Review: How has cognitive behaviour therapy been adapted for adolescents with comorbid depression and chronic illness? A scoping review, 2020, Loades

[Andy]

Background
Depression becomes increasingly common in adolescence. Around 10%–20% of adolescents have a chronic illness, and they are more likely to experience depression. There is emerging evidence for cognitive behaviour therapy (CBT) interventions to treat depression in adolescents with chronic illnesses, yet no review has been undertaken of how these CBT interventions are delivered in practice.

Methods
We conducted a scoping review to summarise how CBT has been delivered in adolescents with chronic illness and depression. We included studies that evaluated CBT aimed at treating depression/depressive symptoms in adolescents with chronic illness. Searches were carried out across Embase and PsycNET.

Results
Twelve studies met our inclusion criteria. These included diabetes (n = 3), inflammatory bowel disease (n = 3), polycystic ovary syndrome (n = 2), chronic headache (n = 1), chronic pain (n = 1), chronic fatigue syndrome (n = 1) and Fanconi anaemia (n = 1). Adaptations made to the delivery of CBT included cognitive restructuring of illness‐related thoughts, behavioural activation balancing illness‐related and enjoyable activities, psychoeducation of the comorbidity and link between the chronic illness and depression, relationship building, skill building and parental or familial involvement. CBT was typically delivered by trained professionals with expertise in working with adolescents, who worked under supervision.

Conclusions
CBT for depression is commonly adapted for this population, and the nature of cognitions and behaviours targeted in CBT may typically depend on how the chronic illness presents. There is relatively little evidence to date, and a need for more research into the efficacy and effectiveness of treatments for adolescent depression in this vulnerable population specifically.


Key Practitioner Message
What is known?

• Adolescents with chronic illness are more likely than healthy adolescents to experience depression.
• There is emerging evidence of the effectiveness of cognitive behaviour therapy (CBT) for depression in adolescents with chronic illness.

What is new?

• Psychoeducation tends to include information about the chronic illness, and illness‐relevant cognitions and behaviours are also targeted with this population.
• Furthermore, more flexible delivery of CBT, including by telephone, may be used, and parents may be more involved than in usual practice.

What is significant for clinical practice?

• Chronic illness may necessitate adaptations to both the content and delivery of CBT.
• The adaptations may be specific to the nature and impact of the chronic illness.

Open access, https://acamh.onlinelibrary.wiley.com/doi/10.1111/camh.12421

 

[rvallee]

When you find yourself having to admit that something has been used in practice for decades without there being any evidence whatsoever about whether it is of any use and see no problem with it, you have found your problem and it is the one staring back at you in a mirror.

This stuff has not only been used for decades, its groundbreaking efficacy has been touted for decades. It is constantly hyped as effective, even though research published today is still nothing but a bunch of "may be" and "could be" that suggest it would be great if someone could figure out how to make it work.

It's the fact that everyone in this field is either oblivious or indifferent to this that guarantees failure. This is exactly how not to science. This is the exact opposite of science, in fact it's identical to how the alternative medicine industry works. No coincidence.

At this point the clinical psychology industry exists to provide employment to people who work in clinical psychology. The field could be so much more than that, but it has chosen to huff on paint and just ram it through without any afterthought, hell even without the ability for hindsight. Everything is new, but also proven and old. It's groundbreaking, now if only someone could figure out how to make it work.

Absurd. Completely absurd.