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A critical evaluation of the role of cognitive behaviour therapy in children and adolescents with depression

Published online by Cambridge University Press:  01 June 2009

Maura Delaney
Maura Delaney*
Affiliation:
Department of Child and Adolescent Psychiatry, City General Hospital, Cork City, Ireland
*
*Author for correspondence: Dr M. Delaney, Department of Child and Adolescent Psychiatry, City General Hospital, Cork City, Ireland (email: maura.delaney@hse.ie)
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Abstract

Depressive disorders are relatively common in adolescents although less so in younger children. They accrue significant morbidity and frequent long-term sequelae as well as increased suicide risk in sufferers. Evidence-based treatment of depression in children and adolescents is the subject of intense investigation and debate. This article reviews the current evidence base for cognitive behaviour therapy in this group and makes recommendations for further areas of research.

Keywords

children and adolescentscognitive behaviour therapydepressionevidence-based practice
Type
Review
Information
the Cognitive Behaviour Therapist , Volume 2 , Issue 2 , June 2009 , pp. 83 - 91
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2009

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References

Recommended follow-up reading

Treatment of Adolescents with Depression Study (TADS) (2007). Cognitive Behaviour Therapy Manual (https://trialweb.dcri.duke.edu/tads/manuals.html). Accessed 1 November 2008.Google Scholar
Reinecke, MA, Dattillio, FM, Freeman, A (eds). (2006). Cognitive Therapy with Children and Adolescents: A Casebook for Clinical Practice. New York, London: The Guilford Press.Google Scholar
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CWD-A. (1990). Coping with Depression for Adolescents programme (http://www.kpchr.org/public/acwd/acwd.html). Accessed 10 August 2008.Google Scholar
Angold, A, Messner, SC, Strangl, D, Farmer, EM, Costello, EJ, Burns, BJ (1998). Perceived parental burden and service use for child and adolescent psychiatric disorders. American Journal of Public Health 88, 75–80.CrossRefGoogle ScholarPubMed
Brent, D, Emslie, G, Clarke, G, Dineen Wagner, K, Asarnow, J, Keller, M, Vitiello, B, Ritz, L, Iyengar, S, Abebe, K, Birmaher, B, Ryan, N, Kennard, B, Hughes, C, DeBar, L, McCracken, J, Strober, M, Suddath, R, Spirito, A, Leonard, H, Melhem, N, Porta, G, Onorato, M, Zelazny, J (2008). Switching to another SSRI or to venlafaxine with or without cognitive behavioural therapy for adolescents with SSRI-resistant depression. The TORDIA randomised control trial. Journal of the American Medical Association 299, 901–913.CrossRefGoogle ScholarPubMed
Brent, D, Perper, J, Moritz, G, Allman, C, Friend, A, Roth, C, Scheuers, J, Bulach, L, Waugher, M (1993). Psychiatric risk factors of adolescent suicide: a case control study. Journal of the American Academy of Child and Adolescent Psychiatry 33, 521–529.CrossRefGoogle Scholar
Brent, DA, Holder, D, Kolko, D (1997). A clinical psychotherapy trial for adolescent depression comparing cognitive, family and supportive treatments. Archives of General Psychiatry 54, 877–885.Google Scholar
Brent, D, Kolko, D, BirmaherB, Baugher MA, Bridge J, Roth C, Holder D B, Baugher MA, Bridge J, Roth C, Holder D (1998). Predictors of treatment efficacy in a clinical trial of three psychosocial treatments for adolescent depression. Journal of the American Academy of Child and Adolescent Psychiatry 37, 906–914.CrossRefGoogle Scholar
Clarke, G, LewinsohnP, Hops H P, Hops H (1990). Instructors Manual for the CWD-A Course. Portland, Oregon: Kaiser Permanante Center for Health Research.Google Scholar
ClarkeG, Hops H G, Hops H, LewinsohnJ, Seeley J, Williams J J, Seeley J, Williams J (1992). Cognitive behavioural group treatment of adolescent depression: prediction of outcome. Behaviour Therapy 23, 341–354.CrossRefGoogle Scholar
Clarke, G, Hornbrook, M, Lynch, F, Polen, M, Gale, G, Beardslee, W, O'Conner, E, Seeley, J (2001). A randomised trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents. Archives of General Psychiatry 85, 1127–1134.Google Scholar
Compton, S, March, J, BrentD, Alban A, Weersing R, Curry J D, Alban A, Weersing R, Curry J (2004). Cognitive behavioural psychotherapy for anxiety and depressive disorders in children and adolescents. An evidence based medicine review. Journal of the American Academy of Child and Adolescent Psychiatry 43, 930–939.Google Scholar
Costello, EJ, Pine, DS, Hammen, C, March, JS, Plotsky, PM, Weissman, MM, Biederman, J, Goldsmith, HH, Kaufmann, J, Lewinsohn, PM, Hellander, M, Hoagwood, K, Kovetz, DS, Nelson, DA, Leckman, JF (2002). Development and natural history of mood disorders. Biological Psychiatry 52, 529–542.CrossRefGoogle ScholarPubMed
Drinkwater, J (2005). Cognitive case formulation. In: Cognitive Behaviour Therapy for Children and Families, 2nd edn (ed. Graham, P.), pp. 84–103. Cambridge, UK: Cambridge University Press.Google Scholar
Esseau, C, Dobson, K (1999). Epidemiology of depressive disorders. In: Depressive Disorders in Children and Adolescents: Epidemiology, Course and Treatment (ed. Esseau, C. and Petermann, F.), pp. 69–103. Northvale, NJ: Jason Aronson Inc.Google Scholar
Goodyer, I, Dubicka, B, Wilkinson, P, Kelvin, R, Roberts, C, Byford, S, Breen, S, Ford, C, Barrett, B, Leech, A, Rothwell, J, White, C, Harrington, R (2007). Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care, with and without cognitive behaviour therapy in adolescents with major depression: RCT. British Medical Journal 335, 142.CrossRefGoogle Scholar
Gould, MS, King, R, Greenward, S, Fischer, P, Schwab-Stone, M, Kramer, R, Flischer, A, Goodman, S, Canino, G, Schaffer, D (1998). Psychopathology associated with suicidal ideation and attempts among children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 37, 915–923.CrossRefGoogle ScholarPubMed
Harrington, R (2005). Depressive disorders. In: Cognitive Behaviour Therapy for Children and Families, 2nd edn (ed. Graham, P.), pp. 263–281. Cambridge, UK: Cambridge University Press.Google Scholar
Hetrick, SE, Merry, S, McKenzie, P, Sindahl, P, Proctor, M (2007). Selective serotonin re uptake inhibitors for depressive disorders in children and adolescents. Cochrane Database of Systematic Reviews. Issue 3, Art. No. CD004851.CrossRefGoogle Scholar
Jensen, PS (2006). After TADS, can we measure up, catch up, and ante up? Journal of the American Academy of Child and Adolescent Psychiatry 45, 1456–1460.CrossRefGoogle ScholarPubMed
Kerfoot, M, Harrington, R, HarringtonV, Rogers J, Verduyn C V, Rogers J, Verduyn C (2004). A step too far? Randomised trial of cognitive behaviour therapy delivered by social workers to depressed adolescents. European Child and Adolescent Psychiatry 13, 92–99.CrossRefGoogle ScholarPubMed
Lewinsohn, PM, Clarke, GN (1999). Psychosocial treatments for adolescent depression. Clinical Psychology Review 19, 329–324.CrossRefGoogle ScholarPubMed
Lewinsohn, P, Clarke, G, HopsH, Andrews J H, Andrews J (1990). Cognitive behavioural treatment for depressed adolescents. Behaviour Therapy 21, 385–401.Google Scholar
Lewinsohn, PM, Hops, H, Roberts, RE (1993). Adolescent psychopathology: 1: Prevalence and incidence of depression and other DSM-III-R disorders in high school students. Journal of Abnormal Psychology 102, 133–144.CrossRefGoogle ScholarPubMed
Lynch, FL, Hornbrook, M, Clarke, GN (2005). Cost effectiveness of an intervention to prevent depression in at risk teens. Archives of General Psychiatry 62, 1241–1248.CrossRefGoogle ScholarPubMed
Melvin, G, Tonge, B, KingN, Heyne D, Gordon M, Klimkeit E N, Heyne D, Gordon M, Klimkeit E (2006). A comparison of cognitive behavioural therapy, sertraline, and their combination for adolescent depression. Journal of the American Academy of Child and Adolescent Psychiatry 45, 1151–1161.CrossRefGoogle ScholarPubMed
Michael, KD, Crowley, SL (2002). How effective are treatments for child and adolescent depression? a meta analytic review. Clinical Psychology Review 22, 247–269.Google Scholar
Mufson, L, Dorta, KP, Wickramaratne, P, Nomura, Y, Olfson, M, Weissman, MM (2004). A randomised effectiveness trial of interpersonal psychotherapy for depressed adolescents. Archives of General Psychiatry 61, 577–584.Google Scholar
NICE (2005). CG28 Depression in children and young people: NICE guideline (www.nice.org.uk/CG028/). National Institute for Clinical Excellence. Accessed 5 December 2007.Google Scholar
Reinecke, MA, Ryan, NE, Dubois, DC (1998). Cognitive behavioural therapy of depression and depressive symptoms during adolescence: a review and meta analysis. Journal of the American Academy of Child and Adolescent Psychiatry 37, 26–34.Google Scholar
Rohde, P, Clarke, G, LewinsohnP, Seeley J, Kaufman N P, Seeley J, Kaufman N (2001). Impact of co-morbidity on a cognitive behavioural group treatment for adolescent depression. Journal of the American Academy of Child and Adolescent Psychiatry 40, 795–802.CrossRefGoogle ScholarPubMed
Rohde, P, Lewinsohn, PM, Seeley, JR (1994). Are adolescents changed by an episode of major depression? Journal of the American Academy of Child and Adolescent Psychiatry 33, 1289–1298.CrossRefGoogle ScholarPubMed
Sackett, D, Rosenberg, N, GrayJ, Haynes R, Richardson W J, Haynes R, Richardson W (1996). Evidence based medicine, what it is and what it's not. British Medical Journal 312, 71–72.Google Scholar
Spielmans, GI, Pasek, LF, McFall, JP (2007). What are the active ingredients in cognitive and behavioural psychotherapy for anxious and depressed youth? Clinical Psychology Review 27, 642–654.CrossRefGoogle Scholar
Treatment for Adolescents with Depression Study (TADS) (2004). Fluoxetine, cognitive behavioural therapy, and their combination for adolescents with depression. Journal of the American Medical Association 292, 807–820.Google Scholar
Treatment for Adolescents with Depression Study (TADS) (2007 a). Cognitive Behavior Therapy Manual (https://trialweb.dcri.duke.edu/tads/manuals.html). Accessed 5 December 2007.Google Scholar
Treatment for Adolescents with Depressions Study (TADS) (2007 b). Research knowledge among the participants in the treatment of adolescents with depression study. Journal of the American Academy of Child and Adolescent Psychiatry 46, 1642–1650.Google Scholar
Treatment for Adolescents with Depression Study (TADS) (2007 c). Long term effectiveness and safety outcomes. Archives of General Psychiatry 64, 1132–1144.Google Scholar
Weersing, VR, Brent, DA (2006). Cognitive behavioural therapy for depression in youth. Child and Adolescent Psychiatric Clinics of North America 15, 939–957.Google Scholar
Weissman, MM, Wolk, S, Goldstein, RB, Moreau, D, Adams, P, Greenwald, S, Klier, CM, Ryan, ND, Dahl, KG, Wickramaratne, P (1999). Depressed adolescents grown up. Journal of the American Medical Association 281, 1707–1713.Google Scholar
Weisz, JR, McCarty, CM, Valeri, SM (2006). Effects of psychotherapy for depression in children and adolescents: a meta analysis. Psychological Bulletin 132, 132–149.CrossRefGoogle ScholarPubMed
Angold, A, Messner, SC, Strangl, D, Farmer, EM, Costello, EJ, Burns, BJ (1998). Perceived parental burden and service use for child and adolescent psychiatric disorders. American Journal of Public Health 88, 75–80.CrossRefGoogle ScholarPubMed
Brent, D, Emslie, G, Clarke, G, Dineen Wagner, K, Asarnow, J, Keller, M, Vitiello, B, Ritz, L, Iyengar, S, Abebe, K, Birmaher, B, Ryan, N, Kennard, B, Hughes, C, DeBar, L, McCracken, J, Strober, M, Suddath, R, Spirito, A, Leonard, H, Melhem, N, Porta, G, Onorato, M, Zelazny, J (2008). Switching to another SSRI or to venlafaxine with or without cognitive behavioural therapy for adolescents with SSRI-resistant depression. The TORDIA randomised control trial. Journal of the American Medical Association 299, 901–913.CrossRefGoogle ScholarPubMed
Brent, D, Perper, J, Moritz, G, Allman, C, Friend, A, Roth, C, Scheuers, J, Bulach, L, Waugher, M (1993). Psychiatric risk factors of adolescent suicide: a case control study. Journal of the American Academy of Child and Adolescent Psychiatry 33, 521–529.CrossRefGoogle Scholar
Brent, DA, Holder, D, Kolko, D (1997). A clinical psychotherapy trial for adolescent depression comparing cognitive, family and supportive treatments. Archives of General Psychiatry 54, 877–885.Google Scholar
Brent, D, Kolko, D, BirmaherB, Baugher MA, Bridge J, Roth C, Holder D B, Baugher MA, Bridge J, Roth C, Holder D (1998). Predictors of treatment efficacy in a clinical trial of three psychosocial treatments for adolescent depression. Journal of the American Academy of Child and Adolescent Psychiatry 37, 906–914.CrossRefGoogle Scholar
Clarke, G, LewinsohnP, Hops H P, Hops H (1990). Instructors Manual for the CWD-A Course. Portland, Oregon: Kaiser Permanante Center for Health Research.Google Scholar
ClarkeG, Hops H G, Hops H, LewinsohnJ, Seeley J, Williams J J, Seeley J, Williams J (1992). Cognitive behavioural group treatment of adolescent depression: prediction of outcome. Behaviour Therapy 23, 341–354.CrossRefGoogle Scholar
Clarke, G, Hornbrook, M, Lynch, F, Polen, M, Gale, G, Beardslee, W, O'Conner, E, Seeley, J (2001). A randomised trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents. Archives of General Psychiatry 85, 1127–1134.Google Scholar
Compton, S, March, J, BrentD, Alban A, Weersing R, Curry J D, Alban A, Weersing R, Curry J (2004). Cognitive behavioural psychotherapy for anxiety and depressive disorders in children and adolescents. An evidence based medicine review. Journal of the American Academy of Child and Adolescent Psychiatry 43, 930–939.Google Scholar
Costello, EJ, Pine, DS, Hammen, C, March, JS, Plotsky, PM, Weissman, MM, Biederman, J, Goldsmith, HH, Kaufmann, J, Lewinsohn, PM, Hellander, M, Hoagwood, K, Kovetz, DS, Nelson, DA, Leckman, JF (2002). Development and natural history of mood disorders. Biological Psychiatry 52, 529–542.CrossRefGoogle ScholarPubMed
Drinkwater, J (2005). Cognitive case formulation. In: Cognitive Behaviour Therapy for Children and Families, 2nd edn (ed. Graham, P.), pp. 84–103. Cambridge, UK: Cambridge University Press.Google Scholar
Esseau, C, Dobson, K (1999). Epidemiology of depressive disorders. In: Depressive Disorders in Children and Adolescents: Epidemiology, Course and Treatment (ed. Esseau, C. and Petermann, F.), pp. 69–103. Northvale, NJ: Jason Aronson Inc.Google Scholar
Goodyer, I, Dubicka, B, Wilkinson, P, Kelvin, R, Roberts, C, Byford, S, Breen, S, Ford, C, Barrett, B, Leech, A, Rothwell, J, White, C, Harrington, R (2007). Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care, with and without cognitive behaviour therapy in adolescents with major depression: RCT. British Medical Journal 335, 142.CrossRefGoogle Scholar
Gould, MS, King, R, Greenward, S, Fischer, P, Schwab-Stone, M, Kramer, R, Flischer, A, Goodman, S, Canino, G, Schaffer, D (1998). Psychopathology associated with suicidal ideation and attempts among children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 37, 915–923.CrossRefGoogle ScholarPubMed
Harrington, R (2005). Depressive disorders. In: Cognitive Behaviour Therapy for Children and Families, 2nd edn (ed. Graham, P.), pp. 263–281. Cambridge, UK: Cambridge University Press.Google Scholar
Hetrick, SE, Merry, S, McKenzie, P, Sindahl, P, Proctor, M (2007). Selective serotonin re uptake inhibitors for depressive disorders in children and adolescents. Cochrane Database of Systematic Reviews. Issue 3, Art. No. CD004851.CrossRefGoogle Scholar
Jensen, PS (2006). After TADS, can we measure up, catch up, and ante up? Journal of the American Academy of Child and Adolescent Psychiatry 45, 1456–1460.CrossRefGoogle ScholarPubMed
Kerfoot, M, Harrington, R, HarringtonV, Rogers J, Verduyn C V, Rogers J, Verduyn C (2004). A step too far? Randomised trial of cognitive behaviour therapy delivered by social workers to depressed adolescents. European Child and Adolescent Psychiatry 13, 92–99.CrossRefGoogle ScholarPubMed
Lewinsohn, PM, Clarke, GN (1999). Psychosocial treatments for adolescent depression. Clinical Psychology Review 19, 329–324.CrossRefGoogle ScholarPubMed
Lewinsohn, P, Clarke, G, HopsH, Andrews J H, Andrews J (1990). Cognitive behavioural treatment for depressed adolescents. Behaviour Therapy 21, 385–401.Google Scholar
Lewinsohn, PM, Hops, H, Roberts, RE (1993). Adolescent psychopathology: 1: Prevalence and incidence of depression and other DSM-III-R disorders in high school students. Journal of Abnormal Psychology 102, 133–144.CrossRefGoogle ScholarPubMed
Lynch, FL, Hornbrook, M, Clarke, GN (2005). Cost effectiveness of an intervention to prevent depression in at risk teens. Archives of General Psychiatry 62, 1241–1248.CrossRefGoogle ScholarPubMed
Melvin, G, Tonge, B, KingN, Heyne D, Gordon M, Klimkeit E N, Heyne D, Gordon M, Klimkeit E (2006). A comparison of cognitive behavioural therapy, sertraline, and their combination for adolescent depression. Journal of the American Academy of Child and Adolescent Psychiatry 45, 1151–1161.CrossRefGoogle ScholarPubMed
Michael, KD, Crowley, SL (2002). How effective are treatments for child and adolescent depression? a meta analytic review. Clinical Psychology Review 22, 247–269.Google Scholar
Mufson, L, Dorta, KP, Wickramaratne, P, Nomura, Y, Olfson, M, Weissman, MM (2004). A randomised effectiveness trial of interpersonal psychotherapy for depressed adolescents. Archives of General Psychiatry 61, 577–584.Google Scholar
NICE (2005). CG28 Depression in children and young people: NICE guideline (www.nice.org.uk/CG028/). National Institute for Clinical Excellence. Accessed 5 December 2007.Google Scholar
Reinecke, MA, Ryan, NE, Dubois, DC (1998). Cognitive behavioural therapy of depression and depressive symptoms during adolescence: a review and meta analysis. Journal of the American Academy of Child and Adolescent Psychiatry 37, 26–34.Google Scholar
Rohde, P, Clarke, G, LewinsohnP, Seeley J, Kaufman N P, Seeley J, Kaufman N (2001). Impact of co-morbidity on a cognitive behavioural group treatment for adolescent depression. Journal of the American Academy of Child and Adolescent Psychiatry 40, 795–802.CrossRefGoogle ScholarPubMed
Rohde, P, Lewinsohn, PM, Seeley, JR (1994). Are adolescents changed by an episode of major depression? Journal of the American Academy of Child and Adolescent Psychiatry 33, 1289–1298.CrossRefGoogle ScholarPubMed
Sackett, D, Rosenberg, N, GrayJ, Haynes R, Richardson W J, Haynes R, Richardson W (1996). Evidence based medicine, what it is and what it's not. British Medical Journal 312, 71–72.Google Scholar
Spielmans, GI, Pasek, LF, McFall, JP (2007). What are the active ingredients in cognitive and behavioural psychotherapy for anxious and depressed youth? Clinical Psychology Review 27, 642–654.CrossRefGoogle Scholar
Treatment for Adolescents with Depression Study (TADS) (2004). Fluoxetine, cognitive behavioural therapy, and their combination for adolescents with depression. Journal of the American Medical Association 292, 807–820.Google Scholar
Treatment for Adolescents with Depression Study (TADS) (2007 a). Cognitive Behavior Therapy Manual (https://trialweb.dcri.duke.edu/tads/manuals.html). Accessed 5 December 2007.Google Scholar
Treatment for Adolescents with Depressions Study (TADS) (2007 b). Research knowledge among the participants in the treatment of adolescents with depression study. Journal of the American Academy of Child and Adolescent Psychiatry 46, 1642–1650.Google Scholar
Treatment for Adolescents with Depression Study (TADS) (2007 c). Long term effectiveness and safety outcomes. Archives of General Psychiatry 64, 1132–1144.Google Scholar
Weersing, VR, Brent, DA (2006). Cognitive behavioural therapy for depression in youth. Child and Adolescent Psychiatric Clinics of North America 15, 939–957.Google Scholar
Weissman, MM, Wolk, S, Goldstein, RB, Moreau, D, Adams, P, Greenwald, S, Klier, CM, Ryan, ND, Dahl, KG, Wickramaratne, P (1999). Depressed adolescents grown up. Journal of the American Medical Association 281, 1707–1713.Google Scholar
Weisz, JR, McCarty, CM, Valeri, SM (2006). Effects of psychotherapy for depression in children and adolescents: a meta analysis. Psychological Bulletin 132, 132–149.CrossRefGoogle ScholarPubMed
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