FIRST: A Principal-Guided Approach to Evidence-Based Youth Psychotherapy
About This Program
Target Population: Children and adolescents with disorders and problems involving anxiety (including obsessive compulsive disorder [OCD]), depression, misconduct, and posttraumatic stress
For children/adolescents ages: 6 – 15
Program Overview
FIRST is a transdiagnostic synthesis of empirically supported treatment procedures for children and adolescents with disorders and problems involving anxiety (including OCD), depression, misconduct, and posttraumatic stress. The treatment program is organized around 5 empirically supported principles of therapeutic change:
- Feeling Calm (skills in calming and self-regulation)
- Increasing Motivation (skills, primarily for caregivers, in boosting motivation to change [e.g., praise, differential attention])
- Repairing Thoughts (cognitive restructuring)
- Solving Problems (skills in solving everyday problems rather than being overwhelmed by them)
- Trying the Opposite (identifying and practicing the positive opposite of unhelpful behavior [examples: exposure for anxious avoidance, behavioral activation for depression])
Program Goals
The goals for FIRST: A Principle-Guided Approach to Evidence-Based Youth Psychotherapy are:
- Increased coping skills of the kind represented in the FIRST acronym
- Reduced internalizing (anxiety and depression) symptoms
- Reduced externalizing (anger, aggression, disobedience) symptoms
- Reduced severity of idiographic “top problems” identified by the youth at baseline
Logic Model
View the Logic Model for FIRST: A Principal-Guided Approach to Evidence-Based Youth Psychotherapy.
Essential Components
The essential components of FIRST: A Principle-Guided Approach to Evidence-Based Youth Psychotherapy include:
- For all youths:
- Personalized application of the best-fit FIRST skills
- For Youths with Anxiety and OCD
- Trying the Opposite: Exposure
- With scaffolding, as needed, via one or more of the following:
- Increasing motivation for change
- Repairing anxious cognitions
- Problem solving skills training
- For Depression
- Trying the Opposite: Behavioral activation
- With scaffolding, as needed, via one or more of the following:
- Increasing motivation
- Calming & emotion-regulation skills
- Repairing thoughts
- Problem solving skills training
- For Misbehavior
- Increasing Motivation: Teaching caregivers effective parenting skills (e.g., differential attention, praise, consequences)
- With scaffolding, as needed, via one or more of the following:
- Calming skills
- Cognitive restructuring
- Problem solving skills training for caregiver
- For Posttraumatic Stress
- Calming—emotion regulation skill-building
- Trying the Opposite—building and reviewing a trauma narrative
- With scaffolding, as needed, via one or more of the following:
- Increasing motivation
- Cognitive restructuring
- Problem solving skills training
Program Delivery
Child/Adolescent Services
FIRST: A Principal-Guided Approach to Evidence-Based Youth Psychotherapy directly provides services to children/adolescents and addresses the following:
- Anxiety, OCD, depression, misbehavior/disruptive behavior, posttraumatic stress
Services Involve Family/Support Structures:
This program involves the family or other support systems in the individual's treatment: Caregivers of youth are highly encouraged to be involved in their youth’s treatment, but it is not required.
Recommended Intensity:
Ideally 45- to 60-minute sessions, once per week
Recommended Duration:
Duration of treatment episodes is highly variable, because measurement-based care is used to determine when treatment goals have been met and treatment should end.
Delivery Settings
This program is typically conducted in a(n):
- Community Daily Living Setting
- Hospital
- Outpatient Clinic
- School Setting (Including: Day Care, Day Treatment Programs, etc.)
- Virtual (Online, Telephone, Video, Zoom, etc.)
Homework
FIRST: A Principal-Guided Approach to Evidence-Based Youth Psychotherapy includes a homework component:
Skills are taught in sessions, with skill practice assigned after each session, and then reviewed at the beginning of the next session.
Languages
FIRST: A Principal-Guided Approach to Evidence-Based Youth Psychotherapy has materials available in a language other than English:
Spanish
For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).
Resources Needed to Run Program
The typical resources for implementing the program are:
Personnel who provide counseling or psychotherapy to youths and caregivers in clinics, schools, or hospital settings. Space is needed to permit confidential meetings.
Manuals and Training
Prerequisite/Minimum Provider Qualifications
Training in counseling or psychotherapy. Providers can have a range of degrees from bachelor’s level individuals with a counseling certification to doctoral-level clinicians, but most have master’s degrees in mental health fields (most often social work).
Manual Information
There is a manual that describes how to deliver this program.
Program Manual(s)
Manual details:
- Weisz, J. R., & Bearman, S. K. (2020). Principle-Guided psychotherapy for children and adolescents: The FIRST Treatment Program for Behavioral and Emotional Problems. Guilford Press.
The manual can be purchased via this link.
Training Information
There is training available for this program.
Training Contacts:
- John Weisz, PhD, ABPP
john_weisz@harvard.edu - Sarah K. Bearman, PhD
skb75@uoregon.edu
Training Type/Location:
Multiple trainings are offered each year.
Number of days/hours:
- 18-hour training for front-line clinicians (can be virtual or in-person)
- Consultation/coaching available for clinicians
- Train-the-consultant option also available for supervisors
Regular consultation is provided to clinicians following training. It is offered remotely, with duration determined by clinicians and their employers. Support for effectiveness evaluation can also be provided. Fidelity supports are also available.
Relevant Published, Peer-Reviewed Research
The following studies were not included in rating FIRST: A Principal-Guided Approach to Evidence-Based Youth Psychotherapy on the Scientific Rating Scale...
Weisz, J., Bearman, S. K., Santucci, L. C., & Jensen-Doss, A. (2017). Initial test of a principle-guided approach to transdiagnostic psychotherapy with children and adolescents. Journal of Clinical Child & Adolescent Psychology, 46(1), 44–58. https://doi.org/10.1080/15374416.2016.1163708
The purpose of the study was to address implementation challenges faced by some evidence-based youth psychotherapies. FIRST [now called FIRST: A Principal-Guided Approach to Evidence-Based Youth Psychotherapy] was developed as a transdiagnostic approach—guided by five empirically supported principles of therapeutic change. Measures utilized include the Therapist Integrity in Evidence-Based Interventions (TIEBI), the Therapeutic Alliance Scale for Youths (TASC-C) and Parents (TASC-P), the Client Satisfaction Questionnaire (CSQ-8), the Therapist Satisfaction Inventory (TSI), the Brief Problem Checklist (BPC), the Top Problems Assessment (TPA), the Clinical Global Impression–Improvement (CGI) Scale, the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), the Child Behavior Checklist (CBCL), the Youth Self Report (YSR), and the Services for Youths and Adolescents-Parent Interview (SCAPI). Results indicate that weekly assessments throughout FIRST treatment showed effect sizes for clinical improvement ranging from 0.41 to 2.66 on weekly total problems and problems deemed “most important” by caregivers and youths. Limitations include small sample size, an open trial design, and diversity was limited. Note: This article was not used in the rating process due to the lack of a control group.
Additional References
Kramer, U. (2009). Between manualized treatments and principle-guided psychotherapy: Illustration in the case of Caroline. Pragmatic Case Studies in Psychotherapy, 5(2), 45–51. https://doi.org/10.14713/pcsp.v5i2.970
Marchette, L. K., & Weisz, J. R. (2017). Practitioner review: Empirical evolution of youth psychotherapy toward transdiagnostic approaches. Journal of Child Psychology and Psychiatry, 58(9), 970–984. https://doi.org/10.1111/jcpp.12747
Weisz, J. R., Fitzpatrick, O. M., Venturo-Conerly, K., & Cho, E. (2021). Process-based and principle-guided approaches in youth psychotherapy. World Psychiatry, 20(3), 378–380. https://doi.10.1002/wps.20887
Contact Information
- John R. Weisz, PhD, ABPP
- Title: Professor
- Agency/Affiliation: Harvard University, Department of Psychology
- Email: john_weisz@harvard.edu
- Sarah K. Bearman, PhD
- Agency/Affiliation: University of Oregon, Ballmer Institute for Children’s Behavioral Health, Department of Special Education and Clinical Sciences
- Website: leaplab.uoregon.edu/current-research-projects
- Email: skb75@oregon.edu
Date Research Evidence Last Reviewed by CEBC: October 2024
Date Program Content Last Reviewed by Program Staff: January 2025
Date Program Originally Loaded onto CEBC: December 2021
