Future Directions in Research on Psychotherapy for Adolescent Depression

Journal of Clinical Child & Adolescent Psychology (Impact Factor: 1.92). 04/2014; 43(3):1-17. DOI: 10.1080/15374416.2014.904233
Source: PubMed


Research over the past 3 decades has shown that psychotherapy can successfully address adolescent depression. Cognitive behavioral models have been most extensively and rigorously tested, with evidence also supporting interpersonal psychotherapy and attachment-based family therapy. However, the vast majority of studies have focused on short-term treatment of depressive episodes, even as evidence accumulates that depression is frequently a recurring condition extending into adulthood. Moreover, treatment studies indicate that better longer term outcomes are attained by adolescents who respond earlier and more completely to intervention. Given what has been learned to date about adolescent depression treatment, future psychotherapy research should adopt a longer term perspective and focus on the following key challenges: (a) preventing relapse and recurrent episodes, while improving speed and thoroughness of initial treatment response; (b) identifying the necessary treatment components and learning processes that lead to successful and enduring recovery from depression; (c) determining whether-and, if so, how-to address comorbid disorders within depression treatment; (d) addressing the dilemma of simplicity versus complexity in treatment models. Given the relatively small number of evidence-based treatment models, newer approaches warrant investigation. These should be tested against existing models and also compared to medication and combined (psychotherapy plus medication) treatment. Advances in technology now enable investigators to improve dissemination, to conduct experimental psychotherapeutics and to expand application of Internet-based interventions to the goals of relapse and recurrence prevention.

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    • "These findings suggest that developing ways to strengthen self-compassion in adolescents may be advantageous in guarding against negative mood states which can then result in lifelong psychological and cognitive struggles (Lupien et al. 2009; Pine et al. 1999). As evidence-based forms of stress reduction for adolescents are often limited to cognitive-based therapy which may have limited efficacy over the long term (Curry 2014) and active coping measures which have limited effectiveness on psychological functioning particularly with uncontrollable interpersonal stressors (Clarke 2006), strengthening one's ability to be self-compassionate may offer adolescents an additional personal resource which they can access when needed. The Mindful Self-Compassion program for adults, created and piloted by Neff and Germer (2012), has demonstrated that self-compassion can be developed and maintained. "
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    ABSTRACT: The aim of this study was to determine whether adolescents who were high in self-compassion self-reported different levels of emotional wellbeing than adolescents who were low in self-compassion, and to determine whether those high in self-compassion responded differently under a lab social stressor than those low in self-compassion. In a lab setting, participants (age 13–18; n = 28) completed the Trier Social Stress Test (TSST) and physiological stress was assessed via salivary cortisol, heart rate, blood pressure, and heart rate variability at baseline, during the TSST, and during recovery. After completing the lab protocol, an email was sent to participants that provided a link to an online survey which was composed of emotional wellbeing measures including perceived stress, life satisfaction, positive and negative affect. After conducting repeated measure ANOVAS to determine that the TSST induced a significant stress response, the sample was split at the median of self-compassion. T tests were conducted to determine meaningful differences (Hedges’ g > .20) between the groups. Findings indicated that those in the high self-compassion group (≥the median) self-reported greater emotional wellbeing than those in the low self-compassion group (<the median). Overall, those in the high self-compassion group also had a lower physiologic stress response when exposed to the TSST than those in the low self-compassion group. Regression analyses were also conducted; baseline self-compassion predicted self-reported emotional wellbeing, but did not predict physiological response to the TSST. Findings support the potential buffering effect that self-compassion may have in protecting adolescents from social stressors; yet more research needs to be conducted in larger samples to confirm and replicate these findings.
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    ABSTRACT: Mental health problems in children and adolescents are frequent, with a high risk of persistence into adulthood. Therefore, the investigation of determinants of onset and course of mental health problems is of high importance. The present paper investigates the impact of protective and risk factors on the development of depressive symptoms in children and adolescents. The BELLA study is the mental health module of the German National Health Interview and Examination Survey for children and adolescents (KIGGS). Based on the first three measurement points of the BELLA study (covering a period of 2 years), the present analysis focused on children and adolescents aged 11–17 years at baseline (n = 1,643; 50.6 % female). A longitudinal growth modelling approach was used. Mental health problems in parents (parent-reports) predicted depressive symptoms in children and adolescents (self-reports) as well as the development of these symptoms over time. Further, child-reported protective factors of self-efficacy, positive family climate and social support were associated with less depressive symptoms at baseline. Additionally, positive changes in protective factors were associated with the development of less depressive symptoms over time. Finally, family climate and social support moderated the detrimental influence of parental psychopathology on child’s depressive symptoms. The addressed determinants for the development of depressive symptoms in children and adolescents are highly relevant for prevention and intervention strategies. Future research should investigate specific risk and protective factors focusing in detail on further mental health disorders and their development in children and adolescents.
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