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Cognitive and Behavioral Practice 15 (2008) 1–2www.elsevier.com/locate/cabp

INTRODUCTION TO THE SPECIAL SERIES

Prevention of Mental Disorders

Maureen L. Whittal, University of British Columbia

1077© 20Publ

Given the high prevalence and enormous burden of mental disorders and the efficacy of CBT in reducing symptom severity of a numberof acute disorders, it is reasonable to use these same CBTstrategies at an earlier stage to prevent the full expression of emotional problems.In comparison to treatment outcome research, work in prevention of mental disorders is in its infancy. Ongoing and recent preventiontrials for 4 Axis I problems are introduced and the challenges of doing this work will be addressed. The goal within each one of the articlesis to provide concrete guidelines and examples of the clinical work done in each trial to facilitate therapeutic efforts for individualpractitioners.

LIFETIME PREVALENCE RATES of mental disorders arehigh, with approximately 50% of people reporting

symptom severity and interference levels consistent withclinical diagnosis (Kessler et al., 2005). Moreover, only aminority of individuals pursue treatment, often fromproviders who do not use empirically supported treat-ments (Craske & Zucker, 2002). Given the prevalence andthat most mental disorders begin in adolescence or youngadulthood, the economic and societal burden is tremen-dous (e.g., Greenberg et al., 1999). Cognitive behavioraltreatments (CBT) have established efficacy in a numberof Axis I disorders. It is beyond the scope of the presentintroduction to identify and reference efficacy studies ineach area. Suffice it to say that evidence from randomizedcontrolled trials for the efficacy of CBT includes, but is notlimited to, the anxiety disorders, depression, eatingdisorders, sleep disorders, substance abuse, impulsecontrol, and some somatoform and thought disorders.

As the evidence for CBT continues to build, along withthe prevalence and burden of mental disorders, a clearcase exists for the use of CBT strategies to aid in theprevention of mental disorders. The work in prevention,however, is far behind that of treatment outcome researchand contains a number of challenges. The purpose of thisspecial series is to showcase recent and ongoing work in across-section of disorders that include conduct problems,eating disorders, anxiety, and depression.

The first article in the series (Slough, McMahon, &Conduct Disorders Prevention Group, 2008) presents alarge-scale study on preventing the development of

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conduct disorders in high-risk children. This projectcould be considered the Cadillac of prevention trials as itis a multisite, multicomponent study spanning 10 years andtargets families as well as children. In the second article,Becker, Ciao, and Smith (2008) present an innovativeeffectiveness study to prevent eating disorders. Based uponempirically supported randomized control studies (e.g.,Stice, Shaw, Burton, &Wade, 2006), Becker et al. describe abrief peer-led intervention totaling 4 hours delivered to amixed-risk group of sorority members at a small privateuniversity in Texas. In the third article, Miller (2008)presents a large-scale primary prevention study targetinganxiety, the most common mental health problem.FRIENDS (Barrett, Lowry-Webster, & Turner, 2000) wasconducted by teachers who were trained in the implemen-tation of the 10-week classroom-based program to studentsin grades 4 and 5 in a large, ethnically diverse Canadian city.The fourth prevention article (Wolfe, Dozois, Fisman, &DePace, 2008) describes the Resourceful AdolescentProgram (Shochet, Holland, & Whitefield, 1997), auniversal program designed to prevent depression amongadolescent girls. Wolfe et al. describe the process andchallenges of implementing and sustaining a program thatcontains cognitive behavioral and interpersonal elements.Finally, in a discussion paper, Rapee (2008) comments oneach of these articles and identifies the promises ofprevention research and the challenges in doing it.

Although these articles are not typical of the content inCognitive and Behavioral Practice, they nevertheless show-case an important and challenging area and highlightfuture directions for extending empirically supportedtreatments. In keeping with the mandate of Cognitive andBehavioral Practice, the articles are clinically focused,provide detailed descriptions of the treatment, and,

2 Whittal

where possible, present case descriptions and guidelinesfor the individual practitioner.

Given that cognitive-behavioral treatments are effec-tive in reducing the acuity of symptoms across a numberof disorders, there is a strong foundation to expect thatthese same principles and strategies will serve to inoculateindividuals, thereby potentially preventing the fullexpression of mental disorders and circumventing otherfuture difficulties. However, the empirically supportedwork in the prevention of mental disorders is in itsinfancy and contains a number of challenges and pitfalls.The articles contained in this special series offer a cross-section of the work being done in a variety of areas andwill hopefully provide a sense of the enormity of the effortinvolved in preventing mental disorders. The inherentdifficulties, prevalence, and financial and social burdensare but a few of the reasons why this important workneeds to continue.

ReferencesBarrett, P.M., Lowry-Webster, H., & Turner, C. (2000). Friends for children

group leader manual, Edition II. Brisbane: Australian AcademicPress.

Becker, C. B., Ciao, A. C., & Smith, L. M. (2008). Moving from efficacyto effectiveness in eating disorders prevention: The Sorority BodyImage program. Cognitive and Behavioral Practice, 15, 18–27.

Craske, M. G., & Zucker, B. G. (2002). Prevention of anxiety disorders:

A model for intervention. Applied and Preventive Psychology, 10,155–175.

Greenberg, P. E., Sisitsky, T., Kessler, R. C., Finkelstein, S. N., Berndt,E. R., Davidson, J. R. T., et al. (1999). The economic burden ofanxiety disorders in the 1990s. Journal of Clinical Psychiatry, 60,427–435.

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., &Walters, E. E. (2005). Lifetime prevalence and age-of-onsetdistributions of DSM-IV disorders in the national comorbiditysurvey replication. Archives of General Psychiatry, 62, 593–602.

Miller, L. D. (2008). Facing fears: The feasibility of anxiety universalprevention efforts with children and adolescents. Cognitive andBehavioral Practice, 15, 28–35.

Rapee, R. M. (2008). Prevention of mental disorders: Promises, limit-ations, and barriers. Cognitive and Behavioral Practice, 15, 47–52.

Shochet, I., Holland, D., & Whitefield, K. (1997). Resourceful AdolescentProgram (RAP): Group leader’s manual. Brisbane, Queensland,Australia: Griffith University.

Slough, N. M., McMahon, R. J., Conduct Problems PreventionResearch Group. (2008). Preventing serious conduct problemsin school-age youth: The Fast Track program. Cognitive andBehavioral Practice, 15, 3–17.

Stice, E., Shaw, H., Burton, E., & Wade, E. (2006). Dissonance andhealthy weight eating disorders prevention programs: A rando-mized efficacy trial. Journal of Consulting and Clinical Psychology, 74,263–275.

Wolfe, V. V., Dozois, D., Fisman, S., & DePace, J. (2008). Preventingdepression among adolescent girls: Pathways toward effective andsustainable programs. Cognitive and Behavioral Practice, 15, 36–46.

Address correspondence to Maureen L. Whittal, Vancouver Hospital &Health Science Centre, UBC-Site, Anxiety Disorder Unit, 2211WesbrookMall, Vancouver BC, Canada V6T 2B5; e-mail: whittal@interchange.ubc.ca.