Addressing adolescent depression: a role for school counselors.Depression may be one of the most overlooked and under-treated psychological disorders of adolescence. It is a syndromal disorder that is more than just feeling sad, blue, or down in the dumps. Reynolds (1990) noted that this disorder affects multiple areas of personal functioning, including the behavioral, emotional, somatic somatic /so·mat·ic/ (so-mat´ik)
1. pertaining to or characteristic of the soma or body.
2. pertaining to the body wall in contrast to the viscera.
adj. , and cognitive domains cognitive domain,
n area of study that deals with the processes and measurable results of study, as well as the practical ability to apply intelligence. . It involves changes not only in mood, but also in almost every other area of the adolescent's life such as sleep, appetite, energy, and general health. It interferes with the ability to concentrate and think quickly, causing school performance to decline. It causes stress in family relationships precipitated by the adolescent's moodiness and emotional outbursts. It affects friendships as the depressed adolescent becomes more withdrawn and isolated and more aggressive and argumentative Controversial; subject to argument.
Pleading in which a point relied upon is not set out, but merely implied, is often labeled argumentative. Pleading that contains arguments that should be saved for trial, in addition to allegations establishing a Cause of Action or .
During adolescence, complications of depression such as antisocial antisocial /an·ti·so·cial/ (-so´sh'l)
1. denoting behavior that violates the rights of others, societal mores, or the law.
2. denoting the specific personality traits seen in antisocial personality disorder. behavior may emerge, and depressed youngsters are likely to have increasing difficulty in school, possibly dropping out altogether. Many depressed teenagers also abuse drugs and alcohol. Finally, depression increases the risk of suicide, a leading cause of death among older adolescents in this country (Ingersoll & Goldstein, 1995). Depression in adolescents is more than just teenagers with "growing pains grow·ing pains
Pains in the limbs and joints of children or adolescents, frequently occurring at night and often attributed to rapid growth but arising from various unrelated causes. " or in a moody stage.
Until the 1960s, there was considerable debate on whether or not depression even existed before adulthood (Lamarine, 1995). However, in Western society today, depression and depressive disorders Depressive Disorders Definition
Depression or depressive disorders (unipolar depression) are mental illnesses characterized by a profound and persistent feeling of sadness or despair and/or a loss of interest in things that once were pleasurable. are seen as a pervasive problem with adolescents as well as adults (Reed, 1994). According to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. Cicchetti and Toth (1998), the overall prevalence of depressive de·pres·sive
1. Tending to depress or lower.
2. Depressing; gloomy.
3. Of or relating to psychological depression.
A person suffering from psychological depression. symptoms increases appreciably for both sexes at some point in early-to-middle adolescence, with girls manifesting significantly higher rates of symptoms. The lifetime prevalence rate of Major Depression in adolescents has been estimated to range from 15% to 20%, which is comparable to the adult lifetime rate (Birmaher et al., 1996; Cicchetti & Toth, 1998).
Given the prevalence and seriousness of adolescent depression, it is important that teenagers suffering from this disorder receive quick and effective treatment. Since most teenagers spend a majority of their day in schools, it is not unreasonable to assume that school counselors may need to play a role in addressing adolescent depression. The purpose of this article is to (a) present information on the symptoms and signs of adolescent depression, (b) propose some types of prevention approaches practical in the school setting, and (c) describe some specific Cognitive-Behavioral Therapy Cognitive-Behavioral Therapy Definition
Cognitive-behavioral therapy is an action-oriented form of psychosocial therapy that assumes that maladaptive, or faulty, thinking patterns cause maladaptive behavior and "negative" emotions. strategies that can be integrated into school-based prevention and intervention activities.
Recognizing Adolescent Depression
Depressive Symptomatology symptomatology /symp·to·ma·tol·o·gy/ (simp?to-mah-tol´ah-je)
1. the branch of medicine dealing with symptoms.
2. the combined symptoms of a disease.
n. and Comorbid Conditions
Although school counselors are not expected to diagnose mental health disorders, awareness of depressive symptomatology and comorbid (co-occuring) conditions could help them to identify students in need of referral to and treatment by appropriate mental health care providers. Symptoms of adolescent depression include profound sadness, listlessness listlessness
shows lack of interest in its surroundings. , diminished ability to concentrate, dejection dejection /de·jec·tion/ (de-jek´shun) a mental state marked by sadness; the lowered mood characteristic of depression.
1. Lowness of spirits; depression; melancholy. , pessimism, and low self-esteem (Reynolds, 1992). Teenagers with depression feel worthless and discouraged; they have trouble finding any sense of joy or experiencing any pleasure. They often describe themselves as socially inept, unliked, stupid, and unmotivated; helplessness and hopelessness may predominate as life themes (Lamarine, 1995; Reynolds, 1990). In the early 1960s, adolescents were thought to display symptoms through "masked depression masked depression Psychology A form of depression that occurs in adolescents, who deal with depression through denial, somatization–
headaches, abdominal or other pain, or 'acting out'–truancy, substance abuse, multiple accidents " in which acting-out behaviors (e.g., getting into fights, running away from home), school difficulties (e.g., truancy, poor school performance), or social isolation camouflaged true depressive feelings (White, 1989). Masked depression has given way to a more generally accepted standard that adolescent depression is essentially the same phenomenon as adult depression but with some developmental-specific modifications (Lamarine, 1995).
As compared with adults, adolescents with depression demonstrate a more variable course, exhibit more interpersonal difficulties, are more likely to over-eat and under-sleep, and are more apt to demonstrate suicidal ideation suicidal ideation Suicidality Psychiatry Mental thoughts and images which hinge around committing suicide. See Suicide. (Lamarine, 1995). In fact, the adolescent with depression may exhibit difficulties with academics, concentration, and peers; somatic complaints (e.g., headaches, stomachaches); nervousness; and substance abuse, rather than depressed mood (Rice & Leffert, 1997). Fuller (1992) suggested that adolescents exhibiting maladaptive Maladaptive
Unsuitable or counterproductive; for example, maladaptive behavior is behavior that is inappropriate to a given situation.
Mentioned in: Cognitive-Behavioral Therapy behaviors such as hyperactivity hyperactivity, excessive physical activity of emotional or physiological origin, usually seen in young children; one of the components of attention deficit hyperactivity disorder. , conduct disorders Conduct Disorder Definition
Conduct disorder (CD) is a behavioral and emotional disorder of childhood and adolescence. Children with conduct disorder act inappropriately, infringe on the rights of others, and violate the behavioral expectations of , or attention deficit disorders attention deficit (hyperactivity) disorder (ADD or ADHD)
Behavioral syndrome in children, whose major symptoms are inattention and distractibility, restlessness, inability to sit still, and difficulty concentrating on one thing for any should be evaluated for depression.
The diagnosis of depression with adolescents is based on adult diagnostic criteria (American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential world-wide. Its some 148,000 members are mainly American but some are international. , 1994). The depressive or "mood" disorders most seen with adolescents are Major Depressive Disorder Major depressive disorder
A mood disorder characterized by profound feelings of sadness or despair.
Mentioned in: Conduct Disorder
major depressive disorder (MDD MDD Major depressive disorder, see there ) and Dysthymic Disorder dysthymic disorder
A chronic disturbance of mood lasting at least two years in adults or one year in children, characterized by recurrent periods of mild depression and such symptoms as insomnia, tearfulness, and pessimism. (DD) (Reynolds, 1992), and the specific diagnostic criteria for these are outlined in the Diagnostic and Statistical Manual of Mental Disorders Diagnostic and Statistical Manual of Mental Disorders /Di·ag·nos·tic and Sta·tis·ti·cal Man·u·al of Men·tal Dis·or·ders/ (DSM) a categorical system of classification of mental disorders, published by the American Psychiatric Association, that delineates objective (DSM-IV DSM-IV
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). This reference book, published by the American Psychiatric Association, is the diagnostic standard for most mental health professionals in the United States. ; American Psychiatric Association, 1994). Clinical and epidemiological studies with adolescents have reported that the mean length of an episode of MDD is approximately 7 to 9 months (Birmaher et al., 1996). For a diagnosis of DD, which is chronic and somewhat less severe in symptom distress but of greater duration, symptoms must be manifested most of the time over a 1-year period for an adolescent, in contrast to a 2-year period for an adult (American Psychiatric Association, 1994).
Clinical as well as epidemiological investigations have shown that 40% to 70% of adolescents with depression have comorbid disorders, and at least 20% to 50% have two or more comorbid diagnoses (Birmaher et al., 1996). This suggests that comorbidity may be the rule rather than the exception. A study of depressed adolescents in a large, community sample showed girls more likely to have co-existing eating disorders eating disorders, in psychology, disorders in eating patterns that comprise four categories: anorexia nervosa, bulimia, rumination disorder, and pica. Anorexia nervosa is characterized by self-starvation to avoid obesity. and boys more likely to have disruptive behavioral problems (Rohde, Lewinsohn, & Seeley, 1991). Although the most frequent of the comorbid diagnoses are anxiety and substance abuse, conduct problems may develop as a complication of the depressive disorder depressive disorder Psychiatry Any of a number of conditions characterized by one or more depressive episodes–major DD, depressed mood–dysthymic disorder and adjustment disorder with depressed mood, and those that do not fit the criteria of other and persist after remission. These comorbid diagnoses enhance the risk of recurrent depression and affect the duration of the depressive episode (Birmaher et al., 1996).
Knowledge of depressive symptomatology and comorbid disorders equips school counselors to identify adolescents in need of assessment and referral. An additional aid for school counselors to use in screening for this disorder is an understanding of the cognitive distortions typical of the depressed adolescent.
Cognitions of Depressed Adolescents
The cognitions of depressed adolescents are marked by distortions in attributions, self-evaluations, and information processing information processing: see data processing.
Acquisition, recording, organization, retrieval, display, and dissemination of information. Today the term usually refers to computer-based operations. . Depressed youths are more likely to interpret positive events as occurring in response to external factors of which they have no control, and interpret negative events as entirely their own fault. The depressed adolescent's thoughts are dominated by a negative view of self as worthless, the world as bleak, and the future as hopeless (the cognitive triad; Evans & Murphy, 1997). Through this negative view of the world, they distort experiences and display information processing errors such as overgeneralizing predictions of negative outcomes, catastrophising the consequences of negative events, and selectively attending to the negative features of the events (Evans & Murphy, 1997; Flannery-Schroeder, Henin, & Kendall, 1996).
Depression has a self-sustaining, self-defeating quality. Once an adolescent is depressed, new experiences tend to filter through negative beliefs and despondent de·spon·dent
Feeling or expressing despondency; dejected.
de·spondent·ly adv. feelings. No matter how bright the day is, how many goals are accomplished, or how many compliments are received, the adolescent with depression tends to find some flaw or reason for self-criticism. The more the adolescent believes that it will turn out bad, the greater the likelihood that it will occur (White, 1989), a self-fulfilling prophecy self-fulfilling prophecy, a concept developed by Robert K. Merton to explain how a belief or expectation, whether correct or not, affects the outcome of a situation or the way a person (or group) will behave. .
Because adolescents are somewhat prone to errors in logical thinking due to inexperience and undeveloped abstract reasoning, depressed teenagers may be unaware that their thought processes This is a list of thinking styles, methods of thinking (thinking skills), and types of thought. See also the List of thinking-related topic lists, the List of philosophies and the . are faulty (White, 1989). They fail to recognize their ability to impact the environment positively, resulting in a passive or helpless attitude. Their self-perceptions and self-evaluations reflect these information-processing distortions, and, as a result, they display some deficiencies in problem solving problem solving
Process involved in finding a solution to a problem. Many animals routinely solve problems of locomotion, food finding, and shelter through trial and error. (Kendall, 1993). Depressed youths set more stringent standards for their performance, evaluate themselves more negatively, and tend to self-reinforce positively less than their nondepressed peers (Evans & Murphy, 1997; Flannery-Schroeder et al., 1996). The "depressogenic" thought patterns postulated pos·tu·late
tr.v. pos·tu·lat·ed, pos·tu·lat·ing, pos·tu·lates
1. To make claim for; demand.
2. To assume or assert the truth, reality, or necessity of, especially as a basis of an argument.
3. in the cognitive theory Conitive theory may refer to:
School-Based Prevention Activities
In addition to learning to recognize the symptoms and signs of depression in adolescents, the school counselor can initiate school-based prevention programs. Preventive activities may address topics such as drug and alcohol use, physical and social development, and peer relationships. Preventive efforts may involve primary, secondary, and tertiary prevention tertiary prevention Medtalk Treatment that alters the course of clinical disease--eg, with CABG or PCTA. See Percutaneous transluminal coronary angioplasty Psychiatry Measures to reduce impairment or disability following a disorder–eg, through rehabilitation. .
According to Rice and Leffert (1997), primary prevention targets the entire population of adolescents in schools and focuses on normative events (e.g., puberty puberty (py`bərtē), period during which the onset of sexual maturity occurs. , school transitions). The school counselor can organize school efforts to provide all students with information about how to cope with the stresses of normal growth and development. Beneficial to all adolescents are programs focusing on the typical challenges of adolescence such as resisting peer pressure and negotiating friendships (Rice & Leffert, 1997) as well as those that specifically address the topic of depressive feelings. According to Miezitis, Cole et al. (1992), the "importance of primary prevention services to regular classrooms in raising awareness Raising awareness is a common phrase advocacy groups use to justify a particular event, brochure or even the entire organization. Raising awareness refers to alerting the general public that a certain issue exists and should be approached the way the group desires. about depression cannot be underestimated" (p. 422).
Secondary prevention focuses on adolescents already exhibiting some signs of problems (Kazdin, 1993) as well as those exposed to known risk factors (e.g., a parent with a depressive disorder; Rice & Leffert, 1997). School counselors can conduct small group counseling with these at-risk adolescents, focusing the group sessions on the specific problem (e.g., low self-esteem, social isolation) or the particular risk factor. They can lead counseling groups with at-risk youth including children of alcoholics (Webb, 1993), adolescents who have difficulty managing stress (Hains, 1994), and students at high risk for exposure to extreme acts of crime and violence (Berman, Silverman, & Kurtines, 2000).
Since learning-disabled children appear to be more susceptible to depression (Dwivedi & Varma, 1997), school counselors may need to focus secondary prevention efforts on this population. Heath (1992) described a program aimed at providing the learning-disabled child with successful experiences and a sense of control. Using Heath's model, the school counselor could spearhead efforts to prevent depression of learning-disabled children by providing academic remediation in collaboration with teachers, parents, and children.
Using Miezitis, Cole et al.'s (1992) model of school-based services for depression, tertiary prevention activities are designed to promote optimal functioning in students who have already developed some depressive symptoms and include initial assessment and referral. The school counselor can conduct assessments by interviewing students individually, consulting with teachers who have considerable day-to-day contact with students, and/or by soliciting parent input (Rice & Leffert, 1997). There are also a variety of self-report instruments designed to assess for depression (Corcoran & Fischer, 2000) that are appropriate for use with adolescents and can be easily administered by a school counselor. Moreover, given the relationship between self-esteem and depression, some authors (Levy & Land, 1994; Miezitis, Butler, Friedman, & Roback, 1992) suggest use of a self-esteem inventory as an additional screening aid for depression available to the school counselor.
Some students may exhibit depressive symptoms, however, not be referred or diagnosed. After screening, the school counselor may decide that a student's behaviors warrant ongoing monitoring but no referral for evaluation. In this case, the counselor may want to include the student in secondary prevention activities.
Conversely, based on an assessment, the school counselor may decide that further evaluation is necessary. Making effective referrals for evaluation and treatment may include:
* Expressing concern about students' welfare as a consequence of the symptomatology manifested
* Framing the referral in terms that are congruent con·gru·ent
1. Corresponding; congruous.
a. Coinciding exactly when superimposed: congruent triangles.
b. with students' ethnic, racial, cultural, and psychological status
* Explaining the nature of the services offered to these students
* Understanding, exploring, and responding to elements of ambivalence (Levy & Land, 1994, p. 31)
Since a comprehensive evaluation for depression involves input from multiple sources (Carey, 1993), school counselors may be asked to provide important information to the community mental health professional to whom a referral is made regarding the adolescent's school behavior. School counselors may even be asked to serve as part of a multidimensional mul·ti·di·men·sion·al
Of, relating to, or having several dimensions.
multi·di·men treatment team to support the student receiving outpatient services outpatient services Hospital-based services Managed care Medical and other services provided, to a nonadmitted Pt, by a hospital or other qualified facility–eg, mental health clinic, rural health clinic, mobile X-ray unit, free-standing dialysis unit Examples for depression. In collaboration with the treatment team, the school counselor can serve as a resource person to aid the adolescent in coping with everyday issues arising in the school environment.
School counselors can also provide follow-up and ongoing monitoring for students who have received inpatient treatment for depression to prevent a reoccurrence (Levy & Land, 1994). This could involve short individual sessions to help the student reintegrate re·in·te·grate
tr.v. re·in·te·grat·ed, re·in·te·grat·ing, re·in·te·grates
To restore to a condition of integration or unity.
re into the school setting and cope with day-to-day problems. The recovering student could also participate in small group counseling with at-risk students The term at-risk students is used to describe students who are "at risk" of failing academically, for one or more of any several reasons. The term can be used to describe a wide variety of students, including,
Despite efforts to address adolescent depression, it is highly likely that, at some point, the school counselor will need to provide crisis intervention crisis intervention Psychiatry The counseling of a person suffering from a stressful life event–eg, AIDS, cancer, death, divorce, by providing mental and moral support. See Hotline. services for depressed adolescents as part of tertiary prevention. Smaby, Peterson, Bergmann, Bacig, and Swearingen (1990) described how school counselors can develop a comprehensive suicide prevention Suicide prevention is an umbrella term for the collective efforts of mental health practitioners and related professionals to reduce the incidence of suicide through proactive preventive measures. and intervention program that utilizes school and community resources. They believe that school counselors may need to develop specific skills in suicide prevention, but "have data-gathering skills and a sound developmental perspective for addressing adolescent issues" (p. 376).
Collaboration in Prevention
At all levels of prevention, collaboration with teachers, parents, and community mental health care providers is critical. Collaboration with teachers can strengthen the school counselor's ability to identify students in need. Teachers may refer students experiencing problems to school counselors and, conversely, the counselor may provide the teachers with information to enhance their abilities to make referrals. School counselors can increase teachers' understanding of depression by providing them with information about risk factors, developmental tasks and challenges, normative and non-normative life occurrences, and internal and external resources involved in the development of depression (Rice & Leffert, 1997).
Collaborative efforts with parents may increase the chances for positive outcomes for students at risk for the development of depression or those already manifesting depressive symptoms. Parents influence a child's cognitive development through modeling ways of thinking and behaving (Kaplan, Thompson, & Searson, 1995). Some parents and other family members have distorted perceptions and attitudes and may have difficulty accepting the idea that their child needs evaluation or assistance. They may even reinforce the adolescent's negative attitudes, verbally, responding to adolescents with statements such as "You're hopeless," or "You're worthless" (Schrodt, 1992). The school counselor can help parents learn how to deal with the adolescent's behavior more positively and to become actively involved in reinforcing prevention strategies or maximizing the use of community resources for evaluation and/or treatment. This emphasizes that the adolescent's difficulties are a joint problem to be tackled in partnership with families (Evans & Murphy, 1997; Kaplan et al., 1995).
Finally, preventive approaches require linkages with community mental health care providers. The school counselor who establishes relationships with mental health care professionals can seek them out for consultation and contact them if referrals become necessary (Levy & Land, 1994). Additionally, establishing mutually supportive and collaborative relationships with other community agencies providing youth services (e.g., churches, community centers) may provide a safety net for vulnerable youth (Miezitis, Cole et al., 1992). A network of school counselors, parents, teachers, and community personnel can maximize the effectiveness of youth prevention programs for depression.
Using Cognitive Behavioral Therapy cognitive behavioral therapy
A highly structured psychotherapeutic method used to alter distorted attitudes and problem behavior by identifying and replacing negative inaccurate thoughts and changing the rewards for behaviors. Strategies
School counselors may already be implementing primary prevention programs such as those that address alcohol and substance abuse. Designing and implementing secondary and tertiary prevention programs for depression may be more challenging. However, we propose the use of Cognitive-Behavioral Therapy (CBT (Computer-Based Training) Using the computer for training and instruction. CBT programs are called "courseware" and provide interactive training sessions for all disciplines. ) strategies (Meichenbaum, 1995) as a beginning point for developing these programs. CBT strategies are ideal for adaptation to school based programs at all levels of prevention and, with a minimum of education, school counselors can use these strategies in classroom, group, and individual counseling.
Cognitive-Behavioral Therapy was developed from elements of the cognitive therapies cognitive therapy
Any of a variety of techniques in psychotherapy that utilize guided self-discovery, imaging, self-instruction, and related forms of elicited cognitions as the principal mode of treatment. of Aaron Beck (Beck & Weishaar, 2000) and Albert Ellis Albert Ellis (September 27 1913 – July 24 2007) was an American psychologist who in 1955 developed Rational Emotive Behavior Therapy. He held M.A. and Ph.D. degrees in clinical psychology from Columbia University and founded and was the president and president emeritus of the (2000) combined with those of behavioral therapy behavioral therapy
See behavior therapy. (Evans & Murphy, 1997). This theory has also been influenced by Seligman's theory of learned helplessness learned helplessness
In psychology, a mental state in which a laboratory subject forced to bear aversive stimuli becomes unable or unwilling to avoid subsequent applications, even if they are “escapable,” presumably through having learned that situational and attribution theory Attribution theory is a social psychology theory developed by Fritz Heider, Harold Kelley, Edward E. Jones, and Lee Ross.
The theory is concerned with the ways in which people explain (or attribute) the behavior of others, or themselves (self-attribution), with something (Peterson, Maier, & Seligman, 1993) as well as the concept of self-talk (Meichenbaum, 1995). The major premise major premise
The premise containing the major term in a syllogism.
Noun 1. major premise - the premise of a syllogism that contains the major term (which is the predicate of the conclusion)
major premiss of the CBT approach is that a person's affect and behavior are determined by the way he or she interprets the world. Therefore, CBT interventions are designed to help adolescents identify and correct distorted or irrational beliefs and develop a repertoire of effective and gratifying grat·i·fy
tr.v. grat·i·fied, grat·i·fy·ing, grat·i·fies
1. To please or satisfy: His achievement gratified his father. See Synonyms at please.
2. behaviors (Flannery-Schroeder et al., 1996; White, 1989).
School Counselor's Role in CBT
In CBT, the counselor takes an active role in asking questions, summarizing, getting feedback, and promoting alternative responses. This active approach fits well into the culture of schools (Platts & Williamson, 2000) and is beneficial in avoiding the silences that make teenagers uncomfortable and self-conscious (Evans & Murphy, 1997; Kaplan et al., 1995; McAdam, 1986).
The style of interaction between the counselor and adolescents is one of active collaboration. The counselor needs to establish this style from the beginning, because young people may be reluctant to participate in counseling interventions. The counselor can use adolescents' feelings and thoughts about their reluctance to begin exploring their perceptions of themselves and to create a working alliance (Kaplan et al., 1995).
CBT in Primary Prevention
Problem-solving and social-skills training of CBT are appropriate for primary prevention involving all students, because the goal of these techniques--enhancing coping mechanisms and interpersonal abilities--can be useful for any adolescent. In problem solving, adolescents are taught to confront problems using the following steps: (a) identify the problem, (b) identify the aim, (c) think of alternate solutions, (d) consider possible outcomes for each solution, (e) choose and enact the best solution, (f) evaluate the outcome, and (g) self-reinforce the positive outcome and reconsider the negative (Evans & Murphy, 1997). Adolescents can use these steps in confronting issues they face in normal growth and development. Problem solving encourages them to consider alternate solutions and gives them a sense of mastery and control.
Social-skills development involves instruction in behavioral strategies to enhance interpersonal skills "Interpersonal skills" refers to mental and communicative algorithms applied during social communications and interactions in order to reach certain effects or results. The term "interpersonal skills" is used often in business contexts to refer to the measure of a person's ability (Polyson & Kimball, 1993) as well as attention to cognitive processes Cognitive processes
Thought processes (i.e., reasoning, perception, judgment, memory).
Mentioned in: Psychosocial Disorders involved in interpreting cues in the social environment (Pellegrini, Galinski, Hart, & Kendall, 1993). Social-skills training emphasizes basic assertiveness as well as both verbal (e.g., suitable language, appropriate voice tone) and nonverbal non·ver·bal
1. Being other than verbal; not involving words: nonverbal communication.
2. Involving little use of language: a nonverbal intelligence test. (e.g., eye contact, facial expression facial expression,
n the use of the facial muscles to communicate or to convey mood. ) communication skills. Adolescents can learn these skills through role playing role playing,
n in behavioral medicine, learning exercise in which individuals assume characters different from their own. The individual may also be asked to simulate a particularly difficult situation and apply the characteristics that are common to his and modeling (Dudley, 1997; Evans & Murphy, 1997). Enhancing relationship skills may not only promote positive peer interactions but also help adolescents to resist peer pressure (Dupper & Krishef, 1993).
CBT in Secondary Prevention
For adolescents who are already experiencing some difficulties, a typical CBT session structure can be used in group counseling to address any number of problems experienced by teenagers. CBT sessions are ordered to provide safe boundaries for adolescents, who may find less structured approaches threatening. Evans and Murphy (1997) presented the following structure for sessions:
1. Setting the agenda. Adolescents and counselor together decide what topics are to be worked on during the session, the techniques to be used, and the goals of the session. The counselor asks questions to gain a detailed understanding of problems.
2. Reviewing. Adolescents and counselor review what has happened since the last session, including homework assignments.
3. Working with the day's problems and/or introducing new ideas "New Ideas" is the debut single by Scottish New Wave/Indie Rock act The Dykeenies. It was first released as a Double A-side with "Will It Happen Tonight?" on July 17, 2006. The band also recorded a video for the track. . Agenda items are addressed. Summaries are made throughout and feedback is sought.
4. Setting homework. Adolescents and counselor collaboratively decide on suitable homework. (p. 83)
Specific CBT strategies useful in secondary prevention include automatic thought testing and cognitive restructuring Cognitive restructuring
The process of replacing maladaptive thought patterns with constructive thoughts and beliefs.
Mentioned in: Cognitive-Behavioral Therapy
n . Adolescents may be unaware that they experience automatic thoughts, and it can be useful for the counselor to help them identify such thoughts. The counselor helps adolescents to understand how these thoughts affect their attitudes, moods, and behaviors; to test their own thoughts; and to explore alternative points of view (Schrodt, 1992).
In cognitive restructuring, the adolescents learn to replace their self-defeating thoughts with more useful ones. When the adolescent makes statements like "No one cares about me," the counselor carefully questions the reasoning behind the statement. The adolescent is given assistance in correcting the tendencies to overgeneralize Verb 1. overgeneralize - draw too general a conclusion; "It is dangerous to overgeneralize"
extrapolate, generalize, infer, generalise - draw from specific cases for more general cases , engage in all-or-nothing thinking, maximize isolated unpleasant experiences, and operate on hidden perfectionistic assumptions. This often involves thought stopping in which adolescents learn to interrupt self-defeating cognitions (Webb, 1993). The counselor collaborates with adolescents in exploring alternative more realistic interpretations (Flannery-Schroeder et al., 1996). The goal is to reconstruct the adolescent's way of thinking and establish a repertoire of effective gratifying behaviors (Evans & Murphy, 1997; White, 1989). As a result, the adolescent learns to adopt a more realistic view of self, the environment, and the future (Dudley, 1997). In group counseling with adolescents, feedback from peers is potent in confronting cognitive distortions (Rice & Leffert, 1997).
Affective education is a process of CBT that can also enhance functioning in adolescents manifesting some problems. In affective education, adolescents learn how to identify feelings and emotions. Because emotions of adolescents are new and more intense than those of childhood due to physical, physiological, and cognitive changes (McAdam, 1986), adolescents may find it difficult to talk about emotions and may express beliefs that emotions are silly. The counselor must communicate empathic em·path·ic
Of, relating to, or characterized by empathy.
Adj. 1. empathic - showing empathy or ready comprehension of others' states; "a sensitive and empathetic school counselor"
empathetic understanding for these ideas before beginning a discussion of emotions. Adolescents who feel understood can then learn that emotions are experienced along a continuum according to the intensity of the experiences (e.g., from happy to sad to so sad that it hurts; Kendall, 1991). Discussion encourages them to reveal their emotions, identify situations that precipitate different feelings, and recognize behavior associated with these emotions (Dudley, 1997; Evans & Murphy, 1997).
If CBT interventions fail to promote significant gains, adolescents may experience distress and escalated feelings of hopelessness, helplessness, and delinquency (Reynolds, 1990). Therefore, it is crucial for the school counselor using CBT interventions for secondary prevention to monitor individual student behavior in order to recognize the need for referral for more extensive evaluation.
CBT in Tertiary Prevention
After a student has been referred for evaluation and treatment, the school counselor can play a role in student recovery from depression by maintaining open communication with the community mental health care provider. With the therapist's approval and with appropriate consent, the school counselor may want to use activity scheduling and relaxation training relaxation training,
n method that teaches specific techniques for producing the relaxation response. See also relaxation response.
n with the depressed student. Activity scheduling is a CBT strategy that involves planning daily pleasurable and goal-directed activities to reduce boredom, passivity, and brooding (Dudley, 1997). Adolescents with depression tend to predict that they will receive no pleasure from activities that were pleasurable in the past and to foresee that they will be unsuccessful at the things they were able to do before they were depressed (Evans & Murphy, 1997). Swallow and Segal (1995), therefore, suggested that individuals with depression develop a daily schedule that includes both pleasure and mastery-related activities. It is important that adolescents not only increase the number of pleasant activities, but also reward themselves for successful activity completion (Hops & Lewinsohn, 1995).
Relaxation training techniques have been round to be effective adjuncts to CBT in reducing symptoms of anger, anxiety, and low self-esteem, often associated with depressive mood (Dudley, 1997). Adolescents learn the relationship between stress, muscle tension, and depression; and basic relaxation skills that emphasize choosing a quiet place, sitting or lying quietly, closing their eyes, relaxing all muscles, breathing easily, and thinking positively. The counselor can offer some instruction in relaxation techniques and then encourage adolescents to practice the techniques when faced with stressful situations that cause feelings of anger, anxiety, and sadness (Dudley, 1997). In addition to relaxation training and activity scheduling, the community mental health care provider may suggest other CBT strategies for the school counselor to implement with the student recovering from depression.
Depression represents a serious and often overlooked disorder that is prevalent in adolescent populations. Depressed adolescents have a negative view of self and the world, selectively attend to the negative features of events, and display information processing errors. They often experience comorbid psychiatric disorders that increase their risk for substance abuse, suicidal behavior, and poor psychosocial psychosocial /psy·cho·so·cial/ (si?ko-so´shul) pertaining to or involving both psychic and social aspects.
Involving aspects of both social and psychological behavior. and functional outcome. Additionally, research findings suggest that adolescent depression has long-lasting effects influencing later physical and mental health. Depressive disorders during adolescence not only present an increased risk of recurrent depressive disorders during adulthood (Harrington, 1996; Harrington, Fudge, Rutter, Pickles Pickles may refer to
(Hebrew: “priest”) Jewish priest descended from Zadok (a descendant of Aaron), priest at the First Temple of Jerusalem. The biblical priesthood was hereditary and male. , Gurley, Brook, & Ma, 1998), but also may be predictive of elevated medical problems in adults as well as tobacco dependence in adult females (Bardone et al., 1998). Therefore, the identification of depression in adolescence may not only help to alleviate current distress but also prevent subsequent health problems.
The school counselor is in a unique position to help identify those adolescents suffering from depression. With knowledge of depressive symptomatology, including the developmental variables and cognitive patterns characteristic of adolescent depression, the school counselor can help to identify those students in need of referral. In doing so, school counselors must be attuned at·tune
tr.v. at·tuned, at·tun·ing, at·tunes
1. To bring into a harmonious or responsive relationship: an industry that is not attuned to market demands.
2. to recognize not only typical symptoms of adolescent depression but also individual manifestations of depression in minority groups among the population served (Levy & Land, 1994). Sub-populations, including gay, lesbian, and bisexual bisexual /bi·sex·u·al/ (-sek´shoo-al)
1. pertaining to or characterized by bisexuality.
2. an individual exhibiting bisexuality.
3. pertaining to or characterized by hermaphroditism.
4. youth (Rice & Leffert, 1997), and ethnic/racial minority adolescents (Levy & Land, 1994) are at particular risk for developing depression and its sequelae sequelae Clinical medicine The consequences of a particular condition or therapeutic intervention and warrant special attention from school counselors.
Beyond identification, school counselors can develop school-based prevention programs. At the primary prevention level, these programs address the needs of the entire population of adolescents in schools as they cope with developmental growth and change. At the secondary level, the prevention activities focus on students with current difficulties and risk factors that make them susceptible to depression. Finally, at the tertiary level, prevention efforts aim to provide appropriate referral and evaluation as well as to enhance functioning in students who have already developed depression. These efforts also target prevention of suicide, since depression is an important risk factor for attempted suicide in youth (U. S. Public Health Service, 1999).
Cognitive Behavioral Therapy has emerged as a highly effective intervention for depression (Swallow & Siegel, 1995), and strategies from CBT are also ideal for use in preventing depression. Using CBT techniques, counselors can teach adolescents to use cognitive mediational strategies to guide their behavior and thus improve their adjustment (Birmaher et al., 1996; Brent et al., 1997). CBT is particularly appropriate for use in schools because its format reflects the familiar structures of school, including (a) the process of CBT involving exploration, study, homework, and learning new information and skills; (b) the pattern of each CBT session with goal setting, researching problems, and experimenting with new ideas; and (c) the collaborative style of CBT which can engage students, teachers, and parents (Platts & Williamson, 2000). Moreover, the flexible application of CBT complements the developmental considerations of adolescents (Flannery-Schroeder et al., 1996). While problem-solving and social-skills training can be effectively applied in primary prevention with large groups, a variety of other CBT techniques (e.g., cognitive restructuring, activity scheduling) may help prevent further deterioration in students with difficulties and prevent reoccurrence of symptoms in students diagnosed with depression. With appropriate preparation, school counselors can learn to use CBT strategies in prevention activities involving both group counseling and individual intervention.
Although "the effectiveness of CBT techniques delivered in schools for depressed youth has a cumulative base of support" (Hoagwood & Erwin, 1997, p. 444), more effort and research is needed to discern those particular strategies that really work in the school setting to prevent adolescent depression (Flannery-Schroeder et al., 1996). The school counselor can contribute much needed data to the knowledge base on adolescent depression by evaluating outcomes associated with the use of CBT strategies in school-based prevention programs. By helping to discover the most effective interventions to address the problem of adolescent depression, school counselors not only promote optimal social and emotional growth in adolescents but also enhance students' overall learning experiences in the schools.
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Any form of treatment intended to relieve symptoms or help the patient live with them rather than attempt changes in character structure. . Archives of General Psychiatry Archives of General Psychiatry is a monthly professional medical journal published by the American Medical Association. Archives of General Psychiatry publishes original, peer-reviewed articles about psychiatry, mental health, behavioral science and related fields. , 54, 877-884.
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One that indicates or foreshadows what is to come; a forerunner.
tr.v. har·bin·gered, har·bin·ger·ing, har·bin·gers
To signal the approach of; presage. .
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1. having a single pole or process, as a nerve cell.
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Julia R. Evans is a K-12 certified school counselor in Missouri. Patricia Van Velsor, Ph.D., is an associate professor. Both are with the Department of Counseling, Southwest Missouri State University Missouri State University is a state university located in Springfield, Missouri. It is the state's second largest university in student enrollment, second only to the University of Missouri. From 1972 to 2005, Missouri State was known as Southwest Missouri State University. , Springfield. Joseph E. Schumacher, Ph.D., is an associate professor, School of Medicine, University of Alabama at Birmingham UAB began in 1936 as the Birmingham Extension Center of the University of Alabama. Because of the rapid growth of the Birmingham area, it was decided that an extension program for students who had difficulties which prevented them from studying in Tuscaloosa was needed. . E-mail for Dr. Van Velsor: email@example.com