CBT for childhood depression is based on a multiple pathway model that views depression as resulting from the reciprocal influence of cognitive, behavioral, contextual/interpersonal, and biological factors. The treatment package for childhood depression is often multidimensional, targeting depressive symptoms and other problems often accompanying depression (e.g., familial conflict, interpersonal skill deficits, oppositional behavior). The child's social context (family, school, and peers) is often a focus of treatment. Children are seen as experiencing depressive symptoms due to the stress of negative events or a lack of positive events in their lives, the effects of which are mediated by cognitive factors. Consideration of a child's cognitive developmental level is crucial in designing interventions. Younger children or children with less developed intellectual abilities may not be able to utilize complex cognitive interventions but require behavioral or contextual (e.g., parenting) interventions to evince change in cognitions and depressive symptoms.
CBT for children with depression focuses on identifying and challenging unrealistic beliefs that exacerbate depressive feelings and associated problem behaviors (Friedberg, Crosby, Friedberg, Rutter, & Knight, 2000). Identifying and modifying inaccurate beliefs is accomplished through collaborative experimentation between patient and therapist. The therapist works as consultant; a person with ideas worth trying out and a sounding board for ideas that do not work, diagnostician; making meaningful decisions about treatment based on data and knowledge of psychopathology; and educator, assisting in finding the most effective ways to learn to control behavior and increase cognitive and emotional skills (Kendall, 1993). In the context of a caring, therapeutic relationship, the therapist seeks to nonreinforce depressive affect and behavior while increasing reinforcement for positive, active behaviors. Sessions are generally guided by an agenda and/or goal setting, client feedback is seen as an integral part of the CBT session, and homework is assigned by the therapist to instill a practical and experiential focus to the goals of therapy (Friedberg et al., 2000).
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