During the initial stages, the therapist helps the patient and his family to understand the nature of the illness by assigning a limited sick role that emphasizes the disease model of depression and removes any blame (by self or by a parent). The therapist also uses a closeness circle to help the adolescent map the current connectedness of the significant relationships in his life and to identify those that he would like to deepen, distance, or change (Table 2).
IPT-A is a principle-driven approach with an active patient role. Thus, providers are offered a variety of helpful intervention techniques, but a particular intervention is not prescribed for each week. The selection of the specific techniques to use is driven by the early identification of the interpersonal problem area of focus.
The efficacy of IPT for depressive disorders has been well studied; there have been 38 randomized controlled trials. Five of these specifically examined an adolescent (versus adult) population. Studies that compared adolescents who received IPT-A with a control group (wait list control, clinical monitoring, TAU, CBT) yielded an estimated average effect size of 0.63 in meta-analysis.14 Adolescents who received IPT-A rather than clinical monitoring or TAU reported greater reduction in depressive symptoms posttreatment and greater increase in problem-solving skills and interpersonal functioning at 16-week follow-up.
Several international studies examined the efficacy of IPT-A with Ugandan, Taiwanese, and Puerto Rican adolescents.15-17 These studies yielded similar results, suggesting that IPT-A is as effective as CBT in reducing depressogenic symptoms, including decreases in depressed mood, suicidal ideation, hopelessness, and anxiety. Both IPT-A and CBT were found to be more effective than the wait list control at posttreatment and 3-month follow-up assessments.14-16 However, IPT-A appears to have a supplementary effect on adolescents in that it also increased overall social functioning, self-esteem, and problem-solving skills, which may act as protective factors against relapse.17,18
Although these studies shed light on the efficacy of IPT-A, the treatment has yet to be compared with pharmacotherapy in an adolescent population. The NIMH did, however, conduct a study in which IPT was found to be as effective as imipramine(Drug information on imipramine) in the treatment of MDD in adults.19
Dialectical behavior therapy
DBT was developed by Linehan20 in the early 1990s. It is based on her extensive clinical and research experience in treating chronically suicidal women. The approach was originally aimed at treating borderline personality disorder (BPD), of which chronic suicidality is a major feature. Adaptations to adolescent populations (DBT-A) were made in 2002 by Rathus and Miller,21 eventually culminating in a manual for adolescents in 2007.22