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CBT plus Medication is Effective for Chronic Migraine in Children and Adolescents

According to a recent study published in JAMA, cognitive behavior therapy (CBT) plus amitriptyline (a tricyclic antidepressant used in the treatment of migraines) may be an effective treatment for chronic migraines in children and adolescents. In the current study, researchers compared the efficacy of CBT plus amitriptyline versus headache education plus amitriptyline. Participants included 135 youth aged 10 to 17 diagnosed with chronic migraine. They were randomized to either the CBT plus amitriptyline group (n = 64) or headache education plus amitriptyline group (n = 71). Participants received either 10 CBT sessions or 10 headache education sessions involving equivalent time and therapist attention. At post-treatment, 66% in the CBT group had at least a 50% reduction in headache days versus 36% in the headache education group. At the 12-month follow up, 86% in the CBT group had at least a 50% reduction in headache days versus 69% in the headache education group. These findings support the efficacy of CBT in the treatment of chronic migraine among children and adolescents.

Powers, S. W., Kashikar-Zuck, S. M., Allen, J. R., LeCates, S. L., Slater, S. K., Zafar, M., Kabbouche, M. A., … Hershey, A. D. (December 25, 2013). Cognitive Behavioral Therapy Plus Amitriptyline for Chronic Migraine in Children and Adolescents. Jama, 310, 24, 2622.

CBT Helps Prevent Depression in At-Risk Adolescents

Research from a randomized clinical trial recently published in JAMA Psychiatry indicates that group cognitive-behavioral prevention (CBP) may help prevent depression in at-risk adolescents. Participants included 316 adolescents with current or past elevated depressive symptoms and whose parents experienced current and/or prior depression. They were randomly assigned to either the CBP group or care as usual (CU). The CBP intervention consisted of eight weeks of weekly 90-minute group sessions, as well as six monthly 90-minute booster sessions. Cognitive restructuring and problem solving were emphasized throughout the course of treatment.

Participants were assessed pre-intervention, after the acute intervention, after the booster sessions, and at one year (21 months) and 2 years (33 months) post intervention. Results showed that adolescents in the CBP group had significantly fewer onsets of depressive episodes than the care as usual group. However, parental depression significantly moderated the effect of the intervention. That is, when parents were depressed at baseline, average onset of depression between the CBP group and usual care did not differ. These results indicate that CBPs may be an evidence-based alternative to preventing depression, and that improvements are needed to strengthen the CBP intervention particularly when active parental depression is involved.

Beardslee, W. R., Brent, D. A., Weersing, V. R., Clarke, G. N., Porta, G., Hollon, S. D., … & Garber, J. (2013). Prevention of Depression in At-Risk Adolescents: Longer-term Effects. doi:10.1001/jamapsychiatry.2013.295

CBT Shows Promise for Anxious Youth with Autism Spectrum Disorders

Autism Spectrum Disorders (ASD) is an umbrella term representing a range of persistent cognitive deficits and impairments in communication and social interaction, often diagnosed by age two, and includes autistic disorder, Asperger’s syndrome, and pervasive developmental disorders. Children with ASD are at an elevated risk for developing anxiety disorders, which can become highly debilitating across environmental contexts (home, school, and social contexts). The results of previous research (case studies, small group studies, and randomized clinical trials) have provided evidence and support for the efficacy of modified CBT for youth with ASD and anxiety.

In a 2012 study published in Autism Research and Treatment, researchers developed a modified version of a CBT intervention (“Facing Your Fears”) for adolescents with ASD, titled “Facing Your Fears: Group Therapy for Managing Anxiety in Children with High Functioning ASD” (FYF-A). They then assessed the feasibility and acceptability of the FYF-A intervention program.

Participants included 24 adolescents and their families, age 13-18, with ASD and anxiety. They attended 14, 90-minute sessions, plus 1 booster session, which included large group activities with teens and parents, small-group activities with teens and parents alone, and dyadic work with parent and teen pairs. The program focused on core CBT components (including an introduction to anxiety symptoms and implementation of CBT strategies) and several modifications for teens with ASD. These modifications included: (1) a social skills module to address areas of social challenge; (2) parent-teen dyadic work focused on achieving a mutual understanding and shared goals; (3) the use of technology to both monitor symptoms of anxiety and remind participants to utilize CBT strategies; and (4) a parent curriculum.

At post-treatment, participants showed significant reductions in anxiety severity and intrusiveness. These reductions were maintained at the 3-month follow up. Further, nearly half of the participants met criteria for a positive treatment response on primary diagnosis following the intervention. These finding are encouraging, as they add further evidence that modified CBT for adolescents with ASD is effective in decreasing anxiety symptoms among this group.

Reaven, J., Blakeley-Smith, A., Leuthe, E., Moody, E., & Hepburn, S. (January 01, 2012). Facing Your Fears in Adolescence: Cognitive-Behavioral Therapy for High-Functioning Autism Spectrum Disorders and Anxiety. Autism Research and Treatment, 2012, 2, 1-13.

Cognitive Therapy for Adolescents in School Settings

We are pleased to announce the publication of “Cognitive Therapy with Adolescents in School Settings” – a concise guide for clinicians which features in-depth case examples and hands-on clinical tools. The authors – including renowned CT originator Aaron T. Beck, clinical child psychologist Torrey A. Creed, and school psychologist Jarrod Reisweber – provide an accessible introduction to the cognitive model and demonstrate specific therapeutic techniques that have been used successfully in the schools. Strategies are illustrated for engaging adolescents in therapy, rapidly creating an effective case conceptualization, and addressing a range of clinical issues and stressors frequently experienced in grades 6–12. The challenges and rewards of school-based CT are discussed in detail. In a convenient large-size format with lay-flat binding for easy photocopying, the book contains 16 reproducible handouts, worksheets, and forms. This guide will be a valuable resource for a wide range of professionals, from graduate students seeking a solid knowledge base to experienced professionals looking to expand their repertoire of CT interventions.

Cost-Effectiveness and Clinical-Effectiveness of Combined Therapy versus Medication Only in Adolescents with Resistant Major Depression

Depression in adolescents is a significant issue. Research has focused on treating major depression in adolescents with psychotherapy (CBT), medication (selective serotonin reuptake inhibitors, SSRIs), or a combination of both.  As treatment is not inexpensive, researchers have been looking into the cost-effectiveness of different treatment models.  Previous research has shown that CBT treatment and medication is the most expensive treatment model in the short run.  The least expensive model is medication only.  However, some adolescents do not respond to medication alone.

A recent randomized trial was published in the Archives of General Psychiatry. 334 adolescents with SSRI-resistant depression, were randomly assigned to one of two groups for 24 weeks: a change in medication or a change in medication plus CBT.   Throughout the treatment they were assessed at 6, 12, and 24 weeks for symptom changes, depression-free days, and depression-improvement days.  The researchers also examined the clinical outcomes within certain subgroups of participants: patients with histories of abuse, comorbid disorders, and levels of hopelessness.

The study found that using a combined treatment of CBT and medication led to more depression-free and depression-improved days.  It worked best for patients without a history of abuse or with low levels of helplessness.  While the combined treatment was more costly in the short-run, it may be most cost-efficient in the long run.  This study demonstrates the benefits of further examining the use of combined treatment in adolescents with SSRI-Resistant Depression.

Lynch, F. L., Dickerson, J. F., Clarke, G., Vitiello, B., Porta, G., Wagner, K. D., … Brent, D.  (2011). Incremental cost-effectiveness of combined therapy vs medication only for youth with selective serotonin reuptake inhibitor – resistant depression.  Arch Gen Psychiatry, 68 (3), 253-262.

Family Based Cognitive-Behavioral Therapy is Effective for Youth With OCD

newstudy-graphic-66x60.jpgA recent open trial conducted by researchers at the University of South Florida tested the effect of family-based cognitive-behavioral therapy (CBT) on children and adolescents with Obsessive-Compulsive Disorder (OCD). The participants were 30 youth (7-19 years old), half boys and half girls, who were partial or nonresponders to two or more medication trials. Each patient received 14 sessions of intensive family-based CBT.

At post-treatment and 3-month follow-up, 80% of participants had improved. Symptom severity was reduced by 54%. Over 50% were classified as being in remission at the end of treatment, and at the 3-month follow-up. While there was no notable difference in self-reported anxiety, researchers observed significant reductions in OCD-related impairment, depressive symptoms, behavioral problems, and family accommodation.

To read the entire article, click here: http://www.ncbi.nlm.nih.gov/pubmed/20390817

CBT and CBT Plus Medication for the Treatment of OCD in Children

NewStudy-Graphic-72x72_edited-3 A recent study published in Child and Adolescent Mental Health found both Cognitive Behavior Therapy (CBT) and CBT in combination with medication to be effective in the treatment of Obsessive Compulsive Disorder (OCD) in children. During a ten-year period, 75 children were evaluated and treated for OCD in an outpatient setting. Investigators later contacted a subset of that sample to investigate the long-term maintenance of their therapeutic gains. Treatment groups in this follow up investigation included, (1) those treated with medication before beginning CBT, (2) those treated with CBT only, and (3) those treated with CBT and medication, simultaneously. Participants in each group had all met diagnostic criteria for OCD as determined by their Children’s Yale Brown Obsessive-Compulsive Scale (CYBOCS) scores. Long term maintenance was assessed by comparing post-treatment and pre-treatment CYBOCS scores. Results showed significant improvement for each group, yielding further support for the use of CBT and CBT plus medication (SSRIs) in the treatment of OCD.

Reference

Nakatani, E. (2009). Outcomes of cognitive behaviour therapy for obsessive compulsive disorder in a clinical setting: A 10-year experience from a specialist OCD service for children and adolescents. Child and Adolescent Mental Health, 14, 133-139.

For children and adolescents, psychological harm of traumatic events reduced by CBT

In a review in the American Journal of Preventive Medicine, it was noted that children and adolescents who experience psychological harm caused by traumatic events are often treated by practitioners who are not aware of, and do not employ, treatments that are “based on the best available evidence.”

Meta-analyses were conducted on interventions that included cognitive behavioral therapy (CBT) in individual and group settings, play therapy, psychodynamic therapy, and others.

The traumas themselves covered a wide range and included sexual abuse, domestic violence, serious illness, and natural disasters. The CBT methods included exposure techniques, modification of inaccurate cognitions, reframing counterproductive cognitions regarding the trauma, and others.

Based on their analyses, the review authors concluded there was “strong evidence … that individual and group CBT can decrease psychological harm among symptomatic children and adolescents exposed to trauma.”

Review authors: H. R. Wethington, R. A. Hahn, D. S. Fuqua-Whitley, et al.

UK national guidelines emphasize CBT for children and adolescents

A recent article in Current Opinion in Psychiatry summarized the UK National Institute for Health and Clinical Excellence (NICE) clinical guidelines and reviews of cognitive behavioral therapy (CBT) for children and adolescents with mental health problems.

NICE is the UK’s independent organization responsible for providing national guidance on the “promotion of good health and the prevention and treatment of ill health.”

For the treatment of depression in children and young people, NICE guidelines recommended “that pharmacological approaches should not be the first-line approach to the treatment of depression in this age group.” It recommended instead “the initial use of psychosocial interventions, including CBT, for all severities of depression.”

Meta-analyses of randomized controlled trials suggested the importance of CBT for children and adolescents with generalized anxiety disorder, depression, obsessive compulsive disorder, and posttraumatic stress disorder. More limited evidence suggested CBT’s benefit in attention deficit hyperactivity disorder and others conditions.

The authors noted that CBT for these populations “should be extended by further primary and secondary research.”

Review authors: A. Munoz-Solomando, T. Kendall, C. J. Whittington

Adolescents with Chronic Fatigue Syndrome experience enduring benefits of CBT

A new study in Pediatrics reported that adolescents with Chronic Fatigue Syndrome (CFS) who received 10 sessions (over 5 months) of cognitive behavioral therapy (CBT) continued to experience positive effects at 2-year follow-up. Researchers measured fatigue, functional impairment, school attendance, and work attendance (where applicable). At follow-up, participants continued to experience the same improvement in fatigue as they had at the end of treatment. Their physical functioning, school attendance, and work attendance actually improved during the follow-up period. The authors recommended that this treatment become available to more adolescent patients with CFS.

Study authors: H. Knoop, M. Stulemeijer, L. W. A. M. de Jong, T. J. W. Fiselier, G. Bleijenberg