-wide reminder of the rules.
• Depressive talk spreading in group: point out the group rule warmly, validate in one sentence, then redirect: "Let's put that on a C-A-B form together."
• Unsafe or high-conflict families: if the Issues Checklist or disclosures point to abuse or violence, do not run joint negotiation sessions. Follow child-protection procedures, and coach teens in safety rather than in negotiating with an aggressive parent.
• Reading or language difficulties: read the workbook aloud and use pictures and role-play instead of written forms. The manual notes possible modifications for teens with serious reading problems [source: NHS Scotland EIF]. How to modify is synthesis.
• Individual delivery: the course can be adapted for individual use [source: NHS Scotland EIF]. Keep the session order, replace group role-plays with leader–client rehearsal, and invite parents for the problem-solving sessions [synthesis].
• Cultural fit: adapt cartoons, examples and rewards to members' culture and context, and check that family negotiation suits family norms. Keep the core skills [synthesis].

Sources

Sources:

• Leader's Manual for Adolescent Groups: Adolescent Coping with Depression Course (Clarke, Lewinsohn & Hops; PDF copy, text read through the front chapters and background)
• Adolescent Coping with Depression Course Student Workbook (PDF copy, Sessions 1–12 read)
• CWD-A Leader's Manual (SlideShare copy: front matter, Introduction, Chapters 1–4)
• NHS Scotland Early Intervention Framework: Adolescent Coping with Depression Course
• CEBC: Adolescent Coping With Depression Course
• NNED: Adolescent Coping with Depression Course
• Clearinghouse for Military Family Readiness fact sheet (little content)

Further reading (not drawn on; cited from the sources or from background knowledge, marked [uncertain] where used):

• Behaviour Change review of the CWD course (Lewinsohn, Hoberman & Clarke, 1989). The Leader's Manual background chapter appears to draw on it.
• Developer's original download page: kpchr.org/research/public/acwd/acwd.html.

Books and papers:

• Clarke, G. N., Lewinsohn, P. M., & Hops, H. (1990). Leader's Manual for Adolescent Groups: Adolescent Coping with Depression Course. Castalia / Kaiser Permanente Center for Health Research.
• Clarke, G. N., Lewinsohn, P. M., & Hops, H. (1990). Student Workbook: Adolescent Coping with Depression Course.
• Lewinsohn, P. M., Rohde, P., Hops, H., & Clarke, G. (1991). Leader's Manual for Parent Groups: Adolescent Coping with Depression Course.
• Lewinsohn, P. M., Antonuccio, D. O., Steinmetz, J. L., & Teri, L. (1984). The Coping with Depression Course: A Psychoeducational Intervention for Unipolar Depression. Castalia.
• Lewinsohn, P. M., Muñoz, R. F., Youngren, M. A., & Zeiss, A. M. (1978/1986). Control Your Depression. Prentice-Hall.
• Clarke, G. N., Rohde, P., Lewinsohn, P. M., Hops, H., & Seeley, J. R. (1999). Cognitive-behavioral treatment of adolescent depression: efficacy of acute group treatment and booster sessions. JAACAP.
• Clarke, G. N., et al. (1995, 2001); Garber, J., et al. (2009). Coping with Stress course trials [uncertain].