Cognitive, Interpersonal and Other Individual Therapies 3373 Problems are primarily within the mind and not primarily observable
behaviours, for example, anxiety, depression, traumatic memories.
Cognitive approaches draw upon the behaviourist tradition of precise
measurement and objective empirical validation, and are often combined
with behavioural interventions – when this is the case, the term cognitive-
behavioural therapy (CBT) is often used. Such approaches are backed by a
body of evidence demonstrating cognitive distortions or deficits in various
disorders affecting children and adolescents, including aggression, ADHD,
anxiety, PTSD and depression.
While cognitive approaches designed for specific disorders tend to focus
on the content and structure of specific cognitions within the domain in
question, interpersonal problem-solving approaches focus on enhancing
the general processes required to generate solutions to everyday social
problems. Rather than providing the ‘right’ way of thinking about the
problem, this approach emphasises helping children generate their own,
more useful, solutions.
Cognitive approaches for specific disorders
Depression
Distortions in thinking similar to those found in adults have also been
demonstrated in children and adolescents. Their mental schemata will
often be distorted so that negative events are experienced as internally
caused (that is, their fault, rather than due, say, to bad luck), stable (that
is, this is always what happens, rather than an unusual one-off event), and
general (that is, this is typical of the whole of all areas of their life, rather
than just this specific domain). They typically have pervasively negative
view of the past, themselves now, and the future. Treatment programmes
typically include:
1 Cognitive restructuring, involving confronting children and adolescents
about their lack of evidence for their distorted perceptions.
2 Self-control skills promoting consequences for action (praise self more,
punish self less), self-monitoring (paying attention to positive things
they do), self-evaluation (setting less perfectionist standards for self) and
assertiveness training.
3 Social skills, including methods to initiate interactions, maintain inter-
actions, handle conflict and use relaxation and imagery.
A number of randomised controlled trials have shown that children and
adolescents who receive CT for depression clearly do better than waiting
list controls and those receiving traditional counselling. However, only
about half respond, and even then the subsequent relapse rate is high,
with a further 50% of these becoming depressed again; in adults, this
relapse rate is similar for drug treatment. In adolescents, CT is useful since
the evidence that antidepressants work is far less extensive than in adults.
Refinements and adjunctive treatments in addition to basic CT packages
are currently being developed, including relapse-prevention programmes