Negative cognitions play a key role in the development and maintenance of depression. To reduce depressive symptoms, most interventions either encourage adolescents to change negative cognitions, theorizing that the presence of negative cognitions underlies depression, or to acknowledge negative cognitions, theorizing that one's reaction to negative cognitions underlies depression. We compared these two therapeutic strategies in a multilevel meta-analysis of the effects of changing versus acknowledging cognitions on adolescent depression. We searched three databases in June 2022 and identified 104 randomized controlled trials (335 effect sizes). The sample comprised 27,978 adolescents (sample mean age 14-18 years) with all levels of depressive symptoms (M[subscript age] = 15.6 years; 63% female; 65% ethnic majority). The overall effect of interventions on depression was small (d = 0.21, p < 0.001). We found no evidence that either strategy was superior to the other. Strategies to acknowledge (d = 0.23, p = 0.016) or change cognitions (d = 0.20, p < 0.001) both reduced adolescent depression. Our findings suggest, though based on self-reported outcomes, that both strategies are effective in reducing adolescent depression, which allows for flexibility for clinicians and patients. The next step to further understand these strategies is to scrutinize the relative effects of single versus combined approaches to change and acknowledge negative cognitions.