Depressive disorders and symptoms in young people are similar to those in adults. CBT works on the assumption that emotions, including depressed feelings, are influenced by thoughts and behaviors, and that it is possible to change negative emotions by changing the way young people think about, or act in response to, stressful situations. For example, an adolescent who becomes depressed after an experience of academic failure may have reacted by engaging in overly general self-critical thinking ("I am stupid") and by giving up on studying in a helpless manner. By working with the adolescent to react to frustration with active coping (e.g., seeking help) and by more realistic thinking ("I did not do well on that test but I could do better if I got some additional help"), CBT counters the depressive reaction and helps the adolescent to build skills to prevent future depression.
Although there are several different types of CBT for depression, varying in the extent to which they emphasize changing behavior, changing thoughts, or involving parents in the treatment, they all have in common certain components. First, the therapist works with the adolescent or child to help him or her to identify and label positive and negative feelings. Second, the young person is helped to see what events, situations, and thoughts are associated with positive and negative feelings, including depressed, irritable, or disinterested/bored feelings. Third, CBT involves increasing the child or adolescent's involvement in pleasant, rewarding activities that can function to improve mood. Fourth, CBT involves working with the young person to question, challenge, and ultimately modify the unrealistic, negative thinking patterns that interfere with social involvement, pursuit of personal goals, or overall enjoyment of life experiences. In addition to these core features of CBT, the treatment of depression may involve working with parents to improve the emotional climate at home, helping young people and parents improve their communication patterns, teaching the young person ways to relax or manage anxiety, and helping him or her learn how to solve interpersonal problems more effectively.
Since depression is most often an episodic disorder, it usually improves over time. With young children, CBT has been shown to be more effective than 'watchful waiting' and more effective than traditional school counseling as a treatment for depression. With adolescents, CBT has also been shown to be more effective than 'watchful waiting' and more effective than nondirective supportive therapy.
For moderately to severely depressed adolescents, the most effective treatment at this time is the combination of CBT and an SSRI medication. In the NIMH-sponsored Treatment for Adolescents with Depression Study (TADS), this combination led to the best outcomes in terms of both reduced depression and reduced risk of suicidal events. The CBT manual used in TADS, as well as manuals describing the pharmacotherapy, assessment methods, and quality assurance procedures are available on-line at the following website: https://trialweb.dcri.duke.edu/tads/manuals.html
Brent, D., Emslie, G., Clarke, G. et al. (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, 901-913.
Compton, S. N., March, J. S., Brent, D. A., Albano, A. M., Weersing, V. R., & Curry, J. F. (2004). Cognitive-behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: An evidence based medicine review. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 930-959.
Curry, J. F. (2001). Specific psychotherapies for childhood and adolescent depression. Biological Psychiatry, 49, 1091-1100.
Curry, J. F., & Reinecke, M. A. (2003). Modular cognitive behavior therapy for adolescents with major depression. In M.A. Reinecke, F.M. Dattilio, & A. Freeman (Eds.), Cognitive Therapy with Children and Adolescents (2nd Ed.), pp. 95-127. New York: Guilford.
The Treatment for Adolescents with Depression Study (TADS) Team (2007). The Treatment for Adolescents with Depression Study (TADS): Long-term effectiveness and safety outcomes. Archives of General Psychiatry, 64, 1132-1144.