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Adolescence is a time of increased vulnerability for depression, with risk factors driven by biological,
cognitive, and social-environmental changes in development. More than half of all adolescents report
experiencing depressed mood, and 8% to 10% experience clinically diagnosable symptoms.1
Depression in the young negatively affects all areas of development, including academic, cognitive,
social, and family functioning, and if untreated, it can have significant lasting consequences.
Depression in adolescence is a strong predictor of recurrent depression in adulthood and long-term
functional impairment, and it confers a 10-fold increase in risk for suicidal behavior.2 Clearly,
depression is a significant health concern among youths, with the potential for severe and lasting
consequences: the need for effective intervention is unambiguous.
Fortunately, there is strong empirical evidence for successful therapeutic treatment of adolescent
mental health disorders, including depression. Psychotherapy for depression is as effective as
medication in many cases and is the recommended first-line intervention for mild to moderate
depression in youths. This article offers a brief review of the psychotherapeutic three Ts for
depression: cognitive-behavioral therapy (CBT), interpersonal psychotherapy (IPT), and dialectical
behavior therapy (DBT).
Cognitive-behavioral therapy
CBT is an evidence-based approach that has been tailored to treat a wide variety of mental health
concerns in youths, including anxiety, eating disorders, impulse control disorders, ADHD,
oppositional defiant disorder (ODD), and a range of other problematic behaviors in addition to
specific adaptations for depression. Generally, CBT is directive, time-limited, structured,
problem-focused, and goal-oriented. Weekly session structure begins with collaborative agenda
setting and homework review and ends with review and consolidation of new skills learned and the
assignment of new homework.
Treatment typically ranges from 4 to 20 sessions, depending on program choice and setting,
although treatment of comorbid conditions or severe symptoms can take longer. Clinicians may use
various combinations of CBT techniques, or they may adhere to a specific manualized program.
Common CBT interventions include psychoeducation (helping the patient and parents understand
the connection between thoughts, feelings, and behaviors), mood monitoring (keeping a mood diary,
linking emotions to thoughts), pleasant activities (creating a list of activities that the patient enjoys
and setting aside daily time to engage in them), behavior activation techniques (joining a sports
team, going for nightly family walks), and cognitive restructuring (identifying cognitive distortions
and negative thinking patterns and replacing them with more realistic and/or positive ways of
thinking). Social, communication, conflict-resolution, and problem-solving skills are also frequent
components of CBT programs.
CBT has an extensive research base and a longer history than either IPT or DBT; as such, the
approach has traditionally been considered the gold standard for the treatment of childhood and
adolescent depression. Meta-analyses in 1998 and 1999 found effect sizes for CBT treatment of
depression in youths of 1.02 and 1.27 respectively.3,4 A more recent meta-analysis of 35 studies
found a less pronounced effect size of 0.34, although this still represents a clinically significant small
to medium treatment effect.5 On the basis of these findings, in 2008 CBT received status as a
well-established treatment for youths, according to the guidelines set by Nathan and Gorman.6
In addition to comparisons with wait list control and treatment as usual (TAU), CBT has also been
compared with psychopharmacological intervention, primarily SSRIs. One of the most cited and
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Table 2
Table 1
Table 3
References:
References
1. Shaffer D, Fisher P, Dulcan MK, et al. The NIMH Diagnostic Interview Schedule for Children Version
2.3 (DISC-2.3): description, acceptability, prevalence rates, and performance in the MECA Study.
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Source URL:
http://www.psychiatrictimes.com/printpdf/treating-adolescent-depression-psychotherapy-three-ts/pa
ge/0/2
Links:
[1] http://www.psychiatrictimes.com/adhd
[2] http://www.psychiatrictimes.com/addiction
[3] http://www.psychiatrictimes.com/attention-deficit-disorders
[4] http://www.psychiatrictimes.com/cognitive-behavioral-therapy
[5] http://www.psychiatrictimes.com/depression
[6] http://www.psychiatrictimes.com/major-depressive-disorder
[7] http://www.psychiatrictimes.com/psychotherapy
[8] http://www.psychiatrictimes.com/authors/sanno-e-zack-phd
[9] http://www.psychiatrictimes.com/authors/jenine-saekow-ms
[10] http://www.psychiatrictimes.com/authors/anneliese-radke-msw
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