This document discusses cognitive behavioral therapy (CBT) for adolescents. It begins by defining adolescence and discussing the psychological adjustments that must be navigated during this period. Risk and resilience factors are then examined, along with coping mechanisms like problem solving and cognitive reappraisal. The document outlines considerations for involving parents in adolescent CBT and respecting patient privacy and autonomy. It also reviews how CBT can be applied to disorders that often onset during adolescence like depression, bipolar disorder, and anxiety disorders. A case study of a 16-year-old girl experiencing depression and mania is then presented and formulated. The document concludes by discussing common CBT interventions like cognitive restructuring, coping skills training, and problem-solving training

1. CBTWITH ADOLESCENCE
By: Beenish Nawaz
Sara Ismail

3. WHAT IS ADOLESCENCE?
 A series of major psychological adjustments have to be
negotiated during adolescence.
 Changing relationships
IdentityVs Role confusion
An adult or a child
ExcitementVs Sadness
Freedom and opportunities or loss of dependence and
safety

4. RISK AND RESILIENCE
 Exposure to stress and adversity and the ways that
individuals cope with stress are central to understanding
sources of risk and resilience to psychopathology in
children and adolescents.
 Stressful life events and chronic adversity, most notably
poverty and chronic abuse during development are
powerful, nonspecific predictors of internalizing and
externalizing symptoms and disorders.

6. COPING
 Three-factor control-based model of coping for children
and adolescents:
 Primary control engagement (problem solving, emotional
modulation, emotional expression)
 Secondary control engagement (acceptance, cognitive
reappraisal, positive thinking, distraction)
 Disengagement (cognitive and behavioral avoidance, denial,
wishful thinking).
(Compas et al., 2001, in press; Connor-Smith et al., 2000; Rudolph,
Dennig, &Weisz, 1995)
 The ability to cope with stress is a potential source of
resilience.

7. Integration of coping and emotion regulation
 Differentiating between primary and secondary emotions
 Coping versus Emotional Regulation
 Coping typically refers to the down-regulation of a
negative emotion while emotion regulation also includes
the maintenance or augmentation of a positive emotion
(Eisenberg, Fabes, & Guthrie, 1997).

8. ROLE OF PROTECTIVE FACTORS

9. Special Consideration When Working With Young
People.
Parents can be involved in CBT as co-therapist, which includes
being taught how to manage and address their child’s anxiety using
CBT strategies.
 Parental support with reward system tied to completing specific
task can be help promote desired behaviors an increase the
motivation for therapy tasks.
 A separate parent/ care session can be useful if the formulation
suggests that the factors such as parental expectations of the child
or the way in which problematic behavior is modified or
reinforced are maintaining the difficulties.

10.  Prescribing solutions or deciding for the adolescent is
avoided. They work jointly on the discovery of
dysfunctional patterns in thinking, setting goals and
deciding on activities. Collaboration is to be followed at all
points in therapy.
 CBT in adolescents involves the use of activities,
worksheets and various other methods of communicating
formulation, educating and increasing participation.

11.  Respecting the child and family without any bias and
promotion and supporting the highest level of development
and autonomy in the child are some of the other important
rules (Schetky 1995). The therapist additionally faces
pressures to control the client and force compliance at the
cost of the individuality of the client

12.  To protect the privacy of the adolescent client and
keep him/her informed about frequency of parent
involvement.
 . The exceptions to the rules of privacy and
confidentiality are also to be made clear to the
adolescent.

13. CBTWITH OTHER DISORDERSWITH
ONSET DURING ADOLESCENCE
 Internalizing behavior is behavior that is over-controlled or
covert. It is characterized by anxiety, social withdrawal, and
depression. "Shy" behaviors are hard to detect sometimes
because they are not as obvious as externalized behaviors.
 Externalizing behaviors are those that are under-controlled
or overt. They are characterized by aggression, striking out
against others, impulsive and disobedient behaviors, and
delinquency. They are really obvious and easy to detect.

14. CBT WITH OTHER DISORDERSWITH
ONSET DURING ADOLESCENCE
Externalizing
 Oppositional Defiant
Disorder
 Conduct Disorder
 Juvenile Delinquency
Internalizing
 Eating Disorder
 Depression
 Bipolar disorder
 Obesity (not in DSM)
 Adolescent separation
anxiety.
 Anxiety Disorder

15. Substance Abuse Disorder
ADHD

16. CASE STUDY : EMILY
 Emily is 16 year old girl and referred by her GP who had been
viewing her for depressed mood when Emily disclosed that she
has been thing about killing herself.
 When seen, Emily describes low mood, feeling tired all the
time, gaining no pleasure from her usual interests, inability to
sleep, not eating and having recurrent thoughts of taking an
overdose of paracetamol. She has felt like this for 3 weeks now.
 Before that Emily was the best she had ever felt. She was out
every night with friends until 1 am and only needed 3 hours
sleep at night to keep going.
 In fact she was buzzing, her mind was racing and she could not
stop talking, which had been funny at first but then became
annoying to her friends.

17.  She had fallen out with her friends after she made sexual
advances towards their boyfriends, which is totally out of
character for her.
 Emily attendance at school had became erratic she was
always in trouble with both teachers and pupils for
inappropriate remarks and behavior. This period of felling
high lasted for 2 weeks.

18. ASSESSMENT
 Parents, the child and teachers were interviewed.
 Rating scales such as
Child Behavoiur Checklist
 Parent Young Mania Rating Scale Or Parent General
Bahavoiur Inventory.
 Silverman and Ollendick (2005), provide a comprehensive
list of interview-based as well as self-report measures that
can be used in adolescents.

19. FORMULATION
 Emily is presented during a depressed episode but gives a
clear history of an episode of mania with elated mood,
pressure of speech, grandiosity, disinhibited behavior and
reduced sleep. Therefore se has had the two mood episodes
required by ICD-10 criteria.
 In addition, nice guidelines (2006) are clear that bipolar
disorder is only diagnosed in presence of mania with
euphoria in children and adolescence

20.  In the adolescent age range, it is important to seek a history
of substance abuse, as rates of the use of illegal substance
are high and they can be responsible for a presentation like
this.
 Substance abuse disorder are present in 60 percent of adults
with bipolar disorder (Cassidy et al, 2001) and 32 percent of
young people have a life time history of substance abuse
disorder ( Wilens etal , 2004)

21. INTERVENTION
 Emily will needed treatment for depression as that is
her presenting illness
 The nice guidelines recommend 4 weeks of treatment
with psychological therapy e.g CBT with medication.

22. CBT With Bipolar Disorder Session
Plan
 Initial sessions
Information/development of therapeutic alliance
Socializing to therapy/goal setting
 Intermediate sessions
Mood monitoring
Understanding the relationship between mood and activity
Challenging the positive thoughts
Working with unrealistic positive ideas
Reframing

23. CBT With Bipolar Disorder Session
Plan
 Final sessions
 Coping with early signs
 Identifying early, middle and late warning signs
 Pairing early warning signs with coping skills.
 Long term issues

24. HELPTHEM STAY HOPEFUL

25. COMMONLY USED
INTERVENTIONS
Three main types
 cognitive restructuring
 coping skills training
(CST)
 problem-solving skills
training (PSST)
Specific techniques
 Arousal reduction methods.
 Applied relaxation (AR)
 Exposure and Response
Prevention (ERP)
 Graded exposure
 Social skills training (SST)
 Assertiveness skills
 The Coping Cat programme

26. REFERENCES
 Case….. Margaret Thompson, Christine hooper, Child And
Adolescent Mental HealthTheory And Practice
 Case formulation Cognitive Behavioural therapy …. Nicholas
tarrier and Judith jhonson
 Beauchaine, Hinshaw:Child and Adolescent
Psychopathology, 2nd Edition Risk and Resilience in Child
and Adolescent Psychopathology: Processes of Stress,
Coping, and Emotion Regulation

27. QUESTIONS PLEASE