Term
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Definition
• Anxiety:
o Any anxiety disorder 6-18% among youth |
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Term
| depression prevalence rates |
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Definition
• Depression:
o 2% of preadolescents in population have depression or dysthymia
o 6% in adolescents
o Children and adolescents range from 1.6 to 8.9%
o Rates are significantly higher for girls than boys (adolescents)
o Adolescent depression often runs a chronic and relapsing course, high morbidity, |
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Term
| suicide rates and peak age |
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Definition
• Suicide
o 6 to 13% of adolescents report attempted suicide at least once
o Suicide levels peak at 13-14 |
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Term
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Definition
Anticipation of negative consequences
- increased physiological arousal
- Avoidance of the feared situation
- Reduced physiological arousal
- Reinforcement via reduced physiological arousal and avoidance of feared consequence |
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Term
| • Conceptual Model for Anxiety |
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Definition
| Physical, cognitive and behavioral symptoms |
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Term
| Cog. Model of anxiety- PHYSICAL Sx |
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Definition
o Physical symptoms or Physiological arousal
Recognize your anxiety cues
Relaxation strategies: deep breathing, relaxation, PMR, visualization
Incompatibility with anxiety |
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Term
| Cog model of anxiety- cognitive Sx |
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Definition
o cognitive symptoms (anxiety related cognitions)
identify cognitive distortions—negative self talk
replace with self talk |
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Term
| Cog model of anxiety- Behavioral Sx |
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Definition
o Behavioral symptoms (avoidance)
Plan and conduct exposure to feared situations
Reward brave behaviors and using coping skills |
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Term
• Interpersonal Psychotherapy Conceptual Model
o Grief |
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Definition
Facilitating mourning
Re-establish interests and relationships |
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Term
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Definition
| Identify the dispute, develop a plan, modify communication and expectations |
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Term
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Definition
Understand the meaning of transition, demands of new situation, and what teen has lost/gained
Teach new skills |
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Term
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Definition
| Reduce social isolation, improve social skills, increase self confidence, improve and expand relationships |
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Term
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Definition
understand feelings regarding situation and parents
alleviate guilt
define roles and expectations in relationships |
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Term
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Definition
Exploration
Encouragement of affect expression
Linking affect to interpersonal events
Clarification of conflicts
Communication analysis
Decision analysis
Behavior change techniques (e.g. role playing) |
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Term
| • CBT for child depression: Starks conceptual Model (ACTION) |
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Definition
| Emotions, Behaviors, Cognitions |
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Term
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Definition
Learn to identify feelings
• Emotion cards, emotion charades, emotion statues
Learn how thoughts, behaviors, and feelings are related
• Monitor thoughts and activities while rating your mood, plot on a graph |
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Term
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Definition
To reduce withdrawal from pleasant and goal-directed activities
• Schedule pleasant and goal directed activities
• Note improved mood
• Reward yourself
to reduce social isolation
• teach social skills and interpersonal problem-solving
• negative vs. positive self
to reduce interpersonal conflict
• teach communication skills (like active listening)
• teach conflict resolution skills (communication, negotiating, problem-solving)
to improve coping skills
• teach problem-solving techniques
to reduce rumination (replaying bad things)
• suggest strategies “changing the channels” mostly behavior in nature |
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Term
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Definition
To alter maladaptive, depressive thoughts
• Cognitive restructuring including:
o What’s the evidence
o What if?
o Model adaptive, corrective responses to events
o Challenge maladaptive, irrational, or exaggerated responses to events |
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Term
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Definition
1.) Assess fear levels in child
2.) Arrange for child to observe live or video model performing feared activity, with level of intensity increasing over time
3.) Invite child to engage in activity, initially low level then increasing intensity
4.) (optional) arrange positive consequences for successful imitation of the model |
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Term
| Systematic desensitization |
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Definition
1.) asses fear levels in child
2.) establish fear hierarchy with feared stimuli arranged from least to most anxiety-provoking
3.) train child to relax, often using muscle tensing/relaxing plus pleasant imagery
4.) expose child (in vivo or imagination) to items in the hierarchy, moving from least to most anxiety-provoking
5.) whenever child signals uncomfortable anxiety (e.g. by raising hand) revert to lower items in the hierarchy and/or restate relaxation instructions
6.) when child remains relaxed through the full hierarchy, repeat process in one or more review sessions |
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Term
| Systematic desensitization- pitfall |
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Definition
- therapist difficult in conveying a vivid image for imaginal exposure
o may need to work on the imaginal script with the child, may have the child write the script alone that requires certain trigger words like afraid…vivid drawings, pictures in books, movie clips
- child difficulty in imagining and in mental elaboration
o therapist can help sharpen skill by guiding them through pleasant imagery at first and then moving to unpleasant images
o Ask questions: what color is the dog’s fur? Is his mouth open? Is he making noises? What’s the smell”
o make sure area is comfortable for imaging… soft furniture, lights dimmed, muffled sounds |
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Term
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Definition
1.) identify feared objects/ situations, and arrange a way for graduated exposure to occur
2.) present child with situation and response options, noting reward for increased exposure
3.) durin exposure give child feedback and reward and praise increments
4.) Continue until child reaches preestablished criterion for success |
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Term
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Definition
- low credibility of the model (model is not believable enough )
o Therapist should figure out why the model is not credibile… for example if the model is an adult and the model is a child, might need to find another child to model
o Or model does it too easily…child might think that they could never do that….it helps if the model shows initial fear but works through it
- Failure to repeat the model’s behavior
o Downgrade the intensity that is less intimidating
o Add incentives to increase motivation to imitate
o Strengthen the physical connection between youth and model…hold my hand and while I touch the dog, then stand next to me, then stand in front
- excessive dependence on the model
o child won’t do activity unless model is there…. Fade out the model… every time, to every other time, every third exposure, etc
o do exactly what model does…. Play novelty game where you do or say something different each time and pair with rewards to increase motivation |
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Term
| Reinforced Exposure pitfall |
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Definition
- exposure task too easy or too hard
o might need to elaborate fear hierarcy, id-ing additional kinds of exposure in the mid-range of difficulty
o rewards might be necessary if child wont try certain stages
- rewards not rewarding enough
o therapist may find home observation helpful to determine rewards
o talk to the child about salient rewards…child chooses spontaneously and invests significant time in (t.v. watching, video games, phone) |
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Term
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Definition
1.) identify feared situations and assess baseline fear levels (or have parents do so at home)
2.) identify thoughts child has that makes the situation frightening
3.) teach child alternative thoughts in the form of coping self statements (like I am a brave boy. I can take care of myself in the dark) and when to use them (in target fear situations)
4.) Observe and record child’s degree of tolerance of feared situations when self-talk is being used (or train parents to observe and record at home)
5.) Give child feedback on progress (via chart or stars) and reward success
6.) Continue until child reaches pre-established criterion for success |
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Term
| SELF-TALK ("I don't know"-problem) |
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Definition
- The “I don’t know” problem
o Make a rule that “I don’t know” is not an answer, take your best guess
o Make the task concrete, like using cartoons and cartoon bubbles they have to write things in
o Start with pleasant thoughts then work to negative ones
o Think-aloud activities where child says aloud what they are doing and thinking, starting again in pleasant activities
o Ask “what would most kids do in this situation” or how would so and so feel |
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Term
| SELF TALK pitfall-confusing thoughts with feelings |
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Definition
o focus children on the concept of guessing…thoughts are guesses.
o Asked to say what guesses various children might have in various cartoons or pictured scenes and therapist points out thoughts…move from talking to others thoughts to own thoughts |
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Term
| Self talk pitfall- failure of self talk to generalize |
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Definition
o require self-talk during all exposures done in treatment sessions or in practice outside session
o older children therapist stresses that self talk needs to be automatic and practice is how this happens
o youncher children it helps to write self-statements down on note cards and encourage/reward use during session and practice |
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Term
| Starks CBT for depression |
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Definition
| 1.) learn labels for various emotions and learn to id the emotions in self 2.) learn how emotions are connected to thoughts and behaviors (pleasant events and activities lead to pleasant emotions, positive mood) 3) learn problem solving techniques (id the problem, think of solutions, evaluate consequences, choose one and try it, examine outcome, praise self or try another solution) 5.) apply problem solving to mood disturbance, interpersonal problems and daily hassles 6.) learn to catch negative thoughts when they happen and restructure them by thinking about whether they are realistic and whether there are reasonable alternative interpretations 7.) learn procedures for self-monitoring, self talk, self control, and self efficacy |
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Term
| CBT pitfall- incomplete homework |
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Definition
- homework not done
o address the problem via incentives and parent involvement. They use example of 2 bags…completed homework really good prizes, not finished okay prizes
o encourage parent to incentivize the process by offering small rewards to the child at home for completing work |
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Term
| CBT pitfall-cognitive focus seems to be criticism of child |
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Definition
| o telling children that the negative thoughts are caused by depression, not the child themselves AND the child and therapist are working together as partners to id those thoughts and change them |
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Term
| CBT pitfall- Mismatch between coping skill and child development |
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Definition
| o reviewing session notes or tapes with colleague or supervisor may clarify the problem and then make appropriate adjustments |
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Term
| CBT pitfall- Child pessimism and hopelessness may undermine efforts to cope |
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Definition
| o therapist works with parents to institute reward system that will support perseverance by the child… be persistent they will see moment when the child’s coping skills pay off and then these are used as opportunities for the therapist to show child how the coping skills worked and could be benefit to use them again |
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Term
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Definition
Live model
participant model
symbolic modeling
"coping" model |
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Term
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Definition
| slow exposure to doing something that frightened you and being reinforced. |
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Term
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Definition
Feeling Frightened?
Expecting Bad Things to Happen?
Attitudes & Actions That Will Help
Results and Rewards |
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Term
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Definition
Identify situations that trigger anxiety
How does your body tell you you’re fearful?
Deep breathing, relaxation, visualization |
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Term
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Definition
Teach the connection btw thoughts & feelings
Identify anxious thoughts |
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Term
| Attitudes and actions that will help |
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Definition
Change the child’s thoughts about the situation
Introduce positive self-talk (younger children)
Challenge negative self-talk & replace with positive self-talk (older children & adolescents)
Make the situation less stressful via problem –solving
EX: teach & practice social skills, set up play date w/ one child before party |
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Term
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Definition
Results and Rewards
Teach child self-evaluation skills (How did I do?)
Praise & Reward efforts and brave behavior
Therapist, parent, child |
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Term
| 1994 Kendall study- Coping cat |
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Definition
Relative to a wait-list control group, Coping Cat kids exhibited significantly less anxiety and depression, less negative self-talk, and more coping skills at the end of treatment and at one-year follow-up.
Coping Cat kids no longer met criteria for an anxiety disorder post-treatment
64% improved in CC, less than 5% improved in the control group |
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Term
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Definition
Improvements were noted:
across multiple reporters (parents, children, but NOT teachers)
across methods (multiple measures, observational measures)
This is a strong methodological feature of the study. |
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Term
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Definition
An even stronger case could be made for Coping Cat if it had been compared to a usual care condition
The different timing of outcome assessments in treatment vs. control conditions complicates the results |
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Term
| Analysis of mediation in Kendall stufy |
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Definition
Kendall (1994): Mediation analyses were not conducted, so we cannot conclusively answer this question. However, the fact that kids were using less negative self-talk and more coping skills suggests that “attitudes and actions that can help” may be a key mediator of program effects.
Indeed, Treadwell & Kendall (1996) found that reductions in negative self-talk, but not increases in positive self-talk, mediated program effects. |
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Term
| For whom did coping cat work? |
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Definition
Kendall (1994): Some children did not improve, suggesting a need to search for treatment moderators
Parental anxiety
Family or environmental stressors
SES, race, ethnicity, gender, age, co-morbidity |
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Term
| Kendall 1997- Found coping cat did not |
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Definition
Kendall (1994): Some children did not improve, suggesting a need to search for treatment moderators
Parental anxiety
Family or environmental stressors
SES, race, ethnicity, gender, age, co-morbidity |
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Term
| Coping cat- better for group or individual |
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Definition
| Both individual and group formats of Coping Cat were efficacious, but individual treatment led to more children improving than group treatment. |
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Term
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Definition
| What do we change?? How do we change it?? |
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Term
| Parents may model worry, anxiety-related cognitions, or avoidance behaviors. |
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Definition
Parents are taught to identify their own anxious behaviors.
Parents are taught to model proactive coping strategies. |
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Term
| Parents may unintentionally overlook brave behaviors & reward anxious or avoidant behavior. |
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Definition
| Parents are taught basic behavioral principles: reward brave behaviors, and do NOT accidentally reward anxious behaviors. |
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Term
| Parents may undermine each other’s parenting efforts, failing to work together as a team. |
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Definition
| Parents are taught communication and problem-solving skills to help them work together as a team. |
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Term
| Does adding a FAM component to coping cat improve outcomes? |
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Definition
| Although both treatments were efficacious, Coping Koala + FAM outperformed Coping Koala alone (96% vs. 70% of kids improved, respectively). |
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Term
| Does adding the FAM component to coping Koala help ALL kids? |
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Definition
The added family component was not equally beneficial to all children.
Indeed, it was most important for:
younger children
girls
children whose parents had anxiety |
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Term
| Interpersonal psychotherapy |
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Definition
The focus of IPT treatment is on the patients’ depression and their interpersonal context, regardless of whether it originally caused the depression.
The treatment involves identifying and modifying problematic interpersonal patterns contributing to the depression, and ultimately, improving relationships. |
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Term
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Definition
| how is the problem, how do we change it? |
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Term
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Definition
Facilitate mourning
Reestablish interests & relationships |
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Term
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Definition
Identify the dispute
Develop a plan
Modify communication & expectations |
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Term
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Definition
Understand meaning of transition, demands of new situation, and what teen has gained/lost
Teach new skills |
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Term
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Definition
Reduce social isolation
Improve social skills
Increase self-confidence
Improve & expand relationships |
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Term
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Definition
Understand feelings re: situation & parents
Alleviate guilt
Define roles & expectations in relationships |
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Term
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Definition
Exploration
Encouragement of affect expression
Linking affect to interpersonal events
Clarification of conflicts
Communication analysis
Decision analysis
Behavior change techniques (e.g., role plays) |
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Term
| Does research on IPT show it works? |
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Definition
Relative to the clinical monitoring group, IPT-A adolescents:
Reported fewer depressive symptoms
Met recovery criteria for MDD
Better problem-solving skills
Reported improved social functioning, peer and dating relationships
Evidence is less clear for parent-child relationships (non-significant trend)
~Mufson et al., 1999 |
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Term
Randomized Controlled Trial comparing IPT-A to CBT to a wait-list control group for Puerto Rican youth with a depression diagnosis
Cultural adaptations made for both IPT-A and CBT groups |
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Definition
Relative to the wait list group, IPT-A adolescents exhibited:
greater reductions in depression
greater increases in self-esteem
greater improvements in social adaptations
~Rossello & Bernal (1999 |
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Term
| Randomized Controlled Trial comparing IPT-A to CBT to a wait-list control group for Puerto Rican youth with a depression diagnosis |
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Definition
Cultural adaptations made for both IPT-A and CBT groups
Relative to the wait list group, CBT adolescents exhibited:
greater reductions in depression
BUT NO IMPROVEMENTS in self-esteem or social adaptations
~Rossello & Bernal (1999) |
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Term
| CBT child- EMOTIONS-learn to identify feelings |
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Definition
Emotion cards
Emotion charades
Emotion statues |
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Term
| learn how thoughts, behaviors, and feelings are related |
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Definition
| Monitor thoughts and activities and rate your mood, then plot on a graph. |
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Term
BEHAVIORS
to reduce withdrawal from pleasant & goal-directed activities |
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Definition
Schedule pleasant & goal-directed activities.
Note improved mood.
Reward yourself. |
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Term
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Definition
Teach social skills & interpersonal problem-solving.
Negative Self vs. Positive Self |
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Term
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Definition
Teach communication skills
(e.g., active listening)
Teach conflict resolution skills (communication, negotiation, & problem-solving) |
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Term
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Definition
| Teach children problem-solving techniques. |
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Term
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Definition
| Suggest strategies for “changing the channel,” mostly behavioral in nature. |
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Term
COGNITIONS
to alter maladaptive, depressive thoughts |
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Definition
Cognitive restructuring techniques, including:
What’s the evidence?
What if...?
Model adaptive, corrective responses to events.
Challenge maladaptive, irrational, or exaggerated responses to events. |
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Term
| to interrupt negative thoughts before they begin |
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Definition
Thought stopping
Rubber band
Worry time |
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Term
| Stark’s CBT-based child depression program was compared to a school-based traditional counseling condition (usual care) |
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Definition
Children in the CBT group were less depressed post-treatment, but these differences disappeared by seven-month follow-up (attrition?)
~Stark, 1990; Stark et al., 1991 |
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Term
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Definition
Based on a two-process model of control
primary control:
change the situation (ACT),
used when situations are modifiable
secondary control:
change your response to the situation (THINK),
used when situations are distressing, but not modifiable |
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Term
| Weisz childhood depression article- is it effective? |
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Definition
Relative to the control group, PASCET children:
were less depressed post-treatment and at nine-month follow-up
more PASCET children shifted into the non-depressed range
~Weisz et al., 1997 |
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Term
| Summary on treatment research for CBT |
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Definition
CBT-based depression programs are superior to waitlist and no treatment control groups
One study reported that CBT was superior to traditional counseling
However, CBT did not consistently outperform other EBTs for child depression, such as relaxation training, self-monitoring, or various combinations |
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Term
| CBT research summary continued |
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Definition
CBT-based depression programs were superior to waitlist control groups.
However, CBT did not consistently outperform other treatments, including “brief supportive therapy,” family therapy, or relaxation training.
In some cases, CBT fared better than other treatments immediately after treatment, but its advantage dissipated by two-year follow-up.
CBT continues to be the most well-studied, and therefore has more of an evidence base to draw from in establishing its effectiveness. |
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Term
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Definition
In the Brent et al. series of studies, youth with higher levels of initial depression fared better in treatment. In contrast, those with comorbid anxiety disorders, higher levels of cognitive distortions, and more hopelessness fared worse in treatment.
These moderators did not completely wash out treatment effects, suggesting that children with the aforementioned risk factors benefited from treatment, just not as much as those without them. |
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