Cognitive-Behavioral Psychotherapy for Anxiety and Depressive Disorders in Children and Adolescents: An Evidence-Based Medicine Review

Abstract

Objective: To review the literature on the cognitive-behavioral treatment of children and adolescents with anxiety and depressive disorders within the conceptual framework of evidence-based medicine. Method: The psychiatric and psychological literature was systematically searched for controlled trials applying cognitive-behavioral treatment to pediatric anxiety and depressive disorders. Results: For both anxiety and depression, substantial evidence supports the efficacy of problem-specific cognitive-behavioral interventions. Comparisons with wait-list, inactive control, and active control conditions suggest medium to large effects for symptom reduction in primary outcome domains. Conclusions:From an evidence-based perspective, cognitive-behavioral therapy is currently the treatment of choice for anxiety and depressive disorders in children and adolescents. Future research in this area will need to focus on comparing cognitivebehavioral psychotherapy with other treatments, component analyses, and the application of exportable protocol-driven treatments to divergent settings and patient populations. J. Am. Acad. Child Adolesc. Psychiatry, 2004;43(8):930-959.Key Words: outcome studies, children and adolescents with major depression and dysthymic disorder, children and adolescents with anxiety disorder, literature review.

Cognitive Behavioral Therapy for Depression in Youth

“…Results of TADS [13] paint a different picture, however, with CBT seeming to produce effects simply on par with placebo and general nonspecific remoralization. As can be seen in Table 1, CBT response rates vary substantially across the entire literature, and CBT effect size estimates have fluctuated dramatically from review [7] to review [6]. How can one make sense of these conflicting findings?…”

Youth Depression in the Family Context: Familial Risk Factors and Models of Treatment

“…In general, the treatment outcome literature for child depression lags significantly behind that of other child disorders (Compton et al, 2004) and treatments may be somewhat less effective (Weisz, McCarty, & Valeri, in press). For example, although family-based therapies have been shown to be effective for treating other child and adolescent disorders, including conduct disorder, substance abuse, and schizophrenia, there is a paucity of family-focused treatments for depression (Diamond, Serrano, Dickey, & Sonis, 1996).…”

Cognitive-Behavioral Therapy for Anxiety in Children With High-Functioning Autism: A Meta-analysis

“…In typically developing children with anxiety disorders, CBT has been evaluated in .40 randomized studies 20 showing positive response in 50% to 60% of participants and moderate to large effect sizes (ESs) across studies. 21 Theoretical underpinnings of CBT assume that pathologic anxiety is the result of an interaction between excessive physiologic arousal, cognitive distortions, and avoidance behavior. 22 Accordingly, the core components of CBT include teaching emotion regulation skills aimed at reducing physiologic arousal and maladaptive thinking, followed by systematic exposure to feared situations to eliminate avoidant behavior.…”