A Model of Therapist Competencies for the Empirically Supported Cognitive Behavioral Treatment of Child and Adolescent Anxiety and Depressive Disorders

While a plethora of cognitive behavioral empirically supported treatments (ESTs) are available for treating child and adolescent anxiety and depressive disorders, research has shown that these are not as effective when implemented in routine practice settings. Research is now indicating that is partly due to ineffective EST training methods, resulting in a lack of therapist competence. However, at present, the specific competencies that are required for the effective implementation of ESTs for this population are unknown, making the development of more effective EST training difficult. This study therefore aimed to develop a model of therapist competencies for the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders using a version of the well-established Delphi technique. In doing so, the authors: (1) identified and reviewed cognitive behavioral ESTs for child and adolescent anxiety and depressive disorders, (2) extracted therapist competencies required to implement each treatment effectively, (3) validated these competency lists with EST authors, (4) consulted with a panel of relevant local experts to generate an overall model of therapist competence for the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders, and (5) validated the overall model with EST manual authors and relevant international experts. The resultant model offers an empirically derived set of competencies necessary for effectively treating children and adolescents with anxiety and depressive disorders and has wide implications for the development of therapist training, competence assessment measures, and evidence-based practice guidelines for working with this population. This model thus brings us one step closer to bridging the gap between science and practice when treating child and adolescent anxiety and depression.     

青少年抑郁症患者的团体人际心理治疗

青少年抑郁症患者的团体人际心理治疗是建立在人际心理理论基础之上,具有循证医学理论依据的心理治疗方法.它是将原本应用于治疗成人抑郁症的人际心理治疗理论和程序经过修正后应用于青少年抑郁症的治疗.实践表明,青少年抑郁症的团体治疗目标明确,实施领城广泛,具有校为明显的疗效和多方面的积极作用.但是该疗法仍然有许多未解决的问题,需要更进一步的理论突破和实务研究.     

Interpersonal Psychotherapy for Co-occurring Depression and Chronic Pain

Up to 37% of individuals experience chronic pain during their lifetimes. Approximately one-fourth of primary care patients with chronic pain also meet criteria for major depression. Many of these individuals fail to receive psychotherapy or other treatment for their depression; moreover when they do, physical pain is often not addressed directly. Women, socioeconomically disadvantaged individuals, African Americans and Latinos all report higher rates of pain and depression compared to other groups. This article describes a version of Interpersonal Psychotherapy tailored for patients with comorbid depression and chronic pain, Interpersonal Psychotherapy for Depression and Pain (IPT-P). While IPT-P potentially could be delivered to many different patient populations in a range of clinical settings, this article focuses on its delivery within primary care settings for socioeconomically disadvantaged women. Adaptations include a brief 8-session protocol that incorporates strategies for anticipating barriers to psychotherapy, accepting patients' conceptualization of their difficulties, encouraging patients to consider the impact of their pain on their roles and relationships, emphasizing self-care, incorporating pain management techniques, and flexible scheduling. In addition, IPT-P is designed as an adjunct to usual medical pain treatment, and seeks to engage non-treatment seeking patients in psychotherapy by focusing on accessibility and relevance of the intervention to concerns common among patients with pain. Identifying patients with comorbid depression and chronic pain and offering IPT-P as a treatment option has the potential to improve clinical outcomes for individuals with depression and chronic pain.     

Adolescent Group Psychotherapy: Collaborative Opportunity for Patients,Parents, and Therapist

This brief report examines the uses of an Observation Team with a Parent Support Group. In particular, attention is placed on the idea of the Observation Team acting as a Reflecting Team in the final session of the group's life. Using the Observation Team in this manner has evolved from an amalgamation of ideas from family therapy and group therapy theory.     

Identifying Cognitive and Interpersonal Predictors of Adolescent Depression

Emerging research has begun to examine cognitive and interpersonal predictors of stress and subsequent depression in adolescents. This research is critical as cognitive and interpersonal vulnerability factors likely shape expectations, perspectives, and interpretations of a given situation prior to the onset of a stressor. In the current study, adolescents (n?=?157; boys=64, girls=93), ages 12 to 18, participated in a 6-month, multi-wave longitudinal study examining the impact of negative cognitive style, self-criticism, and dependency on stress and depression. Results of time-lagged, idiographic multilevel analyses indicate that depressogenic attributional styles (i.e., composite score and weakest link approach) and self-criticism predict dependent interpersonal, but not noninterpersonal stress. Moreover, the occurrence of stress mediates the relationship between cognitive vulnerability and depressive symptoms over time. At the same time, self-criticism predicts above and beyond depressogenic attributional styles (i.e., composite and weakest link approach). In contrast to our hypotheses, dependency does not contribute to the occurrence of stress, and additionally, no gender differences emerge. Taken together, the findings suggest that self-criticism may be a particularly damaging vulnerability factor in adolescence, and moreover, it may warrant greater attention in the context of psychotherapeutic interventions.     

Empirically Supported Treatments for Insomnia

The purpose of this study was to examine the level of fears in Swedish children and to examine the relation of those fears to state and trait anxiety. The purpose was also to do a normative study of FSSC-R (Fear Survey Schedule for Children - Revised). In total, 550 children between 8 and 16 years of age answered the questionnaires. The results indicate that there are no gender differences in total fear score, factor scores and number of fears. In contrast to earlier results, there was no correlation between fear and trait anxiety; however, a modest correlation was found between fear and state anxiety     

Adolescent Depression: Stressful Interpersonal Contexts and Risk for Recurrence

ABSTRACT— High rates of diagnosable depression in adolescence, especially among young women, present challenging clinical and research issues. Depression not only portends current maladjustment but may also signal risk for recurrent or chronic depression and its associated impairment. Because depression is most often a response to stressful events and circumstances, it is important to understand the stress context itself. Individuals with depression histories are known to contribute to the occurrence of interpersonal and other stressors at a high rate, and for young women particularly, the occurrence of interpersonal stressors and conditions in turn predicts recurrences of depression, in a vicious cycle. Interpersonal dysfunction in early adolescence predicts the likelihood of continuing maladaptive functioning in peer, family, romantic, and parenting roles. The transmission of depression from one generation to the next involves not only heritable factors but also the likelihood that depressed youth become caught in life contexts of marital and parenting discord that portend dysfunction for their offspring and continuing depression for themselves.     

Interpersonal Psychotherapy for Late Life Depression: Current Status and New Applications

Interpersonal Psychotherapy (IPT) is an empirically-supported treatment for depression and other mental disorders. This article discusses the structure of IPT, its use with older adults, and research that supports its efficacy with depressed older people. Depressed older persons with significant health problems or cognitive impairment present special challenges for those conducting IPT and other psychotherapies. Promising new psychotherapies developed for depressed older adults with cognitive impairment and those living in nursing homes are reviewed. Recommendations are made for use of IPT with older adults in nursing homes.     

Rules Versus Principles in Psychotherapy: Implications of the Quest for Universal Guidelines in the Movement for Empirically Supported Treatments

In this article we briefly review the mission and criteria of the EST movement and several of its criticisms. We question an often-unacknowledged feature of the EST initiative—its foundation in a rule-governed approach to the regulation of psychotherapy—and argue that this approach encounters significant problems that are better resolved through an alternative, principle-based approach. The contrast between these perspectives is illustrated by presenting results of a qualitative research project identifying the implicit principles actually used by expert therapists across psychotherapy orientations to regulate values and interventions within their practice.     

Implications of the Empirically Supported Treatment Movement for Psychoanalysis

In this article, I critique the empirically supported treatment (EST) movement and discuss the limitations of traditional psychotherapy research from a psychoanalytic perspective. The EST movement is based on a medical model that assumes that a psychotherapeutic treatment can be conceptualized independent of the human relationship in which it takes place. Psychotherapy and psychoanalysis are, however, treatments only in a metaphorical sense and are more akin to educational processes than medical treatments. Every therapeutic dyad is unique, and research that treats therapy as a standardized, disembodied entity will not contribute to our understanding. Nevertheless, there is a real need for psychoanalysts to become more actively involved in psychotherapy research both for political and scientific reasons. Although I do not believe that “empirical validation” in the form envisaged by the American Psychological Association task force is a realistic goal, I do believe in the value of microscopic studies of therapeutic process, particularly in the context of research-informed case histories.     

The Use of Empirically Supported Strategies for Building a Therapeutic Relationship With an Adolescent With Oppositional-Defiant Disorder

Manualized evidence-based treatments, particularly behavioral and cognitive-behavioral interventions, have been found efficacious for the treatment of adolescents with oppositional-defiant disorder (ODD). However, despite research that underscores the importance of the therapeutic relationship for the success of treatment, manuals do not adequately address how a therapist should engage an adolescent and his/her family in treatment. This paper demonstrates how to utilize findings from the empirical literature on youth and parent engagement when delivering evidence-based treatment to an adolescent diagnosed with ODD. Examples of strategies for engaging adolescents and parents in treatment are provided.     

Stress Generation and Adolescent Depression: Contribution of Interpersonal Stress Responses

This research examined the proposal that ineffective responses to common interpersonal problems disrupt youths’ relationships, which, in turn, contributes to depression during adolescence. Youth (86 girls, 81 boys; M age = 12.41, SD = 1.19) and their primary female caregivers participated in a three-wave longitudinal study. Youth completed a measure assessing interpersonal stress responses; youth and caregivers completed semi-structured interviews assessing youths’ life stress and psychopathology. Consistent with the hypothesized model, ineffective stress responses (low levels of effortful engagement, high levels of involuntary engagement and disengagement) predicted the generation of subsequent interpersonal stress, which partially accounted for the association between stress responses and depression over time. Moreover, results revealed that self-generated interpersonal, but not noninterpersonal stress, predicted depression, and that this explanatory model was specific to the prediction of depression but not anxiety. This research builds on interpersonal stress generation models of depression, and highlights the importance of implementing depression-focused intervention programs that promote effective stress responses and adaptive interpersonal relationships during adolescence.     

A Comparison of Rubrics for Identifying Empirically Supported Practices with Single-Case Research

The use of single-case research methods for validating academic and behavioral interventions has gained considerable attention in recent years. As such, there has been a proliferation of methods for evaluating whether, and to what extent, primary research reports provide evidence of intervention effectiveness. Despite the recent interest in harnessing single-case research to identify empirically supported strategies, examination of these tools has revealed that there is a lack of consistency in the methodological criteria sampled and scoring procedures used to evaluate primary research reports. The present study examined the extent to which various evidence rubrics addressed specific methodological features of single-case research and classified studies into similar evidence categories. Results indicated that the methodological criteria included within rubrics tended to vary, particularly for criteria related to determining the generality of the intervention under study. Moreover, there was substantial discordance observed in the evidence classifications assigned to reviewed studies. These findings are discussed in the context of the still-developing nature of single-case evidence reviews. Recommendations for both research and practice are provided.     

一种认知分析心理治疗模式对抑郁症患者的干预

为了探索基于"自我"与感受、需要、能力和角色交互相整合的认知分析心理治疗模式及其在抑郁症患者治疗中的效果,对7例门诊和8例住院抑郁症患者进行心理治疗,采用HAMD和CGI-GI评估治疗的效果,并追踪治疗1年后患者的社会功能及健康状况.所有患者治疗前后HAMD分值差异显著,配对t=8.08(P<0.01),门诊与住院治疗患者HAMD分值和CGI-G1分值均无明显差异(P>0.05),但产生治疗有效的平均时间差异显著,住院者(11.6±3.6)天,门诊者(60.6±25.0)天(P<0.01).该心理治疗模型能够整合到抑郁症患者的药物治疗中,产生整体治疗效果.     

一种认知分析心理治疗模式对抑郁症患者的干预

为了探索基于"自我"与感受、需要、能力和角色交互相整合的认知分析心理治疗模式及其在抑郁症患者治疗中的效果,对7例门诊和8例住院抑郁症患者进行心理治疗,采用HAMD和CGI-GI评估治疗的效果,并追踪治疗1年后患者的社会功能及健康状况。所有患者治疗前后HAMD分值差异显著,配对t=8.08(P0.01),门诊与住院治疗患者HAMD分值和CGI-GI分值均无明显差异(P0.05),但产生治疗有效的平均时间差异显著,住院者(11.6±3.6)天,门诊者(60.6±25.0)天(P0.01)。该心理治疗模型能够整合到抑郁症患者的药物治疗中,产生整体治疗效果。     

人际心理治疗的发展

人际心理治疗是一种有时间限制、基于操作手册和生活事件、诊断指向的实证性心理治疗方法。它最初主要被用于重型抑郁成年患者的门诊治疗,现已被用于治疗多种心理障碍。人际心理治疗过程变化包括：是否还赋予患者“病人”角色、人际关系问题领域的变化、如何处理结束和安排时间等。不过,有关治疗过程的研究还很少。为了更好地满足大众的需要,它与其他心理治疗成分进行了整合及其自身的简化。文章最后讨论了人际心理治疗发展的特点和问题