Banff 2017: Depression and Anxiety in Children and Youth: Innovative Approaches to Evidence-based Practice
March 19 to 22, 2017

A. When Children Refuse School: A Prescriptive Cognitive Behavioral Therapy Approach

Anne Marie Albano, Columbia University Medical Center

A serious and insidious consequence of anxiety and depression in youth is school refusal behavior.  What may begin as complaints about school or delaying the morning routine can quickly escalate to leaving class and eventual absences for the whole school day to weeks or months.  Crying, pleading, tantrums and other misbehavior occurs in response to parents’ attempts to getting their child to attend school.  Upwards of 7% of youth miss school due to internalizing disorders, and for many youth, school refusal becomes fixed and results in serious disability and impairment in functioning.  Academic decline, somatic symptoms and complaints, disturbed or disrupted social behavior, psychiatric comorbidities, and family dysfunction accompany school refusal.  Kearney (2007) identified four principal motivating conditions that maintain school refusal behavior:  (1) escape from negative affect such as generalized anxiety, depression, panic, specific phobias, (2) escape from social and evaluative anxiety, (3) attention seeking behavior often accompanying separation anxiety, and (4) access to tangible reinforcers.  In this workshop, the prescriptive approach to assessing and treating the four motivation conditions of school refusal are presented.  This CBT approach (Kearney, 2007; Kearney & Albano, 2007) is geared towards identifying the motivation for the school refusal and systematically applying specific cognitive behavioral principles and strategies to address the child or adolescent’s needs.  Case examples will be presented and current research will be discussed.

B. Cognitive-behavioural prevention of adolescent depression

Paul Rohde, Oregon Research Institute

This training will provide a thorough introduction to the Blues Program, an evidence-based indicated prevention program for at-risk adolescents. The Blues Program is intended to actively engage high school age adolescents with depressive symptoms or at risk of onset of major depression, and consists of six weekly one-hour group sessions and home practice assignments. Weekly sessions focus on building group rapport and increasing participant involvement in pleasant activities (all sessions), learning and practicing cognitive restructuring techniques (sessions 2-4), and developing response plans to future life stressors (sessions 5-6). The training workshop will include a brief orientation to the cognitive-behavioural model of depression change and the research evidence base. The bulk of the training will consist of a detailed review of each of the core cognitive-behavioural skills contained in the Blues Program, including in-session practice. The final portion of the workshop will focus on discussing process issues, Q&A, and implementation in your specific setting.

C. SENSE: An evidence-based program for improving sleep and emotional functioning in adolescents

Nick Allen, University of Oregon

Sleep problems are a major risk factor for the emergence of mental health problems in adolescence. In this workshop I will describe a cognitive-behavioural/mindfulness-based group sleep intervention for use among at-risk adolescents (i.e., those with sleep problems and/or internalizing symptoms), the Sleep SENSE program. This sleep intervention builds on the work of Bootzin, Dahl and Harvey, and like evidence-based treatments for adult insomnia, is cognitive-behavioural in approach – incorporating sleep education, sleep hygiene, stimulus control, and cognitive restructuring, but also has added mindfulness- and anxiety-specific components. The intervention is tailored to the unique developmental challenges and opportunities of adolescence, including the social, cultural and maturational factors known to affect sleep patterns in adolescence. It has a specific focus on tracking behavioural change and identifying and overcoming barriers to change via incorporation of motivational interviewing techniques. A recently published randomized controlled trial has shown that the SENSE program can improve objective and subjective indices of sleep, as well as anxiety, when compared to an active control intervention.

D. Clinical procedures from empirically supported treatments for anxiety in youth

Phillip Kendall, Temple University

The workshop will provide an initial description of the theory that guides intervention for treating anxiety in youth and an overview of the nature, symptoms, and experience of anxiety in youth. We will consider when anxiety is developmentally reasonable and when it is disordered, and we will consider features of anxiety as they relate to and are expressed by children as well as adolescents. Cognitive, behavioural, family (parenting) and emotional factors will be addressed.
The bulk of the workshop will be on intervention strategies that comprise CBT for anxiety in youth.  Each strategy (e.g., coping modeling, changing self-talk, affect education, exposure tasks) will be described and illustrated with case examples. A flexible implementation of the manual-based approach will be described and encouraged.
Time permitting, sample videos (actual sessions and re-enacted sessions) will be available as will opportunities to engage in a role-play activity.
Research outcomes that inform the provision of clinical services for anxious youth will be considered.

E. Treating anxiety in the transition from adolescence to adulthood

Anne Marie Albano, Columbia University Medical Center

The transition from adolescence to adulthood holds the promise of independence while ushering in the new anxieties accompanying increasing responsibility, freedom and greater expectations for independent functioning. Youth with anxiety disorders may be particularly challenged in launching into adulthood, as the disorder keeps the emerging young adult dependent on family members and lagging same-age peers in achievement of age-appropriate tasks. Overprotective parenting styles can hinder the youth in meeting developmental milestones, often fueled by beliefs that the adolescent/emerging adult will miss out on opportunities that are “too big to fail” due to anxieties. Dr. Albano will present the structure and process of the “Launching Emerging Adult Program” (LEAP). LEAP is implemented as an age- and developmentally-appropriate treatment for anxiety disorders, involving individual, group and family sessions. Specific examples of the LEAP modules to engage parents and adolescents/young adults to address anxiety, reduce parent overprotection, and meet developmental goals will be presented.

F. Focusing on the positive: Treating adolescent depression through building positive emotion and positive experiences

Erika Forbes, University of Pittsburgh

Diminished experience of positive affect (PA) has long been postulated as a core feature of depression, and a recent burgeoning of neuroscience research on reward processing in depression supports the notion that altered function in neural reward systems is a mechanism for this feature. Behaviourist models of depression have traditionally addressed low PA through increasing pleasant experiences in order to generate and maintain PA. More recent treatments have elaborated upon this stance through other techniques to facilitate the experience of PA. This workshop will describe evidence-based approaches that can enhance PA in order to treat adolescent depression. The approaches include behavioural activation therapy, mindfulness-based cognitive therapy, dialectical behavioural therapy (specific elements) and cognitive bias modification training. In addition, the workshop will cover other approaches, including exercise, that are effective and do not require extensive training for practitioners. PA-focused treatments are a valuable tool for treating depression early in its course, and applying them could be particularly helpful early in the course of the disorder and before depression exerts an influence on social and affective development and functioning.

G. Trauma-Focused Cognitive-Behavioural Therapy for children and adolescents

Shannon Dorsey, University of Washington

This workshop will focus on the treatment for child trauma exposure and subsequent sequelae with the most empirical evidence: Trauma-focused Cognitive-Behavioural Therapy (TF-CBT; Cohen, Mannarino, & Deblinger, 2006). TF-CBT is a treatment based on cognitive-behavioural therapy, and includes individual child or adolescent, parent/caregiver, and conjoint (child and caregiver) sessions. TF-CBT includes coping skills building, exposure (imaginal and in vivo), cognitive processing of trauma-related thoughts, and enhancing future safety. The presentation will include a review of the research evidence supporting TF-CBT, a detailed overview of the treatment elements, and information on how to receive training in TF-CBT. The treatment overview will include case examples to illustrate how the different TF-CBT elements are applied with children and adolescents. The workshop also will include information on application to diverse populations and settings from studies conducted by the presenter, including child welfare-involved youth in the United States and children in low- and middle-income countries (e.g., Tanzania and Kenya).

H. Keeping kids well at home and at school: Relapse prevention cognitive-behavioural therapy for youth with depression

Betsy Kennard, University of Texas Southwestern Medical Center

Major depressive disorder is a serious and disabling illness which affects approximately 4 to 6% of children and adolescents. While we have effective acute treatment strategies for this illness (antidepressant medication and psychotherapy), the remission rates are low (23-37%) and relapse rates are high (34-75%). Furthermore, even with effective treatment, the presence of residual symptoms after treatment is considerable, with poor outcomes associated with more residual symptoms. Even in those that do achieve remission, about 30 to 40% will relapse. Strategies to improve long term outcomes and reduce the rate of relapse in youth with depression are lacking. In two randomized controlled trials, Kennard and colleagues developed and tested a treatment strategy (Relapse Prevention CBT) to reduce relapse rates in youth with MDD, with good outcomes. We will present this treatment, which targets preventing relapse, increasing wellness, and developing skills to promote and sustain a healthy emotional lifestyle. We describe the rationale for and components of RP-CBT and how these strategies can be adapted for home and school settings.