Tuesday, 23 April 2013

What is cognitive behavioural therapy like for a teenager?

Most research into CBT (cognitive behavioural therapy) for teenagers has focused on whether it works or not, with largely positive results. Surprisingly little attention has been paid to finding out what it is actually like for a teenager to undertake CBT.

Deanna Donnellan and her colleagues have made an initial effort to plug this gap, conducting in-depth interviews with three teenage girls who'd completed a course of individual CBT, asking them about their perception of the therapy and what it meant to them.

The pseudonymous interviewees were Mary, who had problems with sickness and anxiety; Katherine, who had anxieties around her appearance and restricted her eating; and Samantha, who experienced low mood and practised self-harm. The teenagers were aged 15 years on average.

One the main themes to emerge related to progress and change. Mary saw the therapy in terms of helping to remove her problems; Samantha saw it as more than that, as a chance to move forward in her life; and Katherine felt she had developed new perspectives on life and the future. All three experienced increases to their self-efficacy (their confidence in their own abilities). Donnellan and her colleagues pointed out a related practical insight here - they found the teenagers clearly had "ultimate goals" for therapy (such as a growth in character or a return to "normality"), which could be hidden beneath the immediate aims of the CBT.

Another key theme to emerge related to engagement with therapy. The teens were mostly disengaged and passive at the start, but they gradually began to participate more. Mary achieved this engagement by taking some control - she agreed to take on some of her homework tasks around eating, but refused others. Samantha didn't say much at the start, but came to realise that she could benefit from exploring her emotional issues. Katherine felt desperate and unable to make decisions at the start, but the graded nature of the therapy helped her feel more stable.

The researchers said issues of control were very important in teen therapy given that most teenagers' therapy will have been instigated by their parents. "Power and its ability to impact negatively upon therapeutic potential might ... be mitigated by a process of collaboration and encouraging the client to negotiate their position in the therapeutic relationship," they said.

What about rapport with the therapist? Although she benefited from therapy, Mary was not on the same page as her therapist:
"for an example she might use someone being scared of dogs and how the thoughts of the dog biting them would make them cross the road (...) it was like relates nowhere near to like feeling sick and how feeling sick affects ya it was nothing near that".
Mary blamed part of this on her therapist seeming "really old". "I think for most teenagers," Mary said, "... you'd feel easier to talk to someone who, not obviously dead young, but d'ya know not someone in their 50s or something or like old." In contrast, Samantha was pleasantly surprised at her therapist's ability to relate to her situation:
"It was a bit disconcerting cos she like, not knew about it, but knew how to like deal with all this stuff, which I wasn't entirely expecting but it was helpful."
The final theme related to the structure of the way therapy was delivered. Mary felt like some of the progress was too slow and there was frequent repetition. For Samantha, the structure and predictability of CBT was an advantage, and the boundaries laid down by her therapist helped her feel safe. Katherine also liked the graded pace of therapy, with the gentle start helping her to feel more comfortable.

Donnellan's team said their interviews were a "tentative" first step towards finding out what CBT is like for young people. The findings demonstrate "the importance of the process of therapy, just as much as the content," they said. Based on this, some practical recommendations include: recognising the importance of the first stages of therapy for engaging with a teenage client; addressing the teen client's preconceptions about therapy; and finding out the pace and style they'd like the therapy to progress at.

"The service delivering CBT needs to promote the young person as being in control from the outset," the researchers said, "regardless of who is making the decision to access therapy. This may set the scene for them to develop control over their problems and establish stability in their life."

_________________________________ ResearchBlogging.org

Donnellan, D., Murray, C., and Harrison, J. (2012). An investigation into adolescents' experience of cognitive behavioural therapy within a child and adolescent mental health service. Clinical Child Psychology and Psychiatry, 18 (2), 199-213 DOI: 10.1177/1359104512447032

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.

6 comments:

  1. All three teenage girls interviewed are in the formal operational stage according to Jean Piaget. In this stage the teens are able to think logically when dealing with new concepts and different scenarios (Don Hockenbury and Sandra Hockenbury 390). The girls participating in therapy were trying to work on their problems and gain new perspectives on life. By using the formal operation they are learning to look at thinks logically as to how to solve their problems, etc.

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    1. These three girls in this experiement were in the formal operational stage according to Jean Piaget solely based upon their age which continues into adulthood. The information that these girls recieved earlier on in their lives wasn't only built further into their memory and knowledge, but helped tack on to information they will learn later on in life to give them an overall better understanding of the world around them.

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  2. Anonymous8:30 pm

    As these girls are in adolescence(ages 12-18), they can think for themselves, even though it typically takes ideas from professionals to advocate for themselves. This is when influences and relationships outside of family become important. Fitting in a peer group and appealing to the opposite sex evolves into priority for these up and coming women. Sounds pretty typical for young teens to be disengaged at first until results come around in their moods. Only a few years away from young adulthood (ages 18-40), these young girls are now mentally preparing for the new challenges ahead.

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  3. Renee Allison4:44 am

    According to Jean Piaget all three girls interviewed in this experiment are in the fourth stage of Piaget's Cognitive Development called formal operations. In order to be labeled under this stage you have to be in the adolescence part of life or older. All three girls in this stage should be able to logically solve sll types of problems, think scientifically, solve complex verbal/hypothetical problems, and be able to think abstract. This experiment is to help these three girls be able to do all of these things even though you shouldn’t need help, it should just come natural but for the sake of the experiment to see if it works they chose all girls with problems. In the therapy at the very end all of the girls made changes besides Mary. She was not relating anything right or comparing things right to her problems and she thought that it wasn’t easy to talk to her therapist because she was older. Maybe Mary matured later or earlier than the other girls and that’s why the therapy didn’t work well with her because her brain isn't where it should be for the cognitive development therapy. Just a thought. The other two girls showed major change in this stage from solving concrete problems to logical solving of all classes of problems, including abstract problems.

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  4. Melissa H- date 4/28/13

    The girls are just going through a stage in their development. A psychologist named Jean Piaget came up with four stage of development. They are the sesorimotor stage which birth to age 2, next comes the preoperational stage which is 2 to 7 years old, next comes the concrete operational stage which is ages 7-11 and finally comes the formal operational stage which is 12- adulthood. The teeanage girls are in the formal operational stage. This stage is where teenagers can do things like thinking logically, can handle hard situations and know how to deal with them. Each girl in the experiment had a different view on life and how the therapy helped them or didn't nothing for them. For Samantha and Katherine helpled them get through problems they had to deal with. They both benfitted from the therapy. As in Mary's case she did not like the flow or the repetition of therapy. She was bored and would rather be doing something else. Teenage girls face changes every day and will have to for the rest of their lives.In this experiment they had to control what went on in the therapy, so that they could get even results. It's great for this experiment but not for real life. You can't always be in control plus you are always learning in life. The girls have to deal with problems that may come up. They all have a different way of learning but, they are all on track for their Cognitive Development.

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  5. Hello! Neat post!

    Cognitive-Behavioral therapy is really interesting, especially in all three of the patients cases. CBT is very effective with disorders such as eating disorders, anxiety, etc. All three girls are good candidates for CPT because of the signs of their disorder. Often, therapists will design a plan in therapy to treat the patient efficiently based for the specific problem, which showed when two of the three girls liked the method their doctors were going with.

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