Current Psychiatry Reviews - Volume 12, Issue 1, 2016

This article reviews the existing literature on psychotherapy approaches for preventing subsequent suicidal behavior in adolescents with a history of suicide attempts. At present, there are no well-established treatments for decreasing suicide attempts in adolescents, although promising approaches exist and are continuing to be tested. In this article, we describe interventions with evidence for decreasing suicidal or self-harm behaviors in adolescents in randomized trials. In order to illustrate the types of therapeutic techniques used in these treatments, we provide a more in depth discussion of two CBT-based interventions: 1) Dialectical Behavior Therapy (DBT) for adolescents and the 2) Safe Alternatives for Teens and Youth (SAFETY) Program [1, 2].

The dominant model of delivering psychological interventions is face-to-face (F2F) in oneto- one psychotherapy. Behavioral Intervention Technologies (BITs) may have the capacity to expand delivery models and/or increase the outcomes of therapy. This article is a systematic review of the available literature on BITs for children and adolescents with DSM-5 mental health diagnoses. All articles on EBSCOhost published between 1st January 2000 and 31st December 2014 referencing terms related to youth, BITs, and therapy were collected for analysis (n=7179). After inclusion/exclusion criteria were applied, 53 articles were included in the review, discussing BIT interventions for Anxiety, Depression, Obsessive-Compulsive Disorder, Attention-Deficit/Hyperactivity Disorder, Conduct Disorder, and Oppositional Defiant Disorder. The review found general support for BITs as interventions for child and adolescent disorders. Limitations of the current research and suggestions for future directions are discussed.

Cognitive behavioral therapy (CBT) has burgeoned as the leader in psychosocial treatments for anxious children and adolescents. Despite the established efficacy of CBT for youth with anxiety, there is a disparity amongst individuals and families in need of services, and accessibility to qualified practitioners who can effectively deliver empirically supported treatments. Additionally, a substantial number of children either do not respond at all to CBT or do not achieve sustained improvement. As a result, recent research in the area of childhood anxiety disorders focuses on extending treatment delivery of CBT to families who may not have direct access to trained clinicians, and expanding treatment to youth with comorbid conditions and treatment non-responders. This paper provides a preferably brief overview of research on advancements in the delivery of cognitive-behavioral therapy for anxious youth, discusses practical considerations, and highlights the current state of intervention research in this area. Specifically, the goals of this literature review are to consider innovative adaptations of CBT for anxious youth in the last decade with a particular focus on: (a) computer and Internet-delivered interventions and clinician training platforms; (b) the potential of videoteleconferencing service delivery methods; (c) treatment personalization via modular interventions targeting individual strengths and addressing responsivity to treatment; and, (d) transdiagnostic approaches for

The present article examines the prevalence of obsessive-compulsive and related disorders (OCRD) in the DSM-5 in children and adolescents as well as associated functional impairments. Traditional cognitive-behavioral treatments for OCRD disorders are discussed as well as novel treatments incorporating other forms of therapy, intensive therapy, home-based therapy, medication enhanced therapy, and technology driven therapy. Clinical implications are also discussed.

Cognitive Behavioral Therapy (CBT) is among the most studied EBPs with support for its efficacy across a range of presenting problems in youth, but broad uptake of traditional CBT in school-based settings has been slow. A review of CBT in schools is presented, which suggests that most school-based studies have examined the use of a protocol for a single disorder or presenting problem, delivered by an individual provider (e.g., teacher, counselor). Evidence supports the effectiveness of these interventions for targeted problems, but limitations of these practices may present barriers to broader implementation of CBT. A review of alternative strategies is then presented, which suggests an approach that may flexibly meet the needs of a broader range of students, capitalize on the unique characteristics of a school setting, and emphasize principles of resilience. Finally, the University of Pennsylvania Beck Community Initiative is presented to illustrate an integrated approach to CBT within schools that is case conceptualization-driven, milieu-focused, and resilience-oriented to apply these strategies in a school setting.

Group trial-based cognitive training (G-TBCT) is an adaptation of trial-based cognitive therapy (TBCT) which, in turn, is derived from standard cognitive-behavior therapy (CBT). CBT is recognized as an effective treatment for several psychiatric disorders. Core belief (CB) change seems to play an important role in this regard. However, little is known about methods and techniques specifically used to change dysfunctional CBs in children and adolescents. We present here an approach used as a preventative tool to help adolescents change their dysfunctional CBs in an engaging fashion, by asking them to role-play Detectives of the Mind to uncover such CBs; Attorneys of the Mind to help them evaluate if such CBs are true; Judges of the Mind to help them take distance and become metacognitively aware of the critical voices represented by internal prosecutors and sue them; and finally Masters of the Mind to help them make decisions that help them choose assertive and ethical behaviors. In this paper, we introduce the idea and principles of GTBCT, and, more specifically, the trial-based thought record, a method that was designed to help adolescents restructure dysfunctional CBs about themselves.

CBT for psychosis is becoming a well-established sphere of practice covering not only problems of symptoms persistent to medication and poor medication adherence but also topics of psychosis and relapse prevention and treatment. However, there are only a few studies of specificity of CBTp for children, adolescents and young adults. In this paper, we review literature on CBTp and its efficacy in youth. Based on our clinical experience, we discuss three special topics to consider in work with youth: motivation and meaning of symptoms, developmental issues, family and social issues. First, symptoms are appraised as negative, neutral or positive in the whole context of patients’ expectations, beliefs, hopes and life activities. Second, hospitalization and treatment perceptions depend on family and social communications. Examples of meaning of illness and treatment specific for youth are discussed. Third, treatment formulation should be considered from developmental perspective while decisions and skills that are the best “here and now” may interfere with future challenges, social transitions and situation changes.

Cognitive behavioral therapy (CBT) is efficacious in treating both internalizing and externalizing disorders in youth. As a result, there is an increasing demand among consumers for CBT, unfortunately, community clinical settings are not adequately equipped to competently adopt and sustain CBT practice. Large-scale, system-wide changes are necessary to transform usual care treatment systems. Fortunately, there is a rich, burgeoning literature that documents barriers to dissemination and implementation of EVBP’s. Present system limitations include a need for greater system-wide collaboration, more effective and efficient delivery of training and supervision, better alternatives to quality assurance methods that include pay for performance initiatives, documentation of clinical outcomes that CBT delivers, and innovations to mental health financing methods. Furthermore, psychologists must consider new ways to actively market, promote and brand CBT to change provider attitudes, influence practitioner behavior, and transform treatment as usual. Psychologists have a unique opportunity to transform the delivery of mental health services to youth.

Modular Cognitive Behavioral Therapy (mCBT) is guiding child psychotherapy into the future. mCBT is founded on a growing body of empirical research and clinical applications. Despite its compelling advantages, there are some potential cautions. In order to fit children’s diverse presentations mCBT must be individually tailored via case conceptualization. Case conceptualization is widely regarded as an essential CBT competency area and a pivotal component of evidence based procedures. Nonetheless, case conceptualization is a demanding task and the literature suggests that inter-related reliability is suspected. This article addresses these issues and offers several recommendations for improving inter-clinician reliability. Finally, the paper ends with a presentation of a bench-to-bedside confabulated case to illustrate the cognitive behavioral case conceptualization process.