Cognitive-Behavioral Therapy in Youth

Contents

Foreword: The ABC’s of Psychotherapy xiii

Harsh K. Trivedi

Preface: CBT inYouth xv

Todd E. Peters and Jennifer B. Freeman

History of Cognitive-Behavioral Therapy in Youth 179

Courtney L. Benjamin, Connor M. Puleo, Cara A. Settipani,
Douglas M. Brodman, Julie M. Edmunds, Colleen M. Cummings,
and Philip C. Kendall
The numerous intervention strategies that comprise cognitive-behavioral
therapy (CBT) reflect its complex and integrative nature and include such
topics as extinction, habituation, modeling, cognitive restructuring, prob-
lem solving, and the development of coping strategies, mastery, and
a sense of self-control. CBT targets multiple areas of potential vulnerability
(eg, cognitive, behavioral, affective) with developmentally guided strategies
and traverses multiple intervention pathways. Although CBT is often con-
sidered the “first-line treatment” for many psychological disorders in youth,
additional work is necessary to address nonresponders to treatment and to
facilitate the dissemination of efficacious CBT approaches.

Cognitive-Behavioral Therapy for Adolescent Depression and Suicidality 191

Anthony Spirito, Christianne Esposito-Smythers, Jennifer Wolff,
and Kristen Uhl
Cognitive-behavioral therapy (CBT) is a well-established treatment of de-
pression in children and adolescents but treatment trials for adolescents
with suicidality are few in number, and their efficacy to date is limited.
This article reviews the rationale underlying the use of CBT for the treatment
of depression and suicidality in adolescents, the literature supporting the ef-
ficacy of CBT for depressed adolescents, and whether CBT for depression
reduces suicidal thoughts and behavior. A description of some of the core
cognitive, affective, and behavioral techniques used in CBT treatments of
suicidal ideation and behavior in depressed adolescents is included.

Dialectical Behavior Therapy for Suicidal Adolescents with Borderline

Personality Disorder 205
Dena A. Klein and Alec L. Miller
Although research to date on dialectical behavior therapy (DBT) for adoles-
cents has its limitations, growing evidence suggests that DBT is a promis-
ing treatment for adolescents with a range of problematic behaviors,
including but not limited to suicidal and nonsuicidal self-injury. This article
introduces dialectical behavior therapy’s theoretical underpinnings, de-
scribes its adaptation for suicidal adolescents, and provides a brief review
of the empirical literature evaluating DBT with adolescents.
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Cognitive-Behavioral Therapy for Anxiety Disorders inYouth 217

Laura D. Seligman and Thomas H. Ollendick
Cognitive-behavioral therapies (CBTs) have been shown to be efficacious
for the treatment of anxiety disorders in children and adolescents. Ran-
domized clinical trials indicate that approximately two-thirds of children
treated with CBT will be free of their primary diagnosis at posttreatment.
Although several CBT treatment packages have been investigated in youth
with diverse anxiety disorders, common core components have been
identified. A comprehensive assessment, development of a good thera-
peutic relationship and working alliance, cognitive restructuring, repeated
exposure with reduction of avoidance behavior, and skills training com-
prise the core procedures for the treatment of anxiety disorders in youth.

Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder in Children

and Adolescents 239
Katharina Kircanski, Tara S. Peris, and John C. Piacentini
Obsessive-compulsive disorder (OCD) is a common, chronic, and impair-
ing condition in youth. Cognitive-behavioral therapy (CBT), now widely
recognized as the gold standard intervention for childhood OCD, relies
on exposure and response prevention, and also includes psychoeduca-
tion, creation of a symptom hierarchy, imaginal exposures, cognitive inter-
ventions, and a contingency management system. This article reviews the
theoretical underpinnings of current CBT approaches, key components of
treatment, developmental considerations specific to childhood OCD, and
evidence supporting the use of this psychosocial intervention. The current
state of knowledge will be aided by further study of predictors and mech-
anisms of CBT treatment response.

Cognitive-Behavioral Treatment for Posttraumatic Stress Disorder in Children

and Adolescents 255
Shannon Dorsey, Ernestine C. Briggs, and Briana A. Woods
Several cognitive-behavioral therapy (CBT) approaches are available for
treating child and adolescent posttraumatic stress disorder (PTSD). These
treatments include common elements (eg, psychoeducation, gradual ex-
posure, relaxation). This review (1) delineates common elements in CBT
approaches for treating child and adolescent PTSD; (2) provides a detailed
review of three CBT approaches with substantial evidence of effective-
ness; and (3) describes promising practices in the area of CBT approaches
to treating child and adolescent PTSD. Cultural and implementation con-
siderations are also included.

Cognitive-Behavioral Therapy for Weight Management and Eating Disorders

in Children and Adolescents 271
Denise E. Wilfley, Rachel P. Kolko, and Andrea E. Kass
Eating disorders and obesity in children and adolescents involve harmful
behavior and attitude patterns that infiltrate daily functioning. Cognitive-
behavioral therapy (CBT) is well suited to treating these conditions, given
 Contents ix

the emphasis on breaking negative behavior cycles. This article reviews the
current empirically supported treatments and the considerations for youth
with weight control issues. New therapeutic modalities (ie, enhanced CBT
and the socioecologic model) are discussed. Rationale is provided for ex-
tending therapy beyond the individual treatment milieu to include the family,
peer network, and community domains to promote behavior change, min-
imize relapse, and support healthy long-term behavior maintenance.

Cognitive-Behavioral Therapy forYouth with Body Dysmorphic Disorder:

Current Status and Future Directions 287
Katharine A. Phillips and Jamison Rogers
Body dysmorphic disorder (BDD) usually begins during early adolescence
and appears to be common in youth. BDD is characterized by substantial
impairment in psychosocial functioning and high rates of suicidality. Cog-
nitive-behavioral therapy (CBT) tailored to BDD is the best tested and most
promising psychosocial treatment for adults. CBT has been used for youth
with BDD, but has not been systematically developed for or tested in
youth. This article focuses on CBT for BDD in adults and youth; possible
adaptations and the need for treatment research in youth; and prevalence,
clinical features, diagnosis, recommended pharmacotherapy, and treat-
ments that are not recommended.

Cognitive-Behavioral Therapy for Externalizing Disorders in Children

and Adolescents 305
John E. Lochman, Nicole P. Powell, Caroline L. Boxmeyer,
and Luis Jimenez-Camargo
This article focuses on the use of cognitive-behavioral therapy (CBT) strat-
egies for children and adolescents with externalizing disorders. Following
a description of risk factors for youth antisocial behavior, several compo-
nents common to CBT interventions for youth with externalizing behaviors
will be described. Using the Coping Power Program as a model, child
treatment components including Emotion Awareness, Perspective Taking,
Anger Management, Social Problem Solving, and Goal Setting will be
reviewed. CBT strategies for parents of youth with disruptive behaviors
will also be described. Finally, the article summarizes the evidence for
the effectiveness of CBT strategies for externalizing disorders and pres-
ents specific outcome research on several programs that include CBT
techniques.

Cognitive-Behavioral Therapy for Childhood Repetitive Behavior Disorders:

Tic Disorders and Trichotillomania 319
Christopher A. Flessner
This article provides an overview of cognitive-behavioral therapy (CBT) for
repetitive behavior disorders. Because tic disorders and trichotillomania
are the most often studied and most debilitating of these conditions, this
article focuses on the efficacy of CBT for these 2 conditions. An overview
of CBT for children presenting with these concerns is provided. This review
focuses particularly on habit reversal training, which is at the core of most
CBT-based interventions. Two recent empirical studies on the immense
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potential of CBT in treating childhood repetitive behavior disorders and

future areas of research are also discussed.

Cognitive-Behavioral Therapy for Children with Comorbid Physical Illness 329

Rachel D. Thompson, Patty Delaney, Inti Flores, and Eva Szigethy
In addition to the usual developmental challenges, children and adoles-
cents with chronic physical illness face psychosocial challenges that affect
their quality of life. This review describes different aspects of coping with
chronic physical illness in childhood and the empirical evidence examining
the usefulness of cognitive-behavioral therapy (CBT) for the treatment of
children and adolescents with chronic physical illnesses and related psy-
chological comorbidities. Four diseases (diabetes, inflammatory bowel
disease, cancer, and sickle cell disease) were chosen as model illnesses
to demonstrate key CBT findings in more detail. Future research recom-
mendations in this challenging population are also addressed.

Applying Cognitive-Behavioral Therapy for Anxiety to the Younger Child 349

Dina R. Hirshfeld-Becker, Jamie A. Micco, Heather Mazursky,
Lindsey Bruett, and Aude Henin
Cognitive-behavioral therapy (CBT) protocols for anxiety disorders have
been shown to have efficacy with older children and adolescents; how-
ever, only recently have investigators begun to adapt and pilot such inter-
ventions for younger children. This article reviews data suggesting that
even very young children can benefit from CBT for anxiety, discusses
some of the necessary developmental adaptations when working with chil-
dren of preschool and early elementary school age, and reviews studies
that have implemented CBT for anxiety disorders with youngsters in this
age range. The authors conclude with recommendations for future direc-
tions for research in this area.

Core Principles in Cognitive Therapy withYouth 369

Robert D. Friedberg and Gina M. Brelsford
Cognitive therapy (CT) is increasingly being adopted by child psychiatrists
for a variety of clinical problems. This article explains the cardinal princi-
ples, practices, and processes associated with this approach. More spe-
cifically, a brief overview of the treatment model is offered along with an
emphasis on case conceptualization and modular format for treatment.
The value of collaboration, guided discovery, establishing a good thera-
peutic alliance, empiricism, and transparency in clinical work, as well as
bringing the head and heart to consensus, is explained. Finally, the hall-
mark session structure that characterizes CT is delineated.

Acceptance and Commitment Therapy (ACT): Advances and Applications

with Children, Adolescents, and Families 379
Lisa W. Coyne, Louise McHugh, and Evan R. Martinez
Acceptance and commitment therapy (ACT) is part of a growing body of
literature of “third-wave” behavioral therapy that finds its roots in the de-
velopment of mindfulness. ACT for adults has gained empirical support
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across a broad range of psychiatric disorders and behavioral health

issues, yet the literature looking at the adaptation of ACT for youth popu-
lations is still nascent. This article provides an outline of key components of
ACT, a brief overview of the history and development of ACT, adaptations
for children, the theoretical underpinnings of ACT, assessment and ther-
apy, and a review of the evidence-based literature to date.

Index 401