Evidence-Based Psychosocial Treatments for Pediatric Mood and Anxiety Disorders

Abstract

Treatment of internalizing disorders in youth often entails a multimodal approach, including pharmacotherapy, psychotherapy, and systems-based intervention in familial, school, and social settings. Prior to selecting appropriate treatments, a comprehensive, lifetime assessment employing multiple informants (youth, parents, teachers) and methods (questionnaires, semi-structured evaluation, clinical interview) should be conducted. Given the high rate of co-occurrence of multiple internalizing disorders, comorbidity of mood and anxiety with other psychiatric problems, and symptom overlap across diagnostic categories, thorough assessment taking into account differential diagnoses is essential. Following evaluation, treatment selection should be based on the primary presenting problem, degree of impairment, and current evidence. For moderate-to-severe adolescent depression, a combination of cognitive-behavioral therapy (CBT) with pharmacotherapy (e.g., selective serotonin reuptake inhibitors [SSRIs]) has the strongest empirical base. Mounting evidence also supports the use of CBT and interpersonal therapy (IPT) as monotherapies for depressed youth. CBT for depression involves identifying and challenging cognitive distortions, behavioral activation, problem solving, and emotion regulation, while IPT aims to reduce interpersonal conflict via interpersonal problem-solving and communication skills. For pediatric bipolar disorders, family psychoeducation about the etiology, course, and treatment of mood disorders, plus skill building (problem solving, CBT, communication, emotion regulation), should be employed adjunctive to pharmacotherapy. Finally, for anxiety disorders, various forms of CBT have demonstrated efficacy. Typically, use of SSRIs concurrently with CBT offers additional benefit for anxious youth. Though the format and focus of CBT varies depending on the specific anxiety disorder, most interventions involve psychoeducation, emotion identification and management strategies, cognitive restructuring, exposure, and familial involvement. Recent preliminary research also supports the use of other psychotherapies (e.g., attachment-based family therapy, parent-child interaction therapy, attention bias modification training) and healthy lifestyle changes (e.g., sleep, diet, exercise). In conclusion, CBT-based treatments currently have the most empirical support, and should be considered first-line psychosocial interventions for pediatric internalizing disorders.