MODULE 6 CHAPTERS 11 & 12_ EMOTION AND THOUGHT DISORDERS.pdf

MODULE 6 CHAPTERS 11 & 12: EMOTION AND THOUGHT DISORDERS Adaptive anxiety → acts as a motivator to prepare us for a future danger; apprehension can help us properly prepare Maladpive anxiety → disproportionate anxiety towards a real or perceived...

MODULE 6 CHAPTERS 11 & 12: EMOTION AND THOUGHT DISORDERS Adaptive anxiety → acts as a motivator to prepare us for a future danger; apprehension can help us properly prepare Maladpive anxiety → disproportionate anxiety towards a real or perceived future threat. Interferes with daily tasks and lasts beyond the removal of the threat. Causes intense distress and psychological discomfort Chronic anxiety → causes people to anticipate disaster in the long run constantly and can lead to mental and physical discomfort Anxiety in the context of development Socio-emotional task that depends on the emergence of object permanence, stranger and separation anxiety ○ It helps us build trust in infancy for those who can protect us ○ Chronic anxiety persists beyond the developmentally appropriate age ○ Chronic anxiety can inhibit ability to master future skills or goals later in life Social competence ○ The ability to establish meaningful friendships and play other social roles ○ Increase in empathy and metacognition in adolescence enhances this ○ Fears and doubts can become intense and extend beyond what is expected, disrupting social competence Continuum of fears, anxieties, and worries ○ Adaptive anxiety on one end → maladaptive fear, anxiety, and worry on the other end ○ Most children lie somewhere in between the two extremes Childhood anxiety disorders are predictive of future depression, suicidal behaviour, and substance abuse DSM-5 Anxiety in kids and teens Separation anxiety disorder, selective mutism, selective phobia, and social anxiety disorder → occur during childhood  SAD, specific phobia, social anxiety = fear disorders, panic disorders, agoraphobia = intense apprehension and fear, GAD → emerge later on in life Prevalence 20% of children and teens develop some sort of anxiety disorder before adulthood 5% have anxiety disorders in adulthood Boys to girls ratio middle childhood → 1:2, adolescence → 1:3 Anxiety and depression occur at a gap of about 5 years on average Social anxiety disorder → most common in children and adolescents ○ Fear → behavioural and psychological reaction to a threat; might feel a sense of terror and urge to run away ○ Worry → cognitive response to a threat where a person prepares for a future threat, not a current one A person may exhibit uneasiness and apprehension SELECTIVE MUTISM ○ DSM-5 disorder: consistent failure to speak in social situations where there is an expectation to speak ○ Needs to last 1 month ○ Needs to impair functioning ○ Diagnosed only when the child inability to speak cant be attributed to a lack of knowledge, inability to speak the language, or another disorder (like ASD) ○ Affects less than 1% of children in the gen. Pop. ○ 2X as prevalent in girls than boys ○ Age of onset → 2.7-4.2 years ○ Usually undiagnosed until children go to school ○ Can last an average of 8 years if not treated; about 94% of kids dont receive treatment Kids can go on to develop social anxiety disorder ○ Children tend to have issues with academics and peer rejection ○ Causes  Interplay between genetics, temperament, and early social learning Family studies indicate heredity; 9% of fathers, 18% of mothers, 18% of siblings have selected mutism 50% of parents of children with selective mutism exhibit extreme shyness in social situations Allele associated with selective mutism → CNTNAP2 predisposes children to social anxiety and increases their chance of developing selective mutism or anxiety Behavioural inhibition → children with high behavioural inhibition experience high arousal and stress when presented with new stimuli 15% of infants with this withdraw from that stimuli to cope with it Mowrer’s two-factor theory: anxiety is established via classical conditioning, and maintained through negative reinforcement (operant conditioning) Children learn that remaining silent can lower their arousal and stress SPECIFIC PHOBIA ○ A marked fear or anxiety about a specific object or situation ○ Persists for at least 6 months ○ Causes distress or impairments ○ 5 broad categories: animals, natural environment, blood/injections/injures, specific situations, other stimuli ○ Symptoms → racing heart, shallow breathing, sweaty palms, dizziness, etc Young children may cry, have tantrums, freeze, cling to parents, avoid what theyre afraid of ○ Fears being displayed are out of proportion to the danger the stimuli poses ○ Diagnoses Children merit the diagnosis if they meet 2 criteria: 1) they exhibit fear or anxiety that impairs their daily functioning, and 2) symptoms cause distress and impairment in the child ○ Prevalence 2-9% of children and teens, most common being animals 3-7% fear natural stimuli  3-4% have blood related and dark fears Girls more liekly than boys 91% of girls report fear of animals, 87% fear of specific situations ○ Children experience negative cognitions, decreased autonomic functioning, and escape behaviours when confronted with the feared stimuli ○ Phobias can last for up to 2 years if not treated in time ○ Causes Genes play an insignificant role. Children may inherit a tendency towards anxiety Vasovagal response → rapid increase and sudden decrease in blood pressure that we see in people with blood/injury type phobias Classical conditioning, pairing two stilumi together in time can foster specific phobias (ex little albert) Observational learning → children watching specific fears in their parents Informational transmission → overhearing/conversing with others about feared objects and situations Mowrer’s two-factor theory of anxiety Classical conditioning + negative reinforcements. The children learn to avoid feared objects or situations EVIDENCE BASED TREATMENT FOR SPECIFIC PHOBIA AND SELECTIVE MUTISM ○ Behavioural Interventions Contingency management Person receives positive reinforcement for confronting a fear Person isnt allowed to avoid or escape Based on principles of operant conditioning Therapist has to establish a behavioral contract with the family ○ Family and child will decide on behaviours that provoke the lowest anxiety → highest anxiety Child will be brought closer to the most feared stimulus over time Continues until anxiety dissipates Systematic desensitization Associating a fear with an incompatible response (like relaxation)  Classical conditioning Family and child create that hierarchy of feared stimuli Therapist will teach the child relaxation techniques As they progress up the fear hierarchy, they will use those incompatible relaxation techniques The child is taught to associate previously feared response with relaxation Modeling Acquisition of a new behaviour via imitation The child will observe the therapist confronting the feared stimulus and observe that they are not punished or put in danger; the feared stimulus is then positively reinforced Exposure therapy Anxiety and related disorders Repeatedly confronting the feared stimuli for shorts amount of time, until anxiety is extinguished Exposure can be real or imaginary, it can be spaced out or happen rapidly Efficacy of behaviour therapy? Supported by research for youth with specific phobias ○ Commonplace and atypical fears Supported for selective mutism ○ Graded exposure + systematic desensitization for speaking ○ Therapists use a ladder or hierarchy of speaking, and the children gradually work up it ○ Watching peers having fun doing activities that require speaking also encourages children to speak ○ Medications SSRIs, Fluoxetine, sertraline, fluvoxamine, paroxetine → all effective for specific phobias and selective mutism (45-60% show at least moderate improvement) SSRI’s → 84% of young children with selective mutism show improvement  Keep in mind many studies with SSRIs for this dont involve control groups SEPARATION ANXIETY DISORDER ○ Excessive anxiety about leaving caregivers ○ Developmentally inappropriate and excessive ○ Lasts at least 4 weeks, causes distress and impairment in functioning ○ Normal in infants at 6 months and peaks at 13 months, should decline around age 3-5 ○ Varied symptoms across ages Young children may refuse to go to school, cling to parents, have nightmares about parents being harmed Older kids may have a vague sense of feeling endangered during separations, still experience extreme anxiety and sadness Older children may become ill, separate from social situations, have troubles with concentrating ○ Onset typically 7-9 years of age ○ Causes Genetic factors predispose children via increased autonomic arousal and overall anxiety (smaller contribution compared to other anxiety disorders) Insecure Attachment, insecure-ambivalent attachment Predictor for anxiety problems Parental anxiety and insecurities Overly involved, controlling, over-protective SOCIAL ANXIETY DISORDER ○ Marked anxiety about social situations ○ Lasts at least 6 months and causes distress and impairment ○ Symptoms anxiety/panic in social settings that involve judgment, criticism, or negative evaluation Feelings of embarrassment Being afraid of negative labels May only fear public performances  Youths tend to fear formal presentations and unstructured social interactions Social avoidance is negatively reinforced by reduced anxiety ○ Diagnosis Emerges in late childhood/early adolescence, not usually before the age of 10 ○ 60% report school problems, 53% report a lack of friendships, 27% report extracurricular problems ○ Can lead to depression, social isolation, loneliness, and substance use ○ Causes 50% of variance in symptoms are attributed to genetics Tendency towards social anxiety can be inherited High levels of behavioural inhibition in infants and toddlers can be a predictor Inhibition is sustained via negative reinforcement Parent-child interactions Parents may model anxiety, may be controlling, overprotective, hostile and critical, avoid discourse about emotion Children of overprotective or controlling parents may pass on the message that children need constant reassurance and/or should be afraid of everything; critical parents may lead children to believe that most people will criticize them Bidirectional influences → parents contribute to children’s anxiety, and child’s behaviour can also cause the parents to be overly protective or critical ○ Reading aloud in front of classmates → 75% of children with SAD fear; eating in school cafeteria and using a public bathroom → 23% of children with SAD fear GENERALIZED ANXIETY DISORDER ○ persistent , uncontrollable worry associated with restlessness, poor concentration, fatigue, tension, sleep problems, etc ○ Apprehensive expectation An essential feature of GAD Adults worry too much about aspects of daily life  Children and teens worry about assignments, exams, and cocurricular activities Worries about relationships, family well being ○ Worry is a cognitive activity Marked by excessive dwelling on future real or possible events, thoughts are usually elaborated and people get stuck on potential consequences ○ First signs of worry surface around age 4-5 followed by the ability to think and dwell upon negative events in the future around age 8 ○ GAD usually develops between 8-10, with that ability to dwell on future events ○ The intensity, number, and duration of worry differentiates between children who do and dont have GAD Children with GAD report a larger number of worries, which are more intense and distressing. They can cause impairments → restlessness, fatigue, muscle tension, irritability, problems concentrating Children with GAD spend a considerably larger amount of time worrying about things that children with GAD may worry about ○ Causes mood problems, interferes with functioning, can manifest physically, inhibits the development of more adapting coping strategies ○ The DSM-5 requires at least 1 symptom of worry be displayed; at least 3 in adults ○ Children may be described as perfectionist, punctual, eager to please ○ Comorbid with depression (50-68%) Anxiety problems may precede or occur simultaneously with their depressive symptoms Tees tend to display depressive symptoms an average of 5 years after the emergence of anxiety Factor analysis → depression and anxiety tend to co-occur in the general pop. ○ Internalizing problems 2 factors: Fear factor → explains relationship between anxiety, fear, and panic Anxiety-misery factor → explains relationship between GAD, MDD, and dysthymic disorder Children with GAD have a higher likelihood of developing depression than issues with fear or panic ○ Causes  Difficult temperament Difficulties inhibiting behaviour Less than optimal parent-child interactions Cognitive avoidance theory Maintenance via negative reinforcement Cognitive distortions in children with GAD Catastrophizing → expecting disastrous results from a mildly aversive situation Overgeneralizing cognitive distortions → kids may assume one setback is reflective of future misfortunes Personalizing cognitive distortions → kids blame themselves for their misfortunes TREATMENT FOR SAD, SOCIAL ANXIETY DISORDER, AND GAD ○ CBT Combines feelings, expectations, attitudes, and results Cognitive and behavioural interventions combine to produce a behavioural change Idea that changes in thoughts or behaviour can affect emotion Education phase Kids are taught relationships between thoughts, feelings, and actions Taught coping strategies Identify feelings and physical sensations that contribute to anxiety Recognize and modify negative thoughts and cognitive distortions Reduce the frequency of negative self statements and thoughts Practice phase Techniques are applied to the child’s life Graded exposure → depends on the disorder ○ Children with social anxiety disorder might be encouraged to approach other kids ○ Children with separation anxiety might be encouraged to separate from their parents shortly while shopping ○ Children learn the feared situation wont lead to catastrophe Efficacy  Reduces anxiety, improved self-reports and parental-reports Lasts up to 7 years Most CBT patients dont meet diagnostic criteria for anxiety disorder after treatment is done Development of therapy Packages have been modified to be administered by computer ○ Medication SSRIs are effective (45-65% show at least some moderate improvement) CBT and medication → ideal PANIC DISORDER ○ Diagnosis: Recurrent, unexpected panic attacks (BUT THEY DONT NEED TO HAVE ONE TO HAVE PD) A least 1 month worry about having future panic attacks Causes changes to daily routine and distress Symptoms of a panic attack: Cognitive → thoughts of being out of control, going crazy Emotional → feelings of unreality or detachment Somatic → heart palpitations, chest pains, dizziness ○ Teens report most common symptoms being heart palpitations and dizziness, and the least common being tingliness, choking, or numbness 60% of teens → subthreshold symptoms, 18% → full-blown, pretty evenly in girls and boys, but girls may have it more severe Rare in children Panic disorder occurs between ages of 15-19, but there are usually isolated incidences of it occuring before puberty Parents with panic disorder are more likely to have children with separation anxiety disorder, while children with SAD are 3.5x more likely to develop panic disorder Children and adults may exhibit abnormal respiration that makes them more susceptible to panic symptoms ○ Causes  Multiple, complex Cognitive-behavioural models → max. Empirical support from studies of teens Interaction between biological, cognitive, and behavioural factors that produce attacks Anxiety sensitivity Tendency to perceive anxiety symptoms as upsetting and aversive May explain likelihood of developing panic disorder Low anxiety sensitivity → helps a person acknowledge and cope with anxiety symtpoms High anxiety sensitivity → severe distress and fear response Expectancy theory of panic Poses that people are prone to anxiety about panic attacks because of their high insensitivity to anxiety People with high sensitivity may hyper focus on any symptom of anxiety, which may heighten anxiety and impair ability to cope Catastrophic thinking People often personalize negative events that occur to them ○ Evidence-Based Treatment CBT Relaxation training → muscle relaxation, controlled breathing, pleasant imagery Interoceptive exposure Specific to panic disorder Intentional production of physiological symptoms followed by practicing relaxation techniques 3 benefits: 1) teens understand symtpoms can be produced intentionally so theyre not always out of control, 2) teens realize they wont die or be harmed, 3) teens learn coping skills Cognitive restructuring Challenge biases and distortions that lead to negative emotios by looking for more objective facts to support them Therapist may play detective and ask teens to critically evaluate their thoughts  Efficacy CBT and interoceptive exposure are effective for adults CBT used with children and teens → fist line of treatment, but little pediatric evidence available OCD ○ Obsessions and compulsions that are time consuming and cause significant distress or impairment ○ DSM-5 requires specification of a person’s insight into their own obessions and compulsions; people with a lot of insight may be more compelled to participate in treatment ○ Obsessions → recurrent and persistent unwanted thoughts Most people with OCD surpress these thoughts leading to anxiety and distress Teens understand these are unlikely to come true Young children may believe their thoughts are likely to come true ○ Compulsions → repetitive behaviours/mental acts in response to obsessions People with OCD feel driven to perform these to reduce anxiety around their thoughts Usually very rigid, following some type of rule ○ Prevalence 1-2% of kids and teens 90% of kids dont undergo treatment More common in boys than girls ; 2:1. By teen years the ratio becomes equal Obsessions and compulsions differ from kids to adults; kids might be vague, magical, or superstitious 41% of youth with OCD meet diagnostic criteria after 5 years 20% continue to show sub-threshold symptoms 40% of youth will show reduction in symtpoms by teen years ○ Children may have difficulty describing their obsession or fear saying it out loud ○ In children or adolescents, only an obsession OR compulsion needs to be evident; most show both Mental rituals can be overlooked as a compulsion ○ Effects of OCD Persistent disorder especially if the onset is early Youth with early onset and longer duration of symptoms, symptoms that require hospitalization → worse prognosis ○ Stats Washing or grooming → most prevalent compulsion, dirt/germs → most common obsession in children and adolescents ○ Causes Ppl with a 1st degree relative with OCD are at increased risk 10-25% of youth have at least 1 parent with OCD 45-58% genetic factors account for OCD Parenting style or socio-economic status contribute very little Cortico-basal-ganglionic circuit Pathway that underlies OCD Orbito-frontal cortex → responsible for detecting environmental abnormalities and sending a signal to the cingulate gyrus Cingulate gyrus → cognitive contemplation and feelings of anxiety or tension ○ People with OCD have overactivity here Basal ganglia → behavioural response is generated here to reduce negative thoughts and feelings ○ Relays feedback to the OFC to let it know that the abnormality has been corrected ○ People with OCD have under inhibition in here High levels of serotonin seem to play a large part in OCD symptoms OCD is sustained via learning People start associating specific stimuli with distressing thoughts and beliefs Compulsions are negatively reinforced Cognitive distortions People experience inflated responsibility for a misfortune Too much thought-action fusion; this makes them wrongly believe that simply thinking of a misfortune will lead to it happening  Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDA) Theory: Proposes that strep infections lead to an autoimmune reaction that causes OCD like symptoms, tics, and irritability Disrupts brain functioning Antibiotics are unable to prevent this development and children are almost always diagnosed with OCD after ○ Evidence-Based Treatment for OCD CBT Go-to treatment for OCD Consists of 3 components ○ Info gathering Determine the obsessions and compulsions Clinician will obtain background info and reports from family as well as the child Diff rituals require a diff approach ○ Exposure and response prevention (most critical component) Exposure to distressful stimuli while avoiding compulsive behaviour Extinction → an extinction burst of high distress, and then a gradual decrease of stress over time Relaxation techniques during exposure are taught Behavioural intervention Cognitive restructuring ○ Generalization Generalization training and relapse prevention Parents are taught to coach their children through the tasks at home Parents and children are taught to continue exposure outside of therapy Discussions with parents and children and a plan on what to do if symptoms return Efficacy  ○ Reported 50-67% symptoms reduction that persists after treatment Pediatric OCD Treatment Study (POTS) ○ Ages 7-12 ○ CBT and medication combo most effective ○ CBT OR medication → effective but neither better than the other ○ Medication was Zoloft ○ Therapist is essential for effective treatment Limitations of CBT? ○ Time consuming ○ Lack of trained professionals DEPRESSION, SUICIDE, and SELF-INJURY ○ Characteristics of Mood Disorders Sadness, emptiness, irritability, lack of pleasure and satisfaction, negatively affects relationships and school 8 million youth in the US experience depression prior to adulthood ○ Prevalence Approx. 11% DMDD → 2-4% of school-aged children MDD → 10.6%, girls more than boys (2:1 diagnosis, 3:1 depressive episode) Two-thirds of youths with depression experience multiple depressive episodes before reaching adulthood 4% of teens experience a depressive episode Risk factors? Excessive empathy, excessive compliance, and overcontrol (hiding feelings to cope) (especially in girls) ○ DMDD Severe and recurrent temper tantrums and persistently angry or irritable mood Outbursts are out of proportion to the situation, in terms of intensity and duration Some display intense physical aggression towards people or property  Outbursts are verbal or physical and are inconsistent with child’s developmental level Outbursts have to occur at least 3x a week Above symptoms present for 12 months without more than a 3 month time without an outburst Symptoms present in at least 2 settings, and must be severe in at least one setting Onset age between 6 and 18 Doesn't meet criteria for a manic or hypomanic episode Not better explained by another mental disorder Prevalence and Course Reasons for seeking treatment? Irritable mood and recurring tantrums Children are 2x as likely to develop severe conduct problems, 3x more likely to develop ADHD, and 13x more likely to develop depression Children require special ed, counseling/medication, experience bullying or ostracism Medication and counseling do result in a decline in irritability, but academic and social impairment often resists Differences between DMDD and other disorders? ADHD → ADHD is a neurodevelopmental and behaviour disorder, DMDD is a mood disorder ○ ADHD isn't characterized by recurrent severe outbursts ODD → disruptive behaviour disorder, more spiteful and oppositional, directed towards specific people NOT people and property ○ Tantrums are less severe and shorter ○ Tantrums arent directed towards property ○ Tantrums are more severe in DMDD Pediatric Bipolar Disorder ○ DMDD doesn't include presence of manic or hypomanic episodes ○ DMDD is more depressive than bipolar  ○ Strong association between DMDD and depression in their parents, not found in bipolar disorder ○ Children with bipolar arent at increased risk of developing depression and anxiety disorders Causes of DMDD Inability to regulate emotions, experience heightened arousal and increased negative affect Children experience less happiness, more agitation Heightened reactivity to frustration in angular-singular cortex, brain region associated with distress Under activity in frontal and striatal regions, brain regions responsible for regulating emotions Attention biases towards threatening stimuli and minor displays of anger, negative emotions in others Emotion recognition biases, misinterpreting benign actions or expressions in others as being hostile or threatening ○ These recognition deficits are not shown in children with other mental health problems ○ These deficits are associated with the amygdala, which is associated with reactivity Treatment for DMDD ○ MDD One major depressive episode 5 or more signs of 9 symptoms during a 2 week period, at least 1 is depressed mood OR loss of pleasure most of the day, every day Depressed mood, loss of pleasure (anhedonia), significant weight change or failure to make age-expected weight gains, insomnia/hypersomnia (insomnia more common in teens), psychomotor changes (kids and teens may appear restless), fatigue, feelings of worthlessness/guilt, difficulty concentrating, recurrent thoughts of death/suicidal ideation/suicide attempt/suicide plan  Children and teens may show predominantly irritable rather than depressed mood Clinically significant impairment in social, occupational, or academic functioning Not better explained by another medical condition or disorder No manic or hypomanic episode Assessment of the symptoms for kids and teens? Single episode vs. recurrent → single means current episode is the only time the child experienced it, recurrent means the child has a history of it Mild, moderate, or severe based on number of symptoms, the distress they cause, and the degree functioning is impaired ○ PDD (Dysthymia) Chronic depressed mood for at least 2 years in adults, 1 year for kids 2 or more symptoms Sleep problems, overeating, loss of appetite, decreased energy, low self esteem, poor concentration, feelings of hopelessness Must have depressed mood for most of the day more days than not for at least 2 or 1 year Must cause distress Symptoms must not be absent for more than 2 months No manic/hypomanic episode Not better explained by another psychological disorder or medical condition Children often described as moody, sluggish, down, cranky Teens describe themselves as uninteresting and unlikeable, prone to self-criticism Dysthymia and MDD PDD more gradual, long-term, less severe symptoms; onset of MDD more rapid Co-occurence: wth persistent major depressive episode, with intermittent major depressive episode, pure dysthymic syndrome ○ Depression in ethnic minority and disadvantaged youth  Youth may experience subthreshold symptoms that are never diagnosed Youth in low socioeconomic or single-parent houses more likly to have depression ○ Course and Comorbidity Relapse rate is 60% after 2 years of recovery and 72% after 5 years of recovery Kinding hypothesis: earlier depressive episodes sensitize people to stressors in life and make them more likely to develop depression later in life ○ Developmental Pathways of Depression 1: anxiety predisposes children to depression. separation/social anxiety early in childhood interferes with social functioning and ability to experience pleasure 2: children inherit shared diathesis for anxiety and depression. This emerges over time. When inherited negative affect encounters psychosocial stress, symptoms arise Clinicians can help kids manage their anxiety early in life ○ Causes of MDD and Dysthymia Monoamine hypothesis → dysregulation of neurotransmitters that contribute, like serotonin, norepinephrine, and dopamine Temperament → difficult temperament → more negative emotions, more negative interactions, poor coping Stressful life events Children exposed to psychosocial stressors are at increased risk of depression ONLY if they inherit the genes that predispose them to depression Gene-environment interactions Serotonin transporter gene (short allele inherited + stressful events); dopamine transporter gene (2 minor genes are inherited + stressful events) Stress and coping  Youth might cope with negative experiences by withdrawing from or avoiding positive experiences and environments; helps to cope in the short-term, not a good long-term strategy Negative attributions People dispair rather than coping effectively after repeated failures Tendency to attribute negative events to internal, stable, global factors and positive events to external, unstable events Beck’s Cognitive Theory of Depression Levels of maladaptive thinking: negative automatic thoughts immediately after the stressor, negative cognitive biases, and negative cognitive distortions Negative schemas associated with severity of depressive symptoms Parental depression → 60% of depressed parents have depressed offspring Predicts the emergence of childhood depression independent of other factors Genes, mother’s anxiety during pregnancy can affect development of fetus’s nervous system Depressed parents may model this to children Peer problems Biased social information processing Tendency to interpret ambiguous social situations negatively and react to problems by avoiding them or withdrawing from them ○ Treatment for Depression CBT Therapists and clients work together to challenge and restructure beliefs Psychoeducation ○ Helps youth see the relationship between thoughts, actions, and feelings in their body Goal setting and mood monitoring ○ Smart goals are objectives we state specifically, are measurable, appealing, realistic, and timely  ○ Children rate intensity of their moods and emotions Behavioural activation ○ Increase positive reinforcement for desired behaviours and activities ○ Identifying ways of overcoming behavioural barriers Social information processing training ○ Kids with depression need help developing social processing skills ○ RIBEYE: relaxing, identifying the problem, brainstorming strategies, evaluate each solution, yes to the best solution, encouraging oneself for being brave and thinking it through Cognitive restructuring ○ Challenging cognitive biases and distortions by thinking in more objective and flexible manners ○ Maladaptive cognitions are thought traps that the therapist helps the child to recognize Asking whats the evidence? ○ Emphasizes the power of non negative thinking Interpersonal Therapy Helps with deficits or disruptions in childrens’ relationships 12 week program Best for ages 12 and older Children’s problems are attributed to depression instead of blaming the kids or teens themselves; however, they are still expected to meet their day to day responsibilities Relationship problems can contribute to mood problems Assess which relationships most strongly affect the child’s mood and how their relationships change; “interpersonal inventory” Interpersonal problem areas are noted Closeness circle → child places the name of people in the inner or outer rings depending on how close they feel to each person in their life, and look at who has greatest impact on their mood Communication analysis → asking the child about interactions that have recently them feel negatively and the two analyze it together  CBT and IBT the only evidence-based therapy for child depressive disorders CBT for yougner children; CBT and IPT ideal for older children Medication Trycyclic → ineffective SSRI’s are effective → fluoxetine first one considered Meds and therapy together more effective than meds alone for teens, but may relapse after 3 years Safety of antidepressants? 3-4% of youths who take SSRI’s have an increase in suicidal ideation