Effectiveness of Cognitive Behavioral Therapy in Treating Adolescent Depression: A Systematic Review
Keywords:
Adolescent, Behavior Therapy, Congnitive Behavioral Therapy, Depression, Systematic ReviewAbstract
Depression is a leading mental health issue among adolescents, contributing significantly to the global disease burden. Cognitive Behavioral Therapy (CBT) is recognized as an effective intervention for adolescent depression. This systematic review aimed to evaluate the effectiveness of CBT in reducing depressive symptoms among adolescents through different delivery formats, including face-to-face, group, and digital platforms. A comprehensive literature search was conducted across five databases-Scopus, PubMed, ProQuest, Science Direct, and Cambridge Core-to identify relevant studies published from 2018 to 2022. The inclusion criteria focused on randomized controlled trials involving adolescents diagnosed with depression who received CBT. Initial searches yielded 168,216 articles, which, after deduplication and screening, resulted in 11 articles for final analysis. The findings indicate that CBT effectively reduces depressive symptoms in adolescents, with significant improvements in mood, behavioral activation, and overall functioning. Both face-to-face and internet-based CBT (iCBT) were found to be effective, with iCBT offering advantages such as reduced costs and easier accessibility. Group CBT fostered a supportive environment, promoting peer learning, while individual CBT provided personalized care. CBT was also associated with increased self-efficacy, improved coping strategies, and reduced relapse rates. These results support CBT as a flexible and effective approach to managing adolescent depression. Expanding CBT, particularly via digital means, could help address mental health care gaps, though considerations around adherence and resource availability remain crucial.
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References
Indonesian Ministry of Health. Depression services technical manual. Jakarta: Republic of Indonesia Ministry of Health; 2021.
Milatz F, Klotsche J, Niewerth M, Sengler C, Windschall D, Kallinich T, et al. Anxiety and depression symptoms in adolescents and young adults with juvenile idiopathic arthritis: results of an outpatient screening. Arthritis Res Ther 2024; 26:1–13. doi:10.1186/s13075-024-03312-x
Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet 2013; 382:1575–86. doi:10.1016/S0140-6736(13)61611-6
Copeland WE, Alaie I, Jonsson U, Shanahan L. Asso-ciations of childhood and adolescent depression with adult psychiatric and functional outcomes. J Am Acad Child Adolesc Psych 2021; 60:604-11. doi:10.1016/j.jaac.2020.12.022
World Health Organization. Depressive disorder (depression) [Internet]. WHO; 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/ depression
Indonesian Ministry of Health. Basic Health Research 2018. Jakarta: Balitbangkes Kemenkes RI; 2018.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders V. 5th ed. Washington, DC: Am Psyc Publ; 2013. doi:10.1176/appi.books.9780890425787
Kim AW, Nyengerai T, Mendenhall E. Evaluating the mental health impacts of the COVID-19 pandemic: perceived risk of COVID-19 infection and childhood trauma predict adult depressive symptoms in urban South Africa. Psychol Med 2022; 52:1587-99. doi:10.1017/S0033291720003414
Idsoe T, Keles S, Olseth AR, Ogden T. Cognitive behav-ioral treatment for depressed adolescents: results from a cluster randomized controlled trial of a group course. BMC Psychiatry 2019; 19:1–17. doi:10.1186/s12888-019-2134-3
Hogberg G, Hallstrom T. Mood regulation-focused CBT based on memory reconsolidation reduced suicidal ideation and depression in youth in a randomized controlled study. Int J Environ Res Public Health 2018; 15:1-10. doi:10.3390/ijerph15050921
Ebert DD, Zarski AC, Christensen H, Stikkelbroek Y, Cuijpers P, Berking M, et al. Internet and computer-based cognitive behavioral therapy for anxiety and depression in youth: A meta-analysis of randomized controlled outcome trials. PLoS One 2015; 10:1-15. doi:10.1371/journal.pone.0119895
David D, Cristea I. The new great psychotherapy debate: scientific integrated psychotherapy vs. plurality. Why cognitive-behavior therapy is the gold standard in psychotherapy and a platform for scientific integrated psychotherapy. J Evidence-Based Psychother 2018; 18:1-17. doi:10.24193/jebp.2018.2.11
Weersing VR, Jeffreys M, Do MCT, Schwartz KTG, Bolano C. Evidence base update of psychosocial treatments for child and adolescent depression. J Clin Child Adolesc Psychol 2017; 46:11–43. doi:10.1080/15374416.2016.1220310
Wise J. Depression in children: offer digital CBT as first-line treatment, says NICE. BMJ 2019; 364:l364. doi:10.1136/bmj.l364
Miller I, Peake E, Strauss G, Vierra E, Koepsell X, Shalchi B, et al. Self-guided digital intervention for depression in adolescents: feasibility and preliminary efficacy study. JMIR Form Res 2023; 7:e43260. doi:10.2196/43260
Rossello J, Bernal G, Rivera-Medina C. Individual and group CBT and IPT for Puerto Rican adolescents with depressive symptoms. Cult Divers Ethn Minor Psychol 2008; 14:234–45. doi:10.3390/ijerph15050921
Christ C, Schouten MJ, Blankers M, van Schaik DJF, Beekman AT, Wisman MA, et al. Internet and computer-based cognitive behavioral therapy for anxiety and depression in adolescents and young adults: systematic review and meta-analysis. J Med Internet Res 2020; 22:1-20. doi:10.2196/17831
Grist R, Croker A, Denne M, Stallard P. Technology-delivered interventions for depression and anxiety in children and adolescents: a systematic review and meta-analysis. Clin Child Fam Psychol Rev 2019; 22:147-71. doi:10.1007/s10567-018-0271-8
Considine J, Shaban RZ, Fry M, Curtis K. Evidence-based emergency nursing: designing a research question and searching the literature. Int Emerg Nurs 2017; 32:78–82. doi:10.1016/j.ienj.2017.02.001
Polanin JR. Best practice guidelines for abstract screening large-evidence systematic reviews and meta-analyses. Res Synth Methods 2019; 10:330–42. doi:10.1002/jrsm.1354
Joanna Briggs Institute. Critical appraisal checklist for randomized controlled trial [Internet]. 2023. Available from: https://jbi.global/critical-appraisal-tools
Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ 2020; 368:1-6. doi:10.1136/bmj.l6890
Goplen CM, Verbeek W, Kang SH, Jones CA, Voaklander DC, Churchill TA, et al. Preoperative opioid use is associated with worse patient outcomes after total joint arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord 2019; 20:1-12. doi:10.1186/s12891-019-2619-8
Nagamitsu S, Kanie A, Sakashita K, Sakuta R, Okada A, Matsuura K, et al. Adolescent health promotion interventions using well-care visits and a smartphone cognitive behavioral therapy app: randomized controlled trial. JMIR Mhealth Uhealth 2022; 10:e34154. doi:10.2196/34154
Wright B, Tindall L, Hargate R, Allgar V, Trepel D, Ali S. Computerised cognitive–behavioural therapy for depression in adolescents: 12-month outcomes of a UK randomised controlled trial pilot study. BJPsych Open 2020; 6:e5. doi:10.1192/bjo.2019.91
Mechler J, Lindqvist K, Carlbring P, Topooco N, Falkenstrom F, Lilliengren P, et al. Therapist-guided internet-based psychodynamic therapy versus cognitive behavioural therapy for adolescent depression in Sweden: a randomised, clinical, non-inferiority trial. Lancet Digit Heal 2022; 4:e594–603. doi:10.1016/S2589-7500(22)00095-4
Sakata M, Toyomoto R, Yoshida K, Luo Y, Nakagami Y, Uwatoko T, et al. Components of smartphone cognitive-behavioural therapy for subthreshold depression among 1093 university students: a factorial trial. Evid Based Ment Health 2022; 25:E18-25. doi:10.1136/ebmental-2022-300455
Pedrelli P, Fisher LB, Nyer M, Shapero BG, Farabaugh A, Hayden ER, et al. Evaluating the combination of a brief motivational intervention plus cognitive behavioral therapy for depression and heavy episodic drinking in college students. Psychol Addict Behav 2019; 34:1-38. doi:10.1037/adb0000538
Topooco N, Berg M, Johansson S, Liljethorn L, Radvogin E, Vlaescu G, et al. Chat- and internet-based cognitive-behavioural therapy in treatment of adolescent depression: randomised controlled trial. BJPsych Open 2018; 4:199-207. doi:10.1192/bjo.2018.18
Ede MO, Igbo JN, Eseadi C, Ede KR, Ezegbe BN, Ede AO, et al. Effect of group cognitive behavioural therapy on depressive symptoms in a sample of college adolescents in Nigeria. J Ration Emotive Cogn Behav Ther 2020; 38:306-18. doi:10.1007/s10942-019-00327-1
Geirhos A, Domhardt M, Lunkenheimer F, Temming S, Holl RW, Minden K, et al. Feasibility and potential efficacy of a guided internet- and mobile-based CBT for adolescents and young adults with chronic medical conditions and comorbid depression or anxiety symptoms (youthCOACHCD): A randomized controlled pilot trial. BMC Pediatr 2022; 22:69. doi:10.1186/s12887-022-03134-3
Berg M, Rozental A, Johansson S, Liljethorn L, Radvogin E, Topooco N, et al. The role of knowledge in internet-based cognitive behavioural therapy for adolescent depression: Results from a randomised controlled study. Internet Interv 2019; 15:10-7. doi:10.1016/j.invent.2018.10.001
King CA, Eisenberg D, Pistorello J, Coryell W, Albucher RC, Favorite T, et al. Electronic bridge to mental health for college students: A randomized controlled intervention trial. J Consult Clin Psychol 2022; 90:172–83. doi:10.1037/ccp0000709
Craske MG, Meuret AE, Echiverri-Cohen A, Rosenfield D, Ritz T. Positive affect treatment targets reward sensitivity: A randomized controlled trial. J Consult Clin Psychol 2023; 91:350–66. doi:10.1037/ccp0000805
Gautam M, Tripathi A, Deshmukh D, Gaur M. Cognitive Behavioral Therapy for Depression. Indian J Psychiatry 2020; 62:223. doi:10.4103/psychiatry
Geschwind N, Arntz A, Bannink F, Peeters F. Positive cognitive behavior therapy in the treatment of depression: A randomized order within-subject comparison with traditional cognitive behavior therapy. Behav Res Ther 2019; 116:119-30. doi:10.1016/j.brat.2019.03.005
Pescatello MS, Pedersen TR, Baldwin SA. Treatment engagement and effectiveness of an internet-delivered cognitive behavioral therapy program at a university counseling center. Psychother Res 2021; 31:656–67. doi:10.1080/10503307.2020.1822559
Hedman-Lagerlof E, Axelsson E. Using the Internet to provide treatment for health anxiety. In: The clinician's guide to treating health anxiety. Elsevier 2019; 143-54. doi:10.1016/B978-0-12-811806-1.00008-1
de Gier M, Beckerman H, Twisk J, Knoop H, de Groot V. Blended versus face-to-face cognitive behavioural therapy for severe fatigue in patients with multiple sclerosis: A non-inferiority RCT. Mult Scler J 2023; 29:1316-26. doi:10.1177/13524585231185462
Axelsson E, Andersson E, Ljótsson B, Bjorkander D, Hedman-Lagerlöf M, Hedman-Lagerlof E. Effect of Internet vs Face-to-Face Cognitive Behavior Therapy for Health Anxiety. JAMA Psy 2020; 77:915.
doi:10.1001/jamapsychiatry.2020.0940
Hedman‐Lagerlof E, Carlbring P, Svardman F, Riper H, Cuijpers P, Andersson G. Therapist‐supported Internet‐based cognitive behaviour therapy yields similar effects as face‐to‐face therapy for psychiatric and somatic disorders: an updated systematic review and meta‐analysis. World Psy 2023; 22:305-14. doi:10.1002/wps.21088
Bengtsson J, Nordin S, Carlbring P. Therapists' experi-ences of conducting cognitive behavioural therapy online vis-a-vis face-to-face. Cogn Behav Ther 2015; 44:470-9. doi: 10.1080/16506073.2015
Friedberg RD, Xie I, Goodman C, Zucker J, Neley M, Chen R, et al. Useful techniques in group cognitive behavioral therapy with youth. In: Handbook of Cognitive-Behavior Group Therapy with Children and Adolescents New York: Routledge; 2024; p. 60-72.
Nowakowski ME, Bieling PJ. An overview of group cognitive behavioral therapy: Science and practice. In: Comprehensive Clinical Psychology. Elsevier; 2022. p. 245-62.
Scheffert A. Setting considerations for group-based cognitive behavior therapy for children and adole-scents. In: Handbook of Cognitive-Behavior Group Therapy with Children and Adolescents. New York: Routledge 2024; p 73-84.
Goss C, Rossi A, Moretti F. Assessment stage: Data gath-ering and structuring the interview. In: Communication in Cognitive Behav Ther New York, NY: Springer New York 2011; p. 25-51.
Freeman A. The conceptualization process in cognitive behavioral therapy. Commentary on Chapter “Case formulation in standard cognitive therapy.” In: CBT Case Formulation as Therapeutic Process Cham: Springer International Publishing 2021; p. 35-8.
Karlin BE, Brown GK, Jager-Hyman S, Green KL, Wong M, Lee DS, et al. Dissemination and implementation of cognitive behavioral therapy for depression in the Kaiser Permanente Health Care System: Evaluation of initial training and clinical outcomes. Behav Ther 2019; 50:446–58. doi:10.1016/j.beth.2018.08.002
Terpstra JA, van der Vaart R, Spillekom-van Koulil S, van Dam A, Rosmalen JGM, Knoop H, et al. Becoming an eCoach: Training therapists in online cognitive-behavioral therapy for chronic pain. Patient Educ Couns 2018; 101:1702–7. doi: 10.1016/j.pec.2018.03.029
Givens A, Moeller K, Johnson TL. Prison-based interventions for early adults with mental health needs: A systematic review. Int J Offender Ther Comp Criminol 2021; 65:613–30. doi: 10.1177/0306624X20952395
Yoon IA, Slade K, Fazel S. Outcomes of psychological therapies for prisoners with mental health problems: A systematic review and meta-analysis. J Consult Clin Psychol 2017; 85:783–802. doi: 10.1037/ccp0000214
Hargreaves DS, Elliott MN, Viner RM, Richmond TK, Schuster MA. Unmet health care need in US adolescents and adult health outcomes. Pediatrics 2015; 136:513-20. doi:10.1542/peds.2015-0237
Corrigan PW, Druss BG, Perlick DA. The impact of mental illness stigma on seeking and participating in mental health care. Psychol Sci Public Interes 2014; 15:37-70. doi:10.1177/1529100614531398.
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