Kevin Stark and Philip Kendall
* Goals and objectives (philosophy of treatment, general description of the treatment)
* Degree to which "Taking Action" addresses the core features of childhood depression
* Developmental nature of "Taking Action"
* Specific components of "Taking Action" and their rationale
* Pragmatic application issues (completeness of the manual, ease of use, interest to children, etc.)
* Evaluation of any evidence of effectiveness
The successful treatment of depression in youth is a complex problem-solving process that requires knowledge of effective treatments, including cognitive-behavioral, family, and systems approaches, and understanding of depression in children and adolescents.
"Taking Action" is a manual-based treatment program for children ages 9 to 13 who have unipolar depressive disorder, dysthymia, or depressed mood.
Although the treatment model and procedures are appropriate for all ages of youth, the presentation method used in this program is developmentally appropriate for 9 to 13-year-olds and would have to be altered to address the developmental needs of younger or older children.
General Program Description:
Group (4 to 8 children) or individual format
Each session designed to last about one hour
18 child sessions and 11 family sessions
Child meetings held twice a week for first 4 weeks (to provide more rapid symptom relief), then once a week until completion
Produce a deep, seemingly philosophical change, in the way the children perceive themselves, the world, and the future
Make the treatment "real" by eliciting and integrating the children's daily concerns into the treatment program
Change within-family interactions and communications that may unwittingly support the children's depressive symptoms and cognitions
Practice coping skills through homework assignments, which gets the children to think about the therapy between sessions
1. Affective Education
Recognition of internal cues
Link between thinking and feeling
Personal meaning of event and associated emotions
2. Problem-Solving Training
Always do something to feel better
Catch the positive and let the negative go
Think of it as a problem to be solved
Inspect the situation
Open yourself to the positive
Never get stuck in the negative muck
3. Coping Skills Training
Brainstorm coping strategies for unpleasant emotions
Engage in pleasant activities
4. Cognitive Interventions
Establish a sense of hope
Identify thoughts that are associated with emotions
Identify themes and distortions in thinking
Reconstruct thoughts and images associated with emotions
Observe for pessimism and negative self-evaluations
Develop positive self-statements
Identify and counter thoughts that interfere with coping
Apply whats the evidence to past problems
Self-monitor positive qualities
Build a positive sense of self-funny stories
Identify personal standards
Apply alternative interpretation
Practice using what if
Use change of mood as a cue to tune into negative thoughts
Overall, this program manual and accompanying child workbook are very user-friendly and easy to use. The manual has an excellent introduction, providing good rationale for the treatment program. Additionally, the manual is very easy to follow and provides guidance for the therapist leading the sessions. Any advance preparation or materials needed are clearly indicated. The directions and goals for each session are outlined for the therapist and scripted for explanation to the client. Finally, the child's manual provides an excellent, concrete framework in which the children and therapist are able to work together on the lessons and skills in each section.
Currently, there is not any research that has examined the effectiveness of Taking Action program. However, Taking Action is a cognitive-behavioral program, and there is evidence to suggest the effectiveness of cognitive-behavioral treatments (CBT) on depression for children and adolescents.
CBT focuses on alleviating symptoms of depression by:
The components of Taking Action reflect other CBT programs that are focused on children and youth with depression.
Birmaher, Boris, Ryan, Neal D, Williamson, Douglas E, & Brent, David A (1996). Childhood and Adolesecent Depresssion: A review of the past 10 years. Journal of the American Academy of Child & Adolescent Psychiatry, Vol 35(12) (Dec 1996): 1575-1583
Harrington, Richard, Whittaker, Jane, & Shoebridge, Philip (1998). Psychological treatments of depression children and adolescents: A review of treatment research. British Journal of Psychiatry Vol 173 (Oct 1998): 291-298
Larrson, Bo (1992). Psychological Issues in the assessment and treatment of depression in children and adolescents. Scandinavian Journal of Behaviour TherapyVol 21(1), 3-18