What are the most effective strategies to cultivate communication and problem-solving skills in adolescents struggling with depression? Scroll through the slides for quiz questions and answers on the psychotherapeutic “three T’s” for depression: cognitive-behavioral therapy (CBT), interpersonal psychotherapy (IPT), and dialectical behavior therapy (DBT).
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. Clearly, depression is a significant health concern among youths, with the potential for severe and lasting consequences: the need for effective intervention is unambiguous.
Source: Berman A, Jobes D, Silverman M. Adolescent Suicide: Assessment and Intervention. 2nd ed. Washington, DC: American Psychological Association; 2006.
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) and mood monitoring (keeping a mood diary, linking emotions to thoughts).
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.
In this efficacy study, 439 depressed adolescents were treated with CBT, fluoxetine, a combination of the two, or a placebo. Results favored the combination of fluoxetine and CBT, followed by fluoxetine alone, and then CBT and placebo.
The primary focus of interpersonal psychotherapy (IPT) is to address problem areas in the adolescent’s current relationships and immediate social environments to reduce symptoms that contribute to depression.
IPT identifies 4 interpersonal problem areas that may become the focus of treatment: grief, role dispute, role transition, and interpersonal deficits. Through an interpersonal interview, working as a team, the therapist and patient identify 1 or 2 areas on which to focus.
IPT treatment is structured over 12 to 16 weeks in 60-minute sessions. The framework consists of 3 phases, in which the therapy aims to: • Identify a specific interpersonal problem area • Develop communication and problem-solving strategies • Practice the skills in session
Although experts have suggested that borderline personality disorder (BPD) can be meaningfully diagnosed in adolescents, historically, personality disorders were not diagnosed in persons younger than 18. Thus, DBT for adolescents (DBT-A) was targeted specifically at suicidality, as opposed to BPD.
The underlying theoretical approach to DBT is melded with Zen mindfulness principles to create a dialectic that simultaneously emphasizes acceptance of the patient in his current state and a willingness to continually work to change and improve.
Individual DBT sessions are principle- rather than protocol-driven—the clinician is given a toolbox of techniques and a road map based on DBT principles and the patient’s treatment goals and target behaviors. This allows treatment to stay cohesive in the face of a patient population that typically is under a great deal of stress and distress.