Cognitive Behavioral Therapy for Adolescent Depression

Cognitive Behavioral Therapy (CBT) for Adolescent Depression is a developmental adaptation of the classic cognitive therapy model developed by Aaron Beck and colleagues. CBT emphasizes collaborative empiricism, the importance of socializing patients to the cognitive therapy model, and the monitoring and modification of automatic thoughts, assumptions, and beliefs. To adapt CBT for adolescents, more emphasis is placed on (1) the use of concrete examples to illustrate points, (2) education about the nature of psychotherapy and socialization to the treatment model, (3) active exploration autonomy and trust issues, (4) focus on cognitive distortions and affective shifts that occur during sessions, and (5) acquisition of problem-solving, affect-regulation, and social skills. As teens frequently do not complete detailed thought logs, internal experiences such as monitoring cognitions associated with in-session affective shifts are used to illustrate the cognitive model. To match the more concrete cognitive style of younger adolescents, therapists summarize session content frequently. Abstraction is kept to a minimum, and concrete examples linked to personal experience are used when possible. The treatment program is delivered in 12-16 weekly sessions.

The goal of Cognitive Behavioral Therapy for Adolescent Depression is to treat depressive symptoms in adolescents.

Cognitive Behavioral Therapy for Adolescent Depression showed more rapid treatment response than both systematic behavior family therapy and non-directive support therapy. CBT also showed a greater rate of decline in self-reported depression over time.

CBT for Adolescent Depression has been delivered as part of a comprehensive treatment program at the Services for Teens At Risk (STAR-Center), a research, treatment, and training center in Pittsburgh, Pennsylvania.

One study found that at the end of treatment, 17.1% of youth receiving CBT showed evidence of major depressive disorder, compared with 42.4% of youth receiving nondirective support therapy (p = 0.02). An overall treatment time effect was found in interview-rated depressive symptoms, p = 0.05, where CBT showed more rapid treatment response than both systematic behavior family therapy and non-directive support therapy. A significant pairwise difference between CBT and systemic behavior therapy indicated that CBT showed a greater rate of decline in self-reported depression over time, p = 0.02.

In another study, youth receiving CBT in a clinical practice achieved significant symptom change over the course of 6 months. Using hierarchical linear modeling to compare the trajectory of self-reported symptoms between the CBT randomized clinical trial sample and a clinical sample receiving CBT, youth provided CBT in the clinically representative community practice improved more slowly than youth receiving CBT in the clinical trial, p < 0.001.

The achievement of remission differed among the three treatment conditions (CBT, systematic behavior family therapy, and nondirective support therapy), p = 0.05. Pairwise comparisons showed a higher remission rate for CBT (60%) than for systematic behavior family therapy (37.9%) (p = 0.03) or nondirective support therapy (39.4%) (p = 0.04).