Guide to Effective Programs
for Children and Youth

COGNITIVE-BEHAVIOR THERAPY

OVERVIEW

Cognitive-behavioral therapy is a type of psychotherapy based around the concept that changing the way a person thinks also changes his/her behaviors and the way that he/she feels. Multiple randomized control-group and comparison-group studies have supported the effectiveness of cognitive-behavioral therapy for treating depression and anxiety. More specifically, there is substantial evidence that cognitive-behavioral therapy is significantly more effective than no treatment. However, it is not as clear whether cognitive-behavioral therapy is more effective than alternative forms of psychotherapy such as family therapy or non-directive psychotherapy (see Note, below, or follow this link for more information).

DESCRIPTION OF PROGRAM

Target population: Depressed children, adolescents, and youth

Cognitive-behavioral therapy (CBT) is a form of psychotherapy that emphasizes the role of rational thinking in how individuals feel and behave. A central tenet of this approach is that an individual’s thoughts, not outside people or events, cause feelings and behaviors. When individuals experience unwanted feelings and behaviors, cognitive behavior therapists identify the root of these feelings and behaviors and endeavor to change the way the individual thinks in order to "replace this thinking with thoughts that lead to more desirable reactions" (National Association of Cognitive-Behavioral Therapists, 2002).

EVALUATION(S) OF PROGRAM

Spence, S. H., Donovan, C., & Brechman-Toussaint, M. (2000). The treatment of childhood social phobia: The effectiveness of a social skills training-based, cognitive-behavioral intervention, with and without parental involvement. Journal of Child Psychology and Psychiatry, 41(6), 713-726.

Evaluated population: 50 children and adolescents ages 7 to 14 in Australia diagnosed with social phobia.

Approach: Participants were assigned to cognitive-behavioral therapy (CBT), CBT with parent involvement, or a waitlist control group. Twelve weekly sessions were provided, along with homework and booster sessions at 3 and 6 months, and a detailed outline of the program is available. The parent-involvement condition added a parent training component to help parents model and reinforce skills and ignore anxious and avoidant behaviors.

Results: Both the CBT and CBT with parent involvement treatments had significantly fewer children retain their diagnosis of social phobia than the control group. Both treatment groups also had significant and large reductions in social and general anxiety, along with an increase in parent ratings of social skills performance compared with the control group. At the 12-month follow-up, these improvements were retained. There were no significant differences in self-report anxiety or parental ratings between the two treatment groups, though there was a non-significant trend for children in the parent-involvement condition to be less likely to have a clinical diagnosis of social phobia.

Clarke, G.N., Rohde, P., Lewinsohn, P.M., Hops, H., Seeley, J.R. (1999). Cognitive-behavioral treatment of adolescent depression: Efficacy of acute group treatment and booster sessions. Journal of American Academy of Child Adolescent Psychiatry, 38, 272-279.

Evaluated population: 123 youth (14 to 18 years old)

Approach: The researchers randomly assigned participants to a cognitive-behavioral therapy, cognitive-behavioral therapy plus parent training or a wait-list control group.

Results: Treatment groups showed significant improvement over the control group, with two-thirds of the treatment groups no longer meeting criteria for major depression compared to 48% of the wait-list control group. Furthermore, only 25% of youth across the study experienced a relapse at the two-year follow-up.

Rossello, J. & Bernal, G. (1999). The efficacy of cognitive-behavioral and interpersonal treatments for depression in Puerto Rican adolescents. Journal of Consulting and Clinical Psychology, 67, 734-745.

Evaluated population: 71 Puerto-Rican adolescents and youth (13 to 18 years old) diagnosed with major depressive disorder, dysthymia, or both disorders.

Approach: The researchers randomly assigned 71 Puerto-Rican adolescents and youth to cognitive-behavior therapy, interpersonal therapy, or wait-list control group.

Results: The researchers found that cognitive-behavior therapy and interpersonal therapy both significantly reduced depressive symptoms compared to the control group. In fact, participants who received one of the therapies were functioning better than 72% of the control group. These results provide some preliminary evidence for the cross-cultural effectiveness of psychotherapy on the reduction of depressive symptoms.

Brent, D.A., Holder, D., Kolko, D., Birmaher, B., Baugher, M., Rother, C., Iyengar, S., & Johnson, B.A. (1997). A clinical psychotherapy trial for adolescent depression comparing cognitive, family, and supportive therapy. Archives of General Psychiatry, 54, 877-885.

Evaluated population: 107 adolescents and youth (13 to 18 years old) with major depressive disorder; the majority of the sample was Caucasian (85%) and female (75%).

Approach : Researchers randomly assigned 107 adolescents and youth (13 to 18 years old) with major depressive disorder to one of three groups: cognitive-behavioral therapy, systemic behavior family therapy, and a wait-list control group.

Results: Participants in the cognitive-behavioral therapy treatment showed lower rates of major depressive symptoms than either the family therapy or wait-list groups.

Clarke, G. N., Hawkins, W., Murphy, M., Sheeber, L. B., Lewinsohn, P. M., & Seeley, J. R. (1995). Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: A randomized trial of a group cognitive intervention. Journal of the American Academy of Child and Adolescent Psychiatry, 34(3), 312-321.

Evaluated population: 150 youth (9th- and 10th- graders); 105 females (70%) and 45 males (30%)

Approach: The researchers randomly assigned youth who had been pre-screened as having elevated depressive symptoms, but who did not meet criteria for major depressive disorder or dysthymia, to a cognitive-behavioral therapy group or a “usual care” control group. In the control group, youth were free to continue with any existing treatment or seek any new assistance.

Results: The researchers found at the 12-month follow-up that significantly fewer youth in the cognitive-behavioral group (14.5%) had an affective disorder compared to the control group (25.7%). This shows that cognitive-behavioral therapy also has the potential to prevent depression among youth at high-risk for becoming depressed.

Lewinsohn, P.M., Clarke, G.N., Hops, H., & Andrews, J. (1990). Cognitive-behavioral treatment for depressed adolescents. Behavior Therapy, 21, 385-401.

Evaluated population: 59 depressed youth (mean age was approximately 16 years old)

Approach: This evaluation compared cognitive-behavioral therapy to cognitive-behavioral therapy plus parent training (i.e., instructing the parents on what the youth learn in order to promote acceptance and understanding) and a wait-list control. The participants were randomly assigned to one of the three groups.

Results: Results show that both treatment groups performed better on depression measures than the wait-list control group, though no differences were found between the two treatments.

Reynolds, W.M. & Coats, K.I. (1986). A comparison of cognitive-behavioral therapy and relaxation training for the treatment of depression in adolescents. Journal of Consulting and Clinical Psychology, 54, 653-660.

Evaluated population: 30 moderately depressed high school students and 68 middle school students who were moderately to severely depressed.

Approach: The researchers randomly assigned 30 moderately depressed high school and 68 middle school students to one of the three experimental groups: cognitive-behavioral therapy, relaxation training, and control.

Results: The evaluation found that the high school students in the cognitive-behavioral therapy and relaxation training groups were functioning at a superior state compared to the wait-list control group at the five-week follow-up. Results with the middle school students again showed that cognitive-behavioral therapy and relaxation therapy results in significant clinical improvements compared to a wait-list control group.

Note: As evidenced above, there is a great deal of experimental research that indicates cognitive behavior therapy produces positive impacts in its participants and it is considered a successful, productive type of therapy. There have also been several experimental studies, however, that seem to suggest it is not necessarily cognitive behavior therapy, itself, but the process of talking about problems in a supportive setting that is important to producing positive impacts. This information is important to this discussion on cognitive behavior therapy as well as to the discussion on mentoring and counseling programs, which are designed to provide similarly supportive environments. Information on these evaluations can be found by following this link.

SOURCES FOR MORE INFORMATION

References

Clarke, G. N., Hawkins, W., Murphy, M., Sheeber, L. B., Lewinsohn, P. M., & Seeley, J. R. (1995). Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: A randomized trial of a group cognitive intervention. Journal of the American Academy of Child and Adolescent Psychiatry, 34(3), 312-321.

Clarke, G. N., Rohde, P., Lewinsohn, P. M., Hops, H., Seeley, J.R. (1999). Cognitive-behavioral treatment of adolescent depression: Efficacy of acute group treatment and booster sessions. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 272-279.

Lewinsohn, P. M., Clarke, G. N., Hops, H., & Andrews, J. (1990). Cognitive-behavioral treatment for depressed adolescents. Behavior Therapy, 21, 385-401.

National Association of Cognitive-Behavioral Therapists. (2002). What is CBT? Retrieved October 17, 2003, from http://www.nacbt.org/

Reynolds, W. M. & Coats, K. I. (1986). A comparison of cognitive-behavioral therapy and relaxation training for the treatment of depression in adolescents. Journal of Consulting and Clinical Psychology, 54, 653-660.

Rosselo, J. & Bernal, G. (1999). The efficacy of cognitive-behavioral and interpersonal treatments for depression in Puerto Rican adolescents. Journal of Consulting and Clinical Psychology, 67, 734-745.

Program also discussed in the following Child Trends publication(s):

Zaff, J. F., & Calkins, J. (2001). Background for community-level work on mental health and externalizing disorders in adolescence: Reviewing the literature on contributing factors. Washington, DC: Child Trends.

Program categorized in this guide according to the following:

Evaluated participant ages: 7-18 years, grades 2-12

Program age ranges in the Guide: mid-childhood, adolescence, youth

Program components: clinic-based, counseling/therapy

Measured outcomes: cognitive development, social and emotional health and development, behavioral problems, mental health

Program information last updated 2/20/07