By Jeremy Joves, BA, Courtney Giannini, BA, Hannah Toyoma, BA, Saige Portera, BA, Anika Mehta, BA, Samantha Honnert, MA and Robert Friedberg, PhD
Center for the Study and Treatment of Anxious Youth at Palo Alto University
The following article provides a summary of studies showing the impact of treating depression in youth with CBT, with and without accompanying medication. CBT has shown to be an effective and efficacious treatment modality for youth, with stronger long-term results than medication alone. Modular CBT has produced positive results in youth with comorbidities, indicating that flexibility in treatment is key to maximizing impact.
Cognitive Behavioral Therapy (CBT) demonstrates efficacy and effectiveness across a range of disorders and populations. Crowe and McKay (2017) completed a meta-analysis with far-ranging findings. First, they found that CBT for treating depression had an aggregate weighted effect size of .41 to .79 indicating medium to strong treatment effects. Further, CBT was shown to reduce symptoms long-term. The promising results held in both individual and group settings. Moreover, Crowe and McKay (2017) considered group CBT more cost effective and efficient than other modalities.
Weersing et al. (2016) reviewed 42 randomized clinical trials (RCTs) examining CBT efficacy and effectiveness with children and adolescents. CBT for adolescents diagnosed with depression reached well-established status. Weersing and colleagues noted that CBT with children met the possibly efficacious threshold with the effects attenuated by smaller sample sizes and weaker methodologies. Nonetheless, there were no negative results. In sum, younger age, comorbidities and significant life stressors tempered the efficacy results.
The seminal Treatment for Adolescent Depression Study (TADS, 2004) compared CBT with medication for depression in youth. The TADS team randomly assigned 439 adolescents to one of three conditions: a 12 week course of CBT, treated with sertraline, a pill placebo, or a combination of sertraline and CBT. CBT showed improvement in depressive symptoms equal to that of medication, albeit taking slightly longer to reach treatment success. Similarly, Brent et al. (2008) conducted The Treatment of Resistant Depression in Adolescents (TORDIA) study, which examined 334 adolescents who failed to respond to a 2-month trial of a Selective Serotonin Reuptake Inhibitor (SSRI). Adolescents were assigned to either one of two medication-only groups, or a new medication with CBT. Patients treated with CBT exhibited enhanced functioning and a greater decrease in depressive symptoms. Although medication reduced symptoms faster, CBT was better at maintaining improvements for a year or more.
When treating depression in youth, comorbidity with other disorders presents a difficult problem (Weisz et al., 2015). Weisz et al. (2015) proposed a modular approach to CBT consisting of an aggregated approach of common empirically supported procedures (e.g. behavioral activation, problem-solving, cognitive restructuring) to ameliorate outcomes. This modular application of treatment was found to have significantly steeper trajectories of improvement in youth with depression compared to usual care (Weisz et al., 2015). When properly delivered in an appropriate and flexible way, CBT has been shown to be a reliable and tested treatment for depressed youth (Weisz et al., 2015).
There is ample evidence that CBT for youth with depression is an effective and efficacious treatment. Since CBT grows in efficacy as young patients’ age increases, it is therefore important for clinicians to deliver age-appropriate interventions with youth. It is also pivotal to note that CBT reduces depressive symptoms similar to medication, with better lasting effects. Additionally, life factors may influence response to the treatment. Modular CBT is an emerging and promising way to deal with co-morbidities and contextual variations. When delivered appropriately in the correct manner and context, CBT has been evidenced to be effective and efficacious with youth (Crowe & McKay, 2017; Friedberg & Thordarson, 2018; Weisz et al., 2015).
Brent, D., Emslie, G., Clarke, G., Wagner, K. D., Asarnow, J. R., Keller, M., … Zelazny, J. (2008). Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: The TORDIA randomized controlled trial. Journal of the American Medical Association, 299(8), 901-13.
Crowe, K. & McKay, D. (2017). Efficacy of cognitive-behavioral therapy for childhood anxiety and depression. Journal of Anxiety Disorders, 49, 76-87.
Friedberg, R.D., & Thordarson, M.A. (2018). Cognitive Behavioral Therapy. In J. L. Matson (Ed.), Handbook of Childhood Psychopathology and Developmental Disabilities of Treatment, Autism and Child Psychopathology Series, (43-55). Springer International Publishing.
TADS Team, March, J., Silva, S., Petrycki, S., Curry, J., Wells, K., ... Severe J (2004). Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for adolescents with depression study (TADS) randomized controlled trial. Journal of the American Medical Association, 292(7), 807–820.
Weersing, V. R., Jeffreys, M., Do, M. T., Schwartz, K. T. G., & Bolano, C. (2016). Evidence base update of psychosocial treatments for child and adolescent depression. Journal of Clinical Child & Adolescent Psychology, 46(1), 11-43.
Weisz, J. R., Krumholz, L. S., Santucci, L., Thomassin, K., & Yi Ng, M. (2015). Shrinking the gap between research and practice: Tailoring and testing youth psychotherapies in clinical care contexts. The Annual Review of Clinical Psychology, 11, 139-163.
If you're interested in a deeper dive into this topic, Dr. Wendy Wild will be leading a virtual workshop via Zoom from June 15-17 on CBT for Youth. The workshop is designed to help clinicians build age-appropriate skills – specifically related to the interplay of emotions, behaviors, and cognitions – for caregivers and youth.