Mental Health: A Report by the Surgeon General

Psychosocial Interventions
To be deemed effective and approved by the American Psychological Association, treatments for mental disorders have to meet very strict criteria. While interpersonal therapy and systemic family therapy show promise, they have not been studied sufficiently to evaluate their effectiveness by these standards. However, in a comprehensive review article (Kaslow & Thompson, 1998) that evaluated interventions for depression in children and adolescents against the American Psychological Association Task Force criteria, two forms of cognitive-behavioral therapy (CBT) were found to be “probably effective treatments,” although none of the interventions for depression were deemed, as yet, to meet the Association’s higher standard for a well-established intervention.

In studies that focused on relieving symptoms of depression in preadolescents, only one form of CBT met the criteria for a probably effective intervention. In the first study, the relative efficacy of two types of CBT—12-session group interventions based on either self-control therapy or behavior-solving therapy—were compared with a“waiting list” control group (Stark et al., 1987). Children responded to both CBT interventions with fewer symptoms of depression and anxiety, whereas the waiting list group exhibited minimal change. Because improvement was greatest with self-control therapy, this intervention was compared in a later study with a traditional counseling condition. Self-control therapy, enhanced by doubling the number of sessions, entailed social skills training, assertiveness training, relaxation training and imagery, and cognitive restructuring. Monthly family meetings were also added to both the experimental and control conditions. Children receiving self-control therapy reported fewer symptoms at 7-month followup (Stark et al., 1991).

Among the numerous studies of adolescents reviewed by Kaslow and Thomson (1998), one form of CBT—coping skills—was judged probably efficacious. This intervention, based on the “Coping with Depression” course, was developed originally in Oregon for adults by Lewinsohn and colleagues (Lewinsohn et al., 1996) and adapted by Clarke and colleagues (1992) for school-based programs to treat adolescent depression. Compared with controls on the waiting list, adolescents who received CBT had lower rates of depression, less self-reported depression, improvement in cognitions, and increased activity levels (Lewinsohn et al., 1990, 1996). To achieve well-established status, as defined by the American Psychological Association Task Force, the intervention has to be studied by another team of investigators—which has not as yet been done.

Next

Back to the Mental Health: The Surgeon General's Report Table of Contents

Back to Mental Health Articles