Cognitive-behavioral therapy for adolescent depression

Cognitive variables that predict favorable treatment outcomes in adolescents with depression include higher levels of rational thoughts, less hopelessness, fewer negative thoughts, and fewer cognitive distortions at baseline. ^10,14,22 In an analysis of TADS data, cognitive distortions at baseline were also shown to moderate the effects of combined CBT and fluoxetine, such that adolescents with high levels of cognitive distortion were more likely to experience incremental benefits from CBT as part of combination treatment. ³¹ In an analysis of the Brent study, hopelessness was found to mediate the predictive effects of referral source on outcome across 3 types of psychotherapy. ¹⁴ The only variables that have been found to mediate the results of CBT specifically are negative automatic thoughts, and in a small subclinical sample, dysfunctional attitudes, which suggests that a reduction in these variables may be important mechanisms of change in CBT. ^17,23 Mediational analyses have not yet been conducted on the TADS data, which precludes conclusions about the mechanisms of change in pharmacological and combination treatments. Further research is needed to uncover the specific strategies used in therapy that reframe negative cognition, modify dysfunctional beliefs, and improve depressive symptoms.