Basic Tenets And Philosophy

The major factors distinguishing CBT for children from other psychosocial interventions for youth are their focus on maladaptive learning histories and erroneous or overly rigid thought patterns as the cause for the development and maintenance of psychological symptoms and disorders. However, several other central tenets differentiate CBT from other treatments for children.

Not surprisingly, given CBT's foundations in experimental psychology, CBT has at its core a commitment to the scientific process. In practical terms this implies that testable hypotheses derived from cognitive-behavioral theory are subjected to rigorous study. This is most amply demonstrated today by the endorsement of many cognitive-behavioral psychologists for the empirically supported treatments movement. Undoubtedly, the scientific standards applied in the development of CBTs for children contribute to the overwhelming representation of CBTs for children on the list of empirically supported treatments (see below).

Additionally, CBT for children is focused on the here and now rather than oriented toward uncovering historical antecedents of maladaptive behavior or thought patterns. Treatment goals are often operationalized and parents and youth seeking treatment are asked to consider the types of changes they are hoping to see result from treatment. Progress is monitored throughout treatment using objective indicators of change, such as monitoring forms and rating devices.

CBT for children emphasizes a skills building approach; as a result, it is often action-oriented, directive, and frequently educative in nature. Also for this reason, CBT typically includes a homework component in which the skills learned in treatment are practiced outside the therapy room. Moreover, given the focus of behavioral theory on the context of the behavior, treatments for children often incorporate skills components for parents, teachers, and sometimes even siblings or peers. Because the focus is on teaching the child and his or her family and teachers the skills necessary to effectively cope with or eliminate the child's symptoms, the child and significant others become direct agents of change. In effect, they function as "co-therapists." Therefore, CBT is designed to be time-limited and relatively short term, rarely extending beyond 6 months of active treatment. More recently, however, some CBTs for children have started to incorporate spaced-out "booster sessions" that extend over a longer period of time to ensure maintenance and durability of change.

EMPIRICAL SUPPORT FOR CBTs FOR CHILDREN

Relative to other treatment approaches, CBT for children has received strong empirical support. Today CBTs are applied to a wide range of childhood problems and disorders including anxiety and phobic disorders, depressive disorders, aggressive and disruptive behavior problems, substance abuse and eating disorders, as well as pediatric or medical concerns (e.g., coping with painful medical procedures, enuresis, and irritable bowel syndrome). Although reviews clearly highlight the need to develop more and better empirically supported treatments for youth, CBTs for children and adolescents stand out in that they have led the way in doing so. For example, a recent review of the empirically supported treatment literature finds support for CBTs in the treatment of anxiety disorders and phobic disorders, conduct disorder/oppositional defiant disorder, chronic pain, depression, distress due to medical procedures, and recurrent abdominal pain (Chambless & Ollendick, 2001). In addition, behavior therapy or components of behavior therapy were found to be effective in the treatment of atten-tion-deficit/hyperactivity disorder, encopresis, enuresis, obesity, obsessive-compulsive disorder, recurrent headache, and the undesirable behaviors (e.g., self-injury) associated with pervasive developmental disorders. A growing body of research is addressing the mechanisms of change in these therapies as well as questions about the applicability of these treatments to a variety of clinical settings and populations (i.e., the moderators of change).

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