Depression and Psychotherapy for Teens

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Could Psychotherapy Be The Answer To Adolescent Depression?

It should come as no surprise that depression is becoming more and more widespread among young adults.  Adolescence is not only a time of heightened susceptibility for mental illness such as anxiety and depression, but of increased vulnerability in general as it is a crucial stage in emotional and mental development.  During adolescence, biological, cognitive, and social-environmental factors can have a massive impact on development and general mood.  According to recent studies, more than half of all young adults report feelings of depressed mood (Zack, Saekow, & Radke, 2012).  Additionally, 8 to 10 percent of the adolescent population exhibit clinically diagnosable symptoms.  Depression in adolescence is also a precursor for recurring depression as an adult and delegates a 10-fold increase in risk for suicidal behavior.  With depression in adolescents being not only a large health concern, but also a risk for grim long-term consequences, the urgency for effective treatment is undeniable. Fortunately, there are various treatments which have experimentally been shown to reduce depressive symptoms in youths.  Three psychotherapeutic treatments in particular, which are often referred to as the “three Ts,” will be discussed in this article.

Cognitive-behavioral therapy

Cognitive-behavioral therapy (CBT) is typically referred to as the “gold standard” for the treatment of adolescent depression. (Zack, Saekow, & Radke, 2012) CBT is an evidence-based treatment plan which can be altered to accommodate a large-scale group of mental disorders in addition to depression – i.e., anxiety, eating disorders, ADHD, and oppositional defiant disorder (ODD), to name a few.  CBT, focusing particularly on the patient's behavior as it relates to cognitive processes, generally encompassing intervention techniques such as psychoeducation, mood monitoring, engaging in activities which are pleasant to the patient, behavior activation techniques, and cognitive restructuring. 

CBT has both the longest history and the most extensive empirical foundation of the “three Ts.” (Zack, Saekow, & Radke, 2012)  Most notably, CBT has been widely compared to psychopharmacological treatment – specifically selective serotonin re-uptake inhibitors (SSRIs).  The Treatment of Adolescent Depression Study (TADS), conducted in 2004, is possibly the most notorious study to analyze the effectiveness of CBT. This efficacy study included four separate groups to which 439 clinically depressed adolescents were assigned – treated solely with CBT, treated solely with fluoxetine (a particular SSRI), treated with a combination of CBT and fluoxetine, and a placebo. (Zack, Saekow, & Radke, 2012) The results of this study showed that the combination of CBT and fluoxetine proved to be the most effective treatment, followed by fluoxetine alone, CBT alone, and then the placebo.  However, the results of this study were partly controversial as they also showed that CBT alone was not significantly more effective in treating depression than the placebo.  Although, the efficacy of CBT still remains legitimate as the combination treatment containing CBT was, in fact, the most effective in treating depression in adolescents.  This is due in part to the fact that CBT has potential to act as a strong buffer against negative stress and suicidal behavior, whereas it is unknown whether or not SSRIs alone are able to do the same.

Interpersonal Psychotherapy

Interpersonal psychotherapy (IPT) is a well-established and highly structured form of treatment.  However, instead of focusing on deficits in cognitive behavior, as CBT does, IPT is designed to assess the patient's depression using a more interpersonal approach, focusing strongly on the individual's current relationships and existing social environments.  The primary goal of IPT is to dramatically improve the individual's communication and problem-solving skills.  The expectation is that with the improvement of these crucial skills, the individual's interpersonal connections and relationship satisfaction will also increase, leading to the decrease of depressive symptoms caused by deficits in these relationships.  The hope for IPT as a successful treatment for adolescent depression revolves around the idea that, from a developmental psychopathology perspective, interpersonal relationships are absolutely crucial in adolescent years.  Adolescence is the peak time period for the cultivation of both peer and romantic relationships as well as parent-child relationships.  Therefore, deficits or setbacks in fostering these relationships in adolescence can certainly be detrimental to the mood of the adolescent.

The effectiveness of IPT as a treatment for adolescent depression has been studied extensively.  Research has shown that, generally, adolescents who received IPT intervention demonstrated a greater long-term decrease in depressogenic symptoms and a greater long-term increase in problem-solving skills than those who received mere clinical monitoring.  Many international studies have also compared IPT with CBT and have found that IPT is just as effective as CBT in decreasing symptoms such as depressed mood, suicidal behavior, hopelessness, and anxiety.  Furthermore, IPT seems to have a positive effect on not only depressogenic symptoms, but general overall social functioning and self-esteem as well.  The only setback in efficacy studies conducted on IPT is that it has not been directly compared to pharmacological intervention in an adolescent population, as CBT has.

Dialectal behavior therapy

Dialectal behavior therapy (DBT) is possibly the least common of the “three Ts” in treating adolescent depression, as it was originally developed in the early 1990s to treat borderline personality disorder (BPD) in adults. (Zack, Saekow, & Radke, 2012)  Specifically, it was designed to decrease the chronic suicidal behavior which manifests itself in BPD.  However, DBT has since been adapted to depressed adolescent populations to act as a buffer to the suicidal ideation associated with depression. 

DBT, like CBT, is concerned mostly with the patient's behavior.  However, in addition to the tactics employed by other behaviorally-centered treatments like CBT, DBT also employs a Zen-like model which puts a large emphasis on patient acceptance in his or her current state and a willingness to consistently work to change and improve.  There are five particular target functions with which DBT is concerned.  These five behaviors typically seek to enhance both the capabilities, motivation, and success of the patient as well as the relationship between the patient and therapist and are carried out through four distinct modes of treatment: multifamily group skills training, individual psychotherapy, coaching calls, and a consultation team for the therapist. (Zack, Saekow, & Radke, 2012)  IPT is seen more as a “life enhancement” technique rather than solely a suicide prevention program.  The idea behind IPT is that if the patient is motivated to work towards an achievable, fulfilled life, suicide will no longer be a plausible solution to the patient's problems.

Considering the shockingly high prevalence of depression among young adults, the need for efficient and successful treatments is unambiguous.  Although no one intervention technique has been proven to successfully eradicate adolescent depression, the three Ts – CBT, IPT, and DBT – have been empirically supported as being highly effective in reducing depressogenic symptoms.  As always, research is continually and consistently being conducted not only to further support these claims, but to unmask additional treatment regimens.  However, until a cure-all is found, psychotherapy seems to be one of the most promising paths to take on the road to recovery.

- Mikaela Pricher


Insightful Comments


As a father to two teenagers and one preteen . . .I must pause because I just got dizzy thinking about the fact that I am such a grown-up now.  In less than a year from now, I will be the father of three teenagers all living under the same roof. If any of you have already gone through something like this and survived, please say a prayer for us.

Our family had to abruptly relocate in the middle of my eldest daughter’s junior year of high school, which was and has been quite a traumatic experience for us all, but especially her. 

She was forced by no fault of her own to leave behind friends that she had been with and around for more than half of her life. Poof! They were all gone and she became the new girl in her class.  Over time she began to seek her personal asylum in her bedroom, which she now shared with her six year younger sister, because our new home was a smaller location than our previous home.  She began using her tablet and smartphone, along with the ear buds, not only as communication and entertainment devices, but also as refuge devices - A way to escape from the reality of her pain. Through pop-culture and media she has substituted some of her real life relationships with her fantasy hopes of relationships lived out by her favorite pop stars. 

I was quite troubled, and still am to a degree, by all of the fantasies that she had about relationships, and my wife tried to reassure me that it is a phase, but I tried to convince her that I didn’t think it was normal. My wife again tried to reassure me that she to had gone through a phase like similar to our daughter’s, but I was not reassured.  To me that just made it hereditary and therefore even more frightening.

My concern for the younger demographic of our current society is their lack of socialization. Sure, they communicate on their smartphones with their thumbs through social media, but they are failing to learn the most valuable tools of survival in the world. 

Interpersonal communication in relationships is necessary for the progression of human civilization, but the least taught skill in the world today is relationship building. As a result, I am convinced that we will see a decline in marriages and childbirths over the next two generations at least. The declines are in part, if not completely, due to our apparent desire to keep one another at a distance. 

Is it because we need safety - Be it mentally, emotionally, or otherwise? Are the teenagers of today communicating effectively? Yes, and maybe. Both are happening like never before. 

The old cliché that long-distance relationships will not work is becoming less relevant today because the world is becoming a smaller place with the rapid advancement of technologically and travel. It is also less relevant because many young people are more content with relationships held at arms length. More specifically, the distance has shrunk from miles to the length from their eyes to their technology screens via their thumbs.  When are we going to learn to value real human relationships? I am afraid that could be the key question to the survival of humanity.


- Bergen
 
References

Zack, S., Saekow, J., & Radke, A. (2012, November 6). Treating Adolescent Depression With
            Psychotherapy: The Three T's. Retrieved December 14, 2014, from
            http://www.psychiatrictimes.com/adhd/treating-adolescent-depression-psychotherapy
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