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Intervention Summary

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Penn Resilience Training for College Students

Penn Resilience Training for College Students is a brief prevention program for freshmen university students at risk for depression. The program teaches a range of techniques based on the work of Beck and colleagues on cognitive therapy for depression. The manual-based program helps participants to acquire the following skills: (1) learn the relationship between thoughts, feelings, and behaviors; (2) identify automatic negative thoughts and underlying beliefs; (3) use evidence to question and dispute automatic negative thoughts and irrational beliefs; (4) replace automatic negative thoughts with more constructive interpretations, beliefs, and behaviors; (5) apply behavioral activation strategies; (6) build interpersonal skills; (7) manage stress; and (8) generalize these skills to new and relevant situations. The program is delivered to 10 to 12 freshmen participants per group by a trainer and a cotrainer through 1- to 2-hour weekly meetings over 8 weeks. The workshop meetings consist of rapport-building, lectures and audiovisual presentations, role-play, games and activities, group discussion, and homework reviews. Detailed participant notebooks are used along with homework and written materials to review major points of the workshop. Trainers (trained cognitive specialists) meet with participants individually on six occasions to review the skills the participants learned in the workshop and to discuss any questions they have about applying the skills to their lives.

Descriptive Information

Areas of Interest Mental health promotion
Outcomes Review Date: March 2007
1: Episodes of depression
2: Episodes of anxiety
3: Symptoms of depression
4: Symptoms of anxiety
Outcome Categories Mental health
Ages 18-25 (Young adult)
Genders Male
Female
Races/Ethnicities Data were not reported/available.
Settings Outpatient
School
Geographic Locations Urban
Implementation History Two evaluations of Penn Resilience Training were conducted at the University of Pennsylvania in the late 1990s, with about 200 college students participating.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: Yes
Adaptations No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Selective

Quality of Research
Review Date: March 2007

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Seligman, M. E., Schulman, P., DeRubeis, R. J., & Hollon, S. D. (1999). The prevention of depression and anxiety. Prevention and Treatment, 2(8) [Serial online]. URL: http://www.journals.apa.org/prevention/volume2/pre0020008a.html

Study 2

Seligman, M. E., Schulman, P., & Tryon, A. M. (2007). Group prevention of depression and anxiety symptoms. Behaviour Research and Therapy, 45(6), 1111-1126.  Pub Med icon

Supplementary Materials

Buchanan, G. M., Gardenswartz, C. A., & Seligman, M. E. (1999). Physical health following a cognitive-behavioral intervention. Prevention and Treatment [Serial online].

Horowitz, J. L., & Garber, J. (2006). The prevention of depressive symptoms in children and adolescents: A meta-analytic review. Journal of Consulting and Clinical Psychology, 74(3), 401-415.  Pub Med icon

Outcomes

Outcome 1: Episodes of depression
Description of Measures The Structured Clinical Interview for the DSM-III-R (SCID) was used as a diagnostic interview for episodes of depression at the preworkshop phase of the study. At subsequent interviews, the Longitudinal Interval Follow-Up Evaluation (LIFE), modified to reflect DSM-III-R criteria, was used. These measures rate depression on a scale of 1 through 6; a rating of 3 is considered moderate depression, a rating of 4 is marked depression, a rating of 5 is definite depression, and a rating of 6 is severe depression. One study used a short, self-report version of LIFE to determine which participants might be having current episodes of depression. This instrument included eight yes/no questions pertaining to depression, yielding a score of 0 to 8 (low scores indicating a low level of depression).
Key Findings In one study, 19% of students in the intervention group had moderate depressive episodes, compared with 31% of students who took the questionnaires and had the diagnostic interviews but did not participate in the workshop (p < .03).

In another study, results of the short self-report LIFE measures of depression showed that the students in the intervention group had significantly lower levels of depression compared with students who took the questionnaires and had diagnostic interviews but did not participate in the workshop. Effect size for this finding was large (Cohen's d = 0.50).
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental
Quality of Research Rating 3.5 (0.0-4.0 scale)
Outcome 2: Episodes of anxiety
Description of Measures The Structured Clinical Interview for the DSM-III-R (SCID) was used as a diagnostic interview for episodes of anxiety at the preworkshop phase of the study. At subsequent interviews, the Longitudinal Interval Follow-Up Evaluation (LIFE), modified to reflect DSM-III-R criteria, was used. The LIFE assesses generalized anxiety disorder (GAD) on a 1-3 scale. A rating of 2 is considered moderate, and a rating of 3 is definite GAD. The program used a cutoff score of 2 or more for a diagnosis of GAD. One study used a short, self-report version of LIFE to determine which participants might be having current episodes of anxiety. This instrument included eight yes/no questions pertaining to anxiety, yielding a score of 0 to 8 (low score indicating a low level of anxiety).
Key Findings In one study, 14% of students in the intervention group had episodes of anxiety at moderate level or above, compared with 21% of students who took the questionnaires and had the diagnostic interviews but did not participate in the workshop (p < .04). Students in the comparison group were 1.6 times more likely than students in the intervention group to have an anxiety episode.

There were no significant findings relating to episodes of anxiety in another study.
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental
Quality of Research Rating 3.5 (0.0-4.0 scale)
Outcome 3: Symptoms of depression
Description of Measures Symptoms of depression were assessed using: (1) the Beck Depression Inventory (BDI), a 21-item self-report questionnaire to measure depressive symptoms; and (2) the Structured Interview Guide for the Hamilton Depression Rating Scale (SIGH-D), a 7-item clinician-rated structured interview.
Key Findings In one study, students in the intervention group had significantly fewer depressive symptoms (based on self-report only) compared with students who took the questionnaires and had the diagnostic interviews but did not participate in the workshop. Effect size for this finding was medium (Cohen's d = 0.29).

In another study, results of the BDI indicated that students in the intervention group had significantly fewer symptoms of depression compared with students who took the questionnaires and had diagnostic interviews but did not participate in the workshop. Effect size for this finding was large (Cohen's d = 0.59).
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental
Quality of Research Rating 3.3 (0.0-4.0 scale)
Outcome 4: Symptoms of anxiety
Description of Measures Symptoms of anxiety were assessed using: (1) the Beck Anxiety Inventory (BAI), a 21-item self-report questionnaire to measure anxiety symptoms; and (2) the Structured Interview Guide for the Hamilton Anxiety Rating Scale (SIGH-A), a 14-item clinician-rated structured interview.
Key Findings In one study, students in the intervention group had significantly fewer anxiety symptoms (based on self-report only) compared with students who took the questionnaires and had the diagnostic interviews but did not participate in the workshop. Effect size for this finding was small (Cohen's d = 0.24).

In another study, results of the BAI indicated that students in the intervention group had significantly fewer symptoms of anxiety compared with students who took the questionnaires and had diagnostic interviews but did not receive the workshop. Effect size for this finding was large (Cohen's d = 0.43).
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental
Quality of Research Rating 3.3 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 18-25 (Young adult) 52% Female
48% Male
Data not reported/available
Study 2 18-25 (Young adult) 65% Female
35% Male
Data not reported/available

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Episodes of depression 4.0 4.0 3.3 3.3 2.3 4.0 3.5
2: Episodes of anxiety 4.0 4.0 3.3 3.3 2.3 4.0 3.5
3: Symptoms of depression 3.5 3.5 3.3 3.3 2.3 4.0 3.3
4: Symptoms of anxiety 3.5 3.5 3.3 3.3 2.3 4.0 3.3

Study Strengths

The studies were well constructed and well implemented, using good experimental design. The studies used standardized outcome measures with good reliability and validity. Attrition rates for participants enrolled in both studies were low. Intervention fidelity was well monitored, and experienced therapists were used. A detailed manual was used to standardize the workshops. Additional training was given to therapists before intervention, with frequent supervision thereafter. Stratified randomization for group assignment was used, and interviewers were blinded to participants' assigned condition. Both studies used appropriate statistical analyses.

Study Weaknesses

No information was available on the psychometric properties for the shortened version of the LIFE instrument used in one study. The study design lacked a placebo control; this can be a confounding factor in interpreting study results. The sampling method showed a low response rate for participant recruitment, and the intervention group participants were aware of their group assignment. These factors compromise the external validity and generalizability of findings of both studies.

Readiness for Dissemination
Review Date: March 2007

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Buchanan, G., Gardenswartz, C., & Seligman, M. (1999). Physical health following a cognitive-behavioral intervention. Prevention & Treatment, 2(10).

Horowitz, J. L., & Garber, J. (2006). The prevention of depressive symptoms in children and adolescents: A meta-analytic review. Journal of Consulting and Clinical Psychology, 74(3), 401-415.  Pub Med icon

Positive Psychology Center Web site, http://www.ppc.sas.upenn.edu

Reivich, K., & Shatte, A. (2003). Penn Resilience Training for college students: Leader's guide.

Reivich, K. & Shatte, A. (2003). Penn Resilience Training for college students: Participant's guide.

Seligman, M. E., Schulman, P., DeRubeis, R. J., & Hollon, S. D. (1999). The prevention of depression and anxiety. Prevention and Treatment, 2(8) [Serial online].

Seligman, M. E., Schulman, P., & Tryon, A. M. (2007). Group prevention of depression and anxiety symptoms. Behaviour Research and Therapy, 45(6), 1111-1126.  Pub Med icon

University of Pennsylvania. (2003). Resilience training for college students [PowerPoint presentation].

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
3.5 2.8 3.0 3.1

Dissemination Strengths

The program curriculum is detailed in high-quality leader and participant guides. Both guides are fairly easy to follow, clearly presented, and age and gender appropriate. The leader guide can be used for training purposes. Support resources are available to potential implementers. Outcome and fidelity measurement using well-established instruments is carefully described in available published and unpublished research materials.

Dissemination Weaknesses

Limited information is provided on organizational-level implementation. Little information is provided on identifying and recruiting participants. It is unclear how leaders obtain training from the program's developers and what the training involves. The program materials do not address quality assurance outside the research context.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Participant guide Free Yes
Trainer guide Free Yes
Training, technical assistance/consultation, and quality assurance materials Contact the developer Contact the developer
Replications

Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

* Seligman, M. E., Schulman, P., DeRubeis, R. J., & Hollon, S. D. (1999). The prevention of depression and anxiety. Prevention and Treatment, 2(8) [Serial online]. URL: http://www.journals.apa.org/prevention/volume2/pre0020008a.html

* Seligman, M. E., Schulman, P., & Tryon, A. M. (2007). Group prevention of depression and anxiety symptoms. Behaviour Research and Therapy, 45(6), 1111-1126.  Pub Med icon

Contact Information

To learn more about implementation, contact:
Peter Schulman
(215) 898-2748
schulman@psych.upenn.edu

To learn more about research, contact:
Martin Seligman, Ph.D.
(215) 898-7173
seligman@psych.upenn.edu

Peter Schulman
(215) 898-2748
schulman@psych.upenn.edu

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

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