Treatment of internalizing disorders in children and adolescents Flashcards
internalizing symptoms =
“Internalizing symptoms refer to problems of withdrawal, somatic complaints, and anxiety/depression while externalizing symptoms exhibit themselves in delinquent and aggressive behavior.”
CBT works for …% of people
50%
in both internalizing and externalizing thought and behaviour are affected, but you only notice it better.
oke
the internalizing and externalizing framework….
Not a formal DSM diagnosis, but a framework used to describe etiology, classification, comorbidity, treatment of child and adolescent mental health problems.
prevalence of internalising disorders
20%
gender ratio internalizing
boys 1: girls 2/3
gender barriere in internalizing disorders
difficult to diagnose internalizing in boys and externalzing in girls, because they are researched most often in the other gender. therefore we compare to those standards.
we dont know what the symptoms look like in the other gender, because of socialisation (girls dont climb in trees, boys do not cry).
op welke leeftijd kunnen kinderen al behandeld worden
vanaf 3 jaar
internalising = (3 groepen)
- anxiety
- depression
- stress-relating
Internalizing disorders: anxiety disorders
- social anxiety
- panic disorder
- separation anxiety disorder
- specific phobia
- agoraphobia
- generalized anxiety disorder
separation anxiety DSM
- Excessive anxiety concerning separation from home/parents, 3 or more symptoms:
- Recurrent distress or physical symptoms when separated or when anticipating
- Worry or nightmares
- Fearful or reluctant to be alone or without parents
- Reluctance to go to sleep without being near a parent
- The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder
depressive disorders DSM
- Depressed (and irritable?) mood, most of the day, nearly every day
- Reduced interest or pleasure: anhedonia
- Significant weight loss or increase
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Fatigue
- Feelings of worthlessness, guilt
- Reduced ability to think, concentrate
- Recurrent thoughts on death
stress-related disorders
- obsessive compulsive disorder
- posttraumatic stress disorder
core symptoms of internalizing disorders
- Emotional response: fear, sadness, anger, shame, guilt
- Cognitive response: negative cognitions (self, world, future, attention, interpretation, memory problems)
- Physiological response: trembling, palpitations, sweating hands, tension, headache, abdominal pain
- Behavioural response: avoidance, loss of interest in activities
CBT is focused on
do-think-feel triangle (thoughts, feelings, behaviours)
CBT kenmerken
- Treatment protocol
- Fixed steps
- Fixed amount of sessions
- Many different protocols
- Difference with adult CBT: more generic for kids than for adults (adults more specific per disorder)
- Parent involvement very important
CBT components
- Cognitive therapy/ cognitive restructuring
- Behavioral therapy: exposure / behavioral activation
- Modelling
- Relaxation
- Social skills training
- Problem solving skills
- Goal setting
- Parent involvement
cognitive therapy/cognitive restructuring steps
- Tracing negative thoughts: ’It’s my fault my group didn’t pass the test’
- Challenge negative thoughts: ‘What could be other explanations for not passing the test?’
- Formulating alternative, more neutral/realistic thoughts: ‘All group members have a responsibility’
Behaviour therapy types
- Exposure: for anxiety, stress-related disorders → Exposure to feared stimuli/ situations/
sensations - Behavioral activation: depression → Increasing pleasant activaties, doing even if you do not feel like it
Parent involvement is important when…
- Young kids
- Comorbid externalizing disorders
- Engagement homework
- Systemic nature
- Parents involved in maintaing disorder → family accommodation
percentages of benefits from CBT
- 45-55% benefits
- so half of the kids don’t respond
- high relapse rates in the kids that do respond
wat is de uitleg voor CBT non-efficacy rates
RCTs treatment protocols are tested as a whole: not on the component level. therefore we dont know
RCTs kenmerken en waarom het niet handig is
- Standardized questionnaires (e.g., CBCL, CDI, SCARED) at pre-, post-, and follow up assessment.
- Total group scores (treatment vs. control group) compared to each other at post- and follow-up.
- Averaging of scores across the group means loss of information!
- RCTs treatment protocols are tested as a whole: not on the component level
- Individual differences: large heterogeneity
- Comorbidity
→ So ‘one-size-fits all’ doesn’t fit any more
CBT protocols for children one-on-one translation from adult CBT programs
* Many different formats tested; with/without parental involvement, parental training, group/individual, add-ons….
* Many different treatments tested
→ Results have not improved
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current research directions
- Individual differences → individual approach, personalizing research/treatment
- Modular treatment
- Working mechanisms
- Transdiagnostic approach
individual differences research
- Experience sampling approach
- Idiographic approach vs. Nomothetic approach (i.e. individual vs. group approach)
- Changes over time
- Tracking during treatment: processes/working mechanisms
- Possibility personalized questions
- within-subject designs
- change in one or two variables over time
SPACE =
parental programme, to make sure that parents dont accomodate the symptoms of the child. works with post-treatment assessments and an app
modular treatment
modular treatment refers to a flexible and individualized approach to therapy where interventions are broken down into discrete, smaller units or “modules.” Each module focuses on a specific problem, skill, or therapeutic technique. These modules can be combined or customized to fit the unique needs of a patient, depending on their symptoms or issues.
Studying Modularized CBT protocol (van Steensel et al., 2022)
* RCT with single-case components
* N=106 children aged 7-17 years with anxiety disorder/ problems in
the clinical range, and their (both) parents
* Therapists choose treatment content
werkte beter, anxiety van parents and child nam af
working mechanisms in research
- how does the treatment work?
- theory driven
social anxiety study van Mobach resultaten
- A change in dysfunctional beliefs mediated the change in anxiety
- A change in interpretation bias mediated the change in anxiety
transdiagnostic treatment
- high comorbidity
- shared, underlying mechanisms of internalizing disorders: avoidance, emotion regulation, repetitive negative thinking (worrying, rumination, intrusions etc).
- 50% efficacy
