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Table 1 Overview of LARS&LISA intervention

From: LARS&LISA: a universal school-based cognitive-behavioral program to prevent adolescent depression

1. Brief name LARS&LISA—Lust An Realistischer Sicht & Leichtigkeit Im Sozialen Alltag
2. Why (rationale) The primary aim of this universal, school-based prevention program is to prevent the development or increase of depressive symptoms among adolescents. Depression is a leading mental health concern for adolescents and is associated with a wide array of negative outcomes, which highlights the need for preventative interventions tailored to this population. The theoretical foundation for the program is Dodge’s (1993) social information processing model. Following this conceptual framework, the negatively biased way in which some individuals perceive, interpret, and respond to environmental stimuli contributes to the development of depression. Cognitive-behavioral interventions contained within the program are used to teach adolescents how to identify maladaptive thought patterns and behaviors and replace them with more helpful and realistic alternatives.
3. What (materials) LARS&LISA is a structured program with a manual that provides detailed instructions, examples, and tips for group leaders on how to administer the intervention. The primary materials utilized in the implementation of LARS&LISA are handouts and worksheets, which aid the adolescents in understanding and remembering elements of the program’s content. For example, “Knowledge Checks” are worksheets that the students complete individually at the end of sessions, which are designed to reinforce the concepts that were covered that day. These worksheets simultaneously provide group leaders with feedback about the students’ comprehension of the material. Poster sheets, a whiteboard or blackboard, and a projector can be employed by the group leaders as visual aids to present guidelines, concepts, examples, etc. Candy or popular snacks can be used to create a motivational reward system that encourages participation and observation of the group’s guidelines. Finally, a few specific games and activities require additional materials. For instance, in the initial session, the participants compete in a relay race that requires plastic cups, straws, and small candy-coated chocolates. The LARS&LISA manual can be requested by contacting the authors of the program.
4. What (procedures) Each session of the program follows a similar structure and contains a number of common elements. Group leaders begin by presenting the agenda for the day, providing feedback about last session’s Knowledge Check (described above), and asking how the students might have used the skills taught in LARS&LISA since the last session. A majority of the session is spent on group activities related to one of the five modules (Set Some Goals, Reversible Spiral, Think Tank, Just Do It, and Making Contact). Within these modules, students learn how to generate useful personal goals; understand the interconnected nature of thoughts, feelings, and behaviors; and replace maladaptive thoughts and behaviors with more helpful and realistic alternatives. Group activities may include interactive conversations, the completion of worksheets, or the creation and acting out of role-plays, depending on the session. Knowledge Checks are completed towards the end of most sessions. The group leaders end each session by making connections between that day’s content and the content presented in previous sessions, providing feedback about the observation of guidelines, and giving a preview of the next week’s session.
5. Who provided The intervention has been successfully implemented by psychologists and supervised students in graduate psychology programs. A study was conducted to evaluate whether the program could be implemented by teachers, but like other similar programs, teachers were found to be less effective as group leaders.
6. How (mode of delivery) The program is delivered in person in a group setting. The ideal number of participants is between 8 and 12, but the program has been implemented with larger (n ≤ 20) and smaller (n = 4) groups. It is recommended that two leaders co-lead a group, but groups have also been led by individuals and triads.
7. Where LARS&LISA is designed to be a school-based intervention and therefore is generally administered in classrooms during school hours.
8. When and how much The program was originally designed to be presented in 10, 90-min weekly sessions. However, the material has been reorganized to accommodate the unique class schedules at various schools that have hosted the program. For example, it has been adapted to be delivered in 16, 60-min weekly sessions for a school that had shorter class periods. The groups are always gender homogenous.
9. Tailoring Given that each group presents a unique dynamic, minor accommodations are sometimes necessary to meet the specific needs of individual groups. For example, some groups tend to prefer more group work whereas others prefer to process the material individually. Additionally, some groups respond the best when leaders present content in a didactic manner, while others benefit more from game-like and interactive delivery methods. The program’s manual contains a number of suggestions for alternative ways to deliver the content and group leaders are encouraged to make adjustments to best meet the needs of each group.
10. Modifications LARS&LISA has been modified a number of times to make improvements and accommodate various populations. The program originally contained four main modules, but a fifth was added to increase motivation and make the content more personally relevant to adolescents without depressive symptoms. Additionally, changes were made to make the content more relatable for male adolescents. Finally, the program was originally developed in German and was later translated into American English and culturally adapted to be implemented in the USA.
11. How well (planned) To assure adherence to the manual, group leaders participate in a two-step training and while they implement the program in weekly supervision sessions using video recordings of each session. During the first step of the training, future group leaders participated in a mock version of the program, and in the second step, they study the manual, materials, and procedures and discuss their questions with their supervisors.
12. How well (actual) This has not yet been addressed.