1. New developments in CBT with children and adolescents
Robert D. Friedberg, Ph.D., ABPP
Penn State University Milton Hershey Medical Center
April 3, 2009

2. KIDS
Kids! I don't know what's wrong with these kids today! Kids! Who can understand anything they say? Kids! They are so ridiculous and immature! I don't see why anybody wants 'em! Just you wait and see Kids! They are just impossible to control! Kids! With their awful clothes and their rock an' roll!
Strouse and Adams, 1963
Kids from Bye, Bye Birdie

3. Agenda Established and growing areas of application
Renewed interest in the working alliance
Increased emphasis on the role of emotion
Increased focus on family system and application to family therapy
Expanding uses of group CBT

4. Established areas of application
Depression
Adolescents
Coping with depression course (Clarke, Lewinsohn and colleagues)
TADS
Brent and the Univ of Pitt group
Children
ACTION program (Stark et al.)

5. Anxiety spectrum Generalized Anxiety Social Anxiety Separation anxiety
Kendall (Temple University) Coping Cat
Social Anxiety
Kendall Coping Cat
Albano (Columbia U)
Masia-Warner and colleagues (NYU Child Study Center)
Separation anxiety

6. Anxiety spectrum contd
OCD
March and colleagues (DUKE)
Piacentini and colleagues (UCLA)
Franklin and colleagues (U PENN)
Storch and colleagues (University of South Florida)

7. Disruptive Behavior Disorders
Incredible years program (ages 2-10 yrs) (Webster-Stratton and colleagues)
Group anger control training (Chill out Program) Feindler and colleagues (Long Island University)
Coping Power (Lochman and colleagues, University of Alabama)
Problem-solving skills (Kazdin, Yale University)

8. Expanding areas PTSD Bipolar Depresion PDD
Trauma-Focused Cognitive Behavioral Therapy (TF- CBT) (Cohen & Mannarino, University of South Carolina)
Bipolar Depresion
Fristad and colleagues (Ohio State University)
PDD
Atwood and colleagues
Wood and colleagues (UCLA)

9. Renewed focus on the treatment relationship
Creed and Kendall (2005)
Collaboration is key
Patients preferred a “less formal” stance by the therapist
Shirk and Karver (2003)
Rapport may be more important to children with externalizing disorders than children with internalizing disorders
Karver et al. (2006)
Collaboration with parent and child increased positive outcome

10. Emphasis on emotion
Necessary for self-monitoring (Burum & Goldfried, Ehrenreich et al., 2007)
Fundamental for developing adaptive responses (Zeeman et al., 2006)
Pivotal for increasing interpersonal perception ad social skills (Burum & Goldfried, 2007)
Poor emotional awareness pervades anxiety, depression, and eating disorders (Sloan & Kring, 2007)

11. Emotion in CBT
Emotional arousal in session creates new action tendencies (Barlow, 1988)
Emotional arousal in fundamental in exposure treatment (Barlow et al., 2004)
Emotionally focused CBT help patients free themselves from “holds old habits place upon them ( Samilov & Goldfried, 2000, p. 380)
Emotion in CBT facilitates transfer of learning
Consistent with the state-dependent learning hypothesis

12. Family CBT
Appreciates the fact that children and adolescents are embedded in a systemic context
There is a reciprocal relationship between members in the system. Therefore the child is not sole target of the session
Recognizes the family contribution in the development and maintenance of the problem behavior as well as the potential role in change
Emphasizes the central role of cognition
The most effective and efficient path toward change is through cognitive restructuring, behavioral rehearsal, and performance attainment

13. FCBT
Parents of depressed and anxious children tend to display overprotective, overcontrolling, and/or hostile behaviors (Rapee, 1997)
Greater parental involvement increases the probability of increased tx outcome in depression (Clarke et al)
FCBT outperformed ICBT when both parents had anxiety disorders (Kendall et al., 2008)

14. Group Cognitive Behavioral Therapy
Accomodates greater number of pts
Represents a social learning lab
Includes a peer modeling, feedback, social comparison
Promotes universality; decreases social isolation

15. Group applications Anxiety Disruptive behavior
PTSD with victims of crime and violence (Silverman & Berman, 2000)
Social anxiety
SET-C (Beidel, 2006)
Group CBT (Albano)
Disruptive behavior
Chill out program (Feindler et al)
Coping power (Lochman)
Positive Adolescent Choices Training (PACT) (Hammond, 1991)