The future of psychotherapy for mentally ill children and adolescents

Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA.
Journal of Child Psychology and Psychiatry (Impact Factor: 6.46). 02/2009; 50(1-2):170-9. DOI: 10.1111/j.1469-7610.2008.02034.x
Source: PubMed


Given striking advances in translational developmental neuroscience and its convergence with developmental psychopathology and developmental epidemiology, it is now clear that mental illnesses are best thought of as neurodevelopmental disorders. This simple fact has enormous implications for the nature and organization of psychotherapy for mentally ill children, adolescents and adults.
This article reviews the 'trajectory' of psychosocial interventions in pediatric psychiatry, and makes some general predictions about where this field is heading over the next several decades.
Driven largely by scientific advances in molecular, cellular and systems neuroscience, psychotherapy in the future will focus less on personal narratives and more on the developing brain. In place of disorders as intervention targets, modularized psychosocial treatment components derived from current cognitive-behavior therapies will target corresponding central nervous system (CNS) information processes and their functional behavioral consequences. Either preventive or rehabilitative, the goal of psychotherapy will be to promote development along typical developmental trajectories. In place of guilds, psychotherapy will be organized professionally much as physical therapy is organized today. As with other forms of increasingly personalized health care, internet-based delivery of psychotherapy will become commonplace.
Informed by the new field of translational developmental neuroscience, psychotherapy in the future will take aim at the developing brain in a service delivery model that closely resembles the place and role of psychosocial interventions in the rest of medicine. Getting there will be, as they say, interesting.

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    • "Moreover, the neuroscience findings supporting CBT's capacity to influence brain structures is compelling. Finally, faculty and fellows could also be gently reminded that CBT is finding a home in affective neuroscience departments (March, 2009). When CBT clinicians are citizens in a department dominated by other perspectives, other opportunities emerge. "

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    • "Further, primary care advanced practice nurses also can be instrumental in screening , identifying, and providing evidence-based care for adolescents with mild to moderate depressive and anxiety symptoms. There is strong evidence to support CBT as an effective first-line treatment for depressed and anxious teens (March, 2009; Watanabe, Hunot, Omori, Churchill, & Farukawa, 2007; Williams, O'Connor, Eder, & Whitlock, 2009). There is a need for evidence-based CBT interventions that are portable, have demonstrated ease of use, and can be used in a variety of settings where adolescents are routinely seen. "
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    ABSTRACT: Despite a U.S. prevalence of 9%, less than 25% of depressed adolescents receive treatment because of time constraints in clinical practice and lack of mental health providers available to deliver it. To assess the feasibility and effects of a brief manualized seven-session cognitive-behavioral skills building intervention entitled COPE (Creating Opportunities for Personal Empowerment) delivered to 15 depressed adolescents in routine 30-minute mental health medication management outpatient visits. A preexperimental one group pre- and posttest design was used. Adolescents reported significant decreases in depression, anxiety, anger, and destructive behavior as well as increases in self-concept and personal beliefs about managing negative emotions. Evaluations indicated that COPE was a positive experience for teens and parents. COPE is a promising brief cognitive-behavior therapy-based intervention that can be delivered within 30-minute individual outpatient visits. With this intervention, advanced practice nurses can work with practice time limitations and still provide evidence-based treatment for depressed teens.
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