Table 1.
Examples of developmentally informed adaptations to CBT for anxious adolescents
| Author/Year | Type of publication | Age (years) | Treatment | Intervention focus | Developmentally informed adaptations |
|---|---|---|---|---|---|
| Angelosante et al. (2009) | Treatment description and case study (n = 2) | 12–17 | Adolescent panic control treatment with in vivo exposures with (APE + fam) or without family involvement (APE) | Panic disorder and agoraphobia | Briefer and more intensive treatment to allow young people to more quickly return to developmentally important activities |
| Included clinician-assisted in vivo exposures, to guide the adolescents in their execution rather than letting them do them unsupervised at home | |||||
| Parents/caregivers (in APE + fam) engaged as coaches | |||||
| Assessment of motivation pre-treatment and motivational enhancement techniques used in session | |||||
| Manual adapted to include developmentally appropriate and concrete examples, less technical language, and sentence structure was simplified | |||||
| Gradual transfer of responsibility and ownership of the treatment from clinician to the adolescent | |||||
| Cunningham et al. (2009) | Empirical study (n = 5) | 14–16 | Cool teens CD-ROM for anxiety disorders in adolescents (CBT) | Anxiety | Interactive multimedia presentation (text, audio, illustrations, cartoons, and live video) with examples and presentation relevant to adolescent clients |
| Treatment delivered in a new media (computer-based treatment) suited to adolescents (allows for personal control and flexibility; reduces stigma of receiving treatment) | |||||
| Involvement of young people during content creation | |||||
| Spence et al. (2008) | Treatment description and case study (n = 2) | 13–17 | Online CBT for child and adolescent anxiety (BRAVE–ONLINE)—Teenage version | Anxiety | Interactive multimedia presentation (online, via internet) |
| Visually appealing and interesting (bright, eye-catching graphics including real-life pictures) | |||||
| More complex text, examples, and stories, more advanced graphics, and interspersed with a greater number of interactive exercises (e.g., “quizzes”) than child version | |||||
| Aimed at a minimum reading level of age 12 | |||||
| Use of teenage characters as “models” for the use of coping strategies to overcome anxiety problems | |||||
| Siqueland et al. (2005) | Empirical study (Phase i, n = 8, Phase ii, n = 11) | 12 –18 | Cognitive behavioral and attachment-based family therapy | Anxiety | CBT components taught more quickly |
| Cognitive therapeutic strategies emphasized | |||||
| Level of parent involvement in exposures negotiated as part of overall treatment focus of negotiating a balance of competency, autonomy, and attachment to parents | |||||
| Nauta et al. (2003) | Empirical study (n = 79) | 7–18 | Dutch adaptation of the Coping Cat program (Kendall 1990) | Anxiety | Extra workbook pages added for adolescents (e.g., less childish; more in-depth explanation and application of cognitive techniques such as challenging thoughts) |
| Ginsburg and Drake (2002) | Empirical study (n = 6) | 14–17 | School-based group CBT for African-American adolescents | Anxiety | Manual adapted to be developmentally appropriate and culturally sensitive |
| Adolescent-relevant examples included | |||||
| Parents not included due to time constraints and scheduling conflicts | |||||
| Kendall et al. (2002) | Treatment manual | 14–17 | The C.A.T Project (CBT) | Anxiety | Adolescent can choose their own name for the program (i.e., their own interpretation of the initials C.A.T.) |
| More detailed psychoeducational material | |||||
| Reduced emphasis on affective education | |||||
| Cognitive therapeutic strategies emphasized | |||||
| Increased adolescent autonomy in the context of parental overprotection and control | |||||
| Scapillato and Manassis (2002) | Treatment description | 12 –15 | Group CBT | Anxiety | Group format |
| Cohesion-building introductory group activities | |||||
| Barrett et al. (2000) | Treatment manual | 12 –16 | Friends for youth (CBT) | Anxiety | Group format |
| Features age-appropriate content, activities, and illustrations | |||||
| More room for group discussion rather than didactic interaction in treatment session | |||||
| Less attention to affective education | |||||
| Emphasis on self-esteem building and friendship skills | |||||
| More attention to challenging negative thinking | |||||
| Hoffman and Mattis (2000) | Case study (n = 2) | 13 | Panic control treatment (CBT-based) | Panic disorder | Clear, simplified language and verbal and visual examples used |
| Lively examples of concepts incorporated | |||||
| New terms/analogies designed to help adolescents understand and recall concepts | |||||
| Parents involved in some sessions as ‘coaches’ | |||||
| Focus on active, experiential aspects of treatment over technical psychoeducational information | |||||
| Albano (1995) | Treatment description | 13–17 | Cognitive-behavioral group treatment for adolescents | Social phobia | Group format |
| Protocol was a downward extension of the adult version of the treatment | |||||
| Albano et al. (1995) | Empirical study (n = 5) | Fears and anxieties are evaluated within a developmental context | |||
| Presentation of case formulation to increase motivation and normalize problems | |||||
| Parent involvement in four sessions (psychoeducation, how to support child) | |||||
| Inclusion of behavioral social skills training | |||||
| More modeling, role playing, and behavior shaping in the first four sessions, with a shift toward active participation later | |||||
| Use of workbooks and handouts | |||||
| Focus on typical feared situations for adolescents (‘snack time practice’) | |||||
| Ollendick (1995) | Empirical study (multiple baseline design; n = 4) | 13–17 | CBT | Panic disorder with agoraphobia | Parent involvement in exposure practice |