Psychosocial intervention is an approach that acknowledges the psychological and social factors that influence an individual's well-being. It includes psychoeducation, cognitive and behavioral strategies, social skills training, sleep hygiene, interpersonal therapy, and group therapy. A case study describes a 12-year-old boy presenting with depression who was assessed and received cognitive behavioral therapy targeting negative thoughts, as well as social skills training and group therapy. Research shows cognitive behavioral therapy can have immediate and long-term positive effects on reducing depressive symptoms.

1. Psychosocial Intervention for Children and Adolescents with Depression Mr. PrafulPrabhuappaKapse

2. Outline Introduction - Psychosocial interventionDepression– common featuresCase vignette AssessmentIntervention

3. What is meant by psychosocial intervention?Most basic level - psychosocialPsycho – psychological aspect of our experience. Refers to our feelings, thoughts, desires, belief, values and how we perceive ourselves and others.Social – refers to the our wider social experience i.e. our relationships, traditions and culture.Both aspects are closely intertwined and influence each other.

4. Psychosocial InterventionPsychosocial intervention is an approach aimed at improving people’s well-being. Acknowledges:Psychological well-being of the individualKnowledge and skills of the individualSocial support Culture and values that influence individual’s experience

5. Depression – Common features Depressed or irritable mood most of the day, nearly every day Markedly diminished interest or pleasure in all activitiesSignificant weight lossTrouble sleepingRestlessnessFatigue or loss of energy nearly every day Feelings of worthlessness or excessive guiltRecurrent thoughts of death, suicidal thoughts or suicide attempts

6. Case vignetteMr. A, 12 year old boy, from low-socioeconomic background, presented to NIMHANS, with the complaints persistent sad mood, death wishes, irritability, diminished daily activities, etc.

7. AssessmentTemperament history Family environmentSocial environmentEmotional environmentTraumatic eventsFaulty adaptation

8. Psychosocial interventionPsycho educationCognitive & behavioral strategies Social skill trainingSleep hygiene Interpersonal Psycho therapy Group therapy Rehabilitation

9. Psycho educationEducation about mental illnessFor their social support networkTo help them to understand and deal MITo prevent or plan relapse

10. Cognitive Behavioral StrategiesCognitive strategies Distraction TechniqueCounting ThoughtsBehavioral StrategiesMonitoring ActivitiesScheduling ActivitiesGraded Assignment

11. Cognitive Behavioral StrategiesIdentifying Negative Automatic thoughtsThe self (I am useless)Current experience (nothing I do turn out right)The future (I will never get better)Testing Negative Automatic thoughtsVerbal Challenging Behavioral Experiment Draw Conclusion

12. Evidence based practice in CBTEarly studies with sub clinical populations by Show 1977; Taylor and Marchall 1977 and single case series by Rush, Khatami, and Beck in 1975 show the following results of cognitive behavioral therapy for depression Immediate effect of CBTPreliminary evidences show that interventions designed to reduce the frequency or intensity of depressing thoughts can have an immediate beneficial effect on mood. These include distraction and challenging (Teasdale and Reizin 1978; Deviws 1982 Fennel and Teasdale 1984; Blackburn and Bonham 1980)

13. Post treatment effect of CBTStudies assessing post treatment outcome reliably show cognitive behavioral therapy to be as effective in reducing depression (Rush, Beck, Kovacas, and Hallon 1977, Blackburn et al.1981 Hallon, Evans and DeRubbeis 1983)Long term effectCBT may be more effective in preventing relapse than anti-depressant drugs. (Kovacas et al. 1981; Hollon et al; Simons, Murphy, Levine and Wetzel, 1986)

14. Social skills training To help persons in relating to peopleEspecially when they have difficulty in thatVerbal skillsNonverbal skillsExpression abilityUnderstanding cues and contents

15. Components of Social SkillsNonverbal behaviors: eye contact, facial expression, posture, use of gesture, body orientation, interpersonal distance. Paralinguistic skill: loudness, tone, pitch, affect, rate of speech, clarity of speech, duration of utterance.Verbal content: verbal massage, choice of words, appropriateness of self disclosure.Interactive balance: smoothness of turn-taking, use of social reinforces (e.g. reflective listening skill), balance of time taking.

16. Techniques of Social SkillsInstruction Role playingFeedbackReinforcement Back chaining

17. Interpersonal therapyDeveloped by Gerald Klerman, This therapy is based on two assumptions. current interpersonal problems are likely to have their roots in early dysfunctional relationships current interpersonal problems are likely to be involved in precipitating or perpetuating the current depressive symptoms

18. EvidenceStudy of interpersonal psychotherapy versus supportive psychotherapy for dysthymic patients Subjects with primary DSM-IV dysthymic disorder were randomly assigned 16 weeks of IPT. Patients in both treatments reported improved depressive symptoms Department of Psychiatry, Weill Medical College of Cornell University, New York, New York 10032, USA.

19. Group therapy Group psychotherapy is a treatment in which carefully selected persons who are emotionally ill meet in a group guided by a trained therapist and help one another effect personality change.

20. EvidenceMore than 300 depressed parents participated in group therapy sessions for eight weekly meetings. Through 90-minute group session Throughout the eight-month study, rates of new depressive episodes were lower among those receiving therapy compared to those in traditional care. – 21.4 percent vs. 32.7 percent, respectively. The Journal of the American Medical Association, 2009;301:2215-2224

21. Good Sleep HygieneProtect your need for sleepEnsure that 7.5-8 hours set aside for sleep every dayKeep regular sleep hours an irregular sleep schedule messes up biological clock and can make getting a full night’s sleep more difficultgo to bed at the same time every night and get up at the same time every morning

22. Thank You