Introduction
People of different ages are prone to various psychological and emotional issues, especially in the current world that is transforming at a high pace. Adolescents are specifically vulnerable to the development of certain psychological conditions due to developmental peculiarities (DeRubeis et al., 2019). One of the most common health issues teenagers develop is depression. It has been estimated that approximately 12% of adolescents between 13 and 17 years old suffer from this disorder (Rasing et al., 2017). Moreover, the rate of young people with subclinical depressive symptoms reaches up to 21% (Rasing et al., 2017). People have acknowledged the benefits of diverse types of therapy assisting individuals in coping with the challenges they meet. Cognitive behavioral therapies have become widely used because their efficacy has been proved. These interventions are based on cognitive behavioral theory. This paper includes a brief description of the theory, its application for treating adolescents and some peculiarities of working with this population.
History and Basics
Cognitive behavioral theory is deeply rooted in the behavioral approach and the findings of Pavlov and Skinner, as well as other theorists. O’Donohue and Ferguson (2016) claim that the works of Skinner were critical for the further development of cognitive behavioral theory. Skinner was one of the pioneers who stressed that behavior was not a mere result of certain stimuli coming from the outside. The theorist argued that the way people perceived the world played an important role in the way they chose behavioral patterns to react to this or that situation (O’Donohue & Ferguson, 2016). The emergence of the new practice was a reaction to the dissatisfaction with the behaviorist approach that could not be utilized with numerous conditions.
The theory implies the focus on cognition that affects behavior. According to the cognitive behavioral theory, the way people think shapes their behavioral, emotional, and physiological responses (Wenzel, 2019). In simple terms, theories and practitioners employing this theoretical framework believe that it is not the situation itself that affects people’s behavior but the way they perceive it. When counseling adolescents, this approach is specifically relevant as this age group often views the world around them in black and white, which leads to the development of depression.
Best Practices and Specific Techniques
The primary premise of the theoretical approach in question is the focus on people’s beliefs, expectations, or evaluations. One of the common techniques is distancing that presupposes framing a belief (DeRubeis et al., 2019). This technique consists in asking a client to share their beliefs and suggesting that this belief affects the person’s behavior. The patient eventually dissociated themselves with the belief and has an opportunity to analyze behavior. The client also learns how to react under certain conditions and control the development of beliefs. It is also quite a widespread practice to involve parents in therapies based on cognitive behavioral principles (Vidair et al., 2017). Adolescents learn to interact with their parents, which has a positive effect on their emotional and psychological state.
Other techniques include self-monitoring and scheduled activities. An important feature of the practice is the development of the necessary skills in teenagers who are taught to apply these skills in the real world (DeRubeis et al., 2019). The cognitive behavioral approach is instrumental in treating numerous disorders clients suffering from depression develop (Song et al., 2019). For example, insomnia and depressions are closely linked, and cognitive behavioral models have proved to be effective in treating these health issues.
It is necessary to note that cognitive behavioral theory is widely utilized to treat depression. At the same time, it is stressed that the chosen therapy should take into account the developmental peculiarities of the client (Garber et al., 2016). The therapist should make sure that the adolescent client is capable of understanding and using the skills necessary to address their psychological and emotional states.
Problem-solving and cognitive restructuring are some of the most widespread methods utilized to treat depression (Fréchette-Simard et al., 2018). Fréchette-Simard et al. (2018) identify a peculiarity of the approach that can be seen as a serious shortcoming. The vast majority of programs based on the cognitive behavioral approach are characterized by a variety of techniques and methods. This diversity serves as a considerable obstacle to the analysis of existing programs and the identification of an effective program for a specific situation.
At this point, it is necessary to note that technological advances have brought certain changes to the way therapy is delivered. Computer-based interventions have proved to be effective as adolescents and their parents benefit from their participation (Topooco et al., 2019). Depressive symptoms reduce, and adolescents develop a more pro-active attitude towards their life and specific conditions or beliefs. Various devices are often utilized for out-of-office care, which has a considerable impact on the healing process (Topooco et al., 2019). Clients feel support and remain connected whenever they need it. Technology-based programs may involve individual work or group sessions, which increases the accessibility of the service.
Ethical Issues Involved
Similar to numerous approaches and practices, cognitive behavioral therapies are associated with some ethical issues. It is noteworthy that these are effectively addressed by practitioners. For instance, the use of written consent forms is one of the methods to ensure clients’ understanding of their treatment, its goals, and expected outcomes (Wenzel, 2019). When treating adolescents, practitioners often have to address a dilemma related to the involvement of parents. The extent to which they may be involved is the primary issue as the relationships with parents may be the reason for depression. The practitioner has to maintain trustful relationships with their adolescent client, but make sure that parents receive all the relevant information regarding their child.
Multicultural Implications
As mentioned above, cognitive behavioral therapies are created to meet the needs of diverse groups. Age and gender are only some of the possible aspects to take into account as cultural peculiarities play an important role as well. Consoli et al. (2018) note that every program should be consistent with the cultural domain of a particular client. The therapist should understand the worldview and perspective of the client, which is impossible without paying particular attention to the culture.
As mentioned above, the cognitive behavioral theory is related to people’s beliefs, so it is critical to pay special attention to cultural norms and beliefs. Cultures and subcultures need to be considered when it comes to treating adolescents who often become members of diverse cultural groups (Nagayama Hall & Ibaraki, 2016). It is also important to understand what cultural traditions clients associate themselves with in order to create the most effective intervention (Zigarelli et al., 2016). Group treatment can be a specific challenge as the representatives of different cultural groups can be its members, so the therapist has to shape the program accordingly.
Counselor Roles and Responsibilities
Although the beliefs and behaviors of the client are central to treatment, counselors play an important role in the process. Clearly, these people listen to the client and discuss the issues they find relevant (Wenzel, 2019). Based on these discussions, the counselor develops a treatment plan for the individual or a group. During the implementation stage, the counselor guides the work and clients’ exploration of their selves.
The counselor also creates an atmosphere of trust, collaboration, respect, and support in order to develop the necessary rapport. For some, it may seem that counselor should become a close friend, but, in fact, this kind of relationship may be counterproductive. Termination is an inevitable part of any treatment, so the counselor has to make sure that this stage is implemented successfully. The client has to become an empowered person who has a set of skills that help them in addressing certain challenges.
Conclusion
On balance, the cognitive behavioral theory is instrumental in treating depression in adolescents and related health issues. The therapies based on this theoretical framework concentrate on people’s views, beliefs, and perspectives. Clients are encouraged to evaluate their behaviors within the scope of their perspectives and beliefs. Teenagers acquire skills that can be helpful in their adult life as they are taught to see the world in a pro-active way. A positive worldview is one of the objectives cognitive behavioral therapies try to achieve.
It is necessary to note that these therapies are characterized by a considerable degree of diversity, which is justified by the attempt to address the needs of different groups (based on gender, culture, and other aspects). However, this diversity is also an obstacle to the development of the practice because norms and patterns can hardly be developed. Therefore, practitioners have to create their own techniques and methods instead of utilizing clear protocols or guidelines that could be evidence-based.
References
Consoli, A. J., Blears, K., Bunge, E. L., Mandil, J., Sharma, H., & Whaling, K. M. (2018). Integrating culture, pedagogy, and humor in CBT with anxious and depressed youth. Practice Innovations, 3(2), 138-151. Web.
DeRubeis, R. J., Keefe, J. R., & Beck, A. T. (2019). Cognitive therapy. In K. S. Dobson & D. J. A. Dozois (Eds.), Handbook of cognitive-behavioral therapies (pp. 218–248). The Guilford Press.
Fréchette-Simard, C., Plante, I., & Bluteau, J. (2018). Strategies included in cognitive behavioral therapy programs to treat internalized disorders: a systematic review. Cognitive Behaviour Therapy, 47(4), 263-285. Web.
Garber, J., Frankel, S. A., & Herrington, C. G. (2016). Developmental demands of cognitive behavioral therapy for depression in children and adolescents: Cognitive, social, and emotional processes. Annual Review of Clinical Psychology, 12(1), 181-216. Web.
Nagayama Hall, G. C., & Ibaraki, A. Y. (2016). Multicultural issues in cognitive-behavioral therapy: Cultural adaptations and goodness of fit. In C. M. Nezu & A. M. Nezu (Eds.), The Oxford handbook of cognitive and behavioral therapies (pp. 465–482). Oxford University Press.
O’Donohue, W. T., & Ferguson, K. E. (2016). Historical and philosophical dimensions of contemporary cognitive-behavioral therapy. In C. M. Nezu & A. M. Nezu (Eds.), The Oxford handbook of cognitive and behavioral therapies (pp. 7–28). Oxford University Press.
Rasing, S. P. A., Creemers, D. H. M., Janssens, J. M. A. M., & Scholte, R. H. J. (2017). Depression and anxiety prevention based on cognitive behavioral therapy for at-risk adolescents: A meta-analytic review. Frontiers in Psychology, 8. Web.
Song, W., Hu, X., Fan, B., Gao, C., Qiu, M., & Zhang, J. (2019). Insomnia and depressive symptoms in adolescents: Can cognitive behavioral therapy for insomnia contribute to improve adolescents’ depressive symptoms? Chronobiology in Medicine, 1(2), 60-65. Web.
Topooco, N., Byléhn, S., Dahlström Nysäter, E., Holmlund, J., Lindegaard, J., Johansson, S., Åberg, L., Bergman Nordgren, L., Zetterqvist, M., & Andersson, G. (2019). Evaluating the efficacy of internet-delivered cognitive behavioral therapy blended with synchronous chat sessions to treat adolescent depression: Randomized controlled trial. Journal of Medical Internet Research, 21(11), 1-17. Web.
Vidair, H., Feyijinmi, G. O., & Feindler, E. L. (2017). Termination in cognitive–behavioral therapy with children, adolescents, and parents. Psychotherapy, 54(1), 15-21. Web.
Wenzel, A. (2019). Cognitive behavioral therapy for beginners: An experiential learning approach. Routledge.
Zigarelli, J. C., Jones, J. M., Palomino, C. I., & Kawamura, R. (2016). Culturally responsive cognitive behavioral therapy. Clinical Case Studies, 15(6), 427-442. Web.