Therapy for Depression
Specialized kinds of therapy that have been shown to be effective for depression
Clinical Expert: Jill Emanuele, PhD
There are several different kinds of therapy that are considered evidence-based for treating depression, which means that they have been studied and clinically proven to be effective. Here is a breakdown of some of them:
Cognitive behavioral therapy (CBT)
Cognitive behavioral therapy is the gold standard for treating children and adolescents with depression. CBT works by giving people skills to cope with symptoms like depressed mood and unhelpful thoughts (like “no one likes me” or “things will always be like this”). In CBT, the child and their therapist collaborate to meet goals, like catching those unhelpful thought patterns and improving problem-solving ability.
Central to the treatment is teaching kids that their thoughts, feelings, and behaviors are all interconnected, so changing one of these points can change all three.
For example, one technique called behavioral activation (BA) encourages them to participate in activities, even if they don’t feel like it, and then observe the effect it has on their mood. Getting active can boost mood, and the activity can generate more positive thoughts and feelings.
In BA, therapists work with the child or teenager to identify things they value doing and steps they would need to take to do those things. The child and the therapist make a detailed schedule for the child’s activities, and parents are enlisted to help make sure the schedule is followed.
Identifying what they value helps kids see how withdrawal and avoidance are not working for them and how small steps toward goals that reflect those values can make them feel better. It can also counter the isolation that teenagers with depression often experience, which can reinforce their depressed mood.
Dialectical behavior therapy (DBT)
For teenagers with more severe depression, dialectical behavior therapy can be helpful. DBT is a form of CBT adapted for people who have trouble managing very painful emotions and may engage in risky behavior, self-harm like cutting, and suicidal thoughts or attempts.
To manage intense emotions, people participating in DBT learn to practice mindfulness (being fully present at the moment and focusing on one thing at a time, without judgment) and develop problem-solving skills like tolerating distress, handling difficult situations healthily, and interacting more effectively with friends and family. DBT is a highly structured treatment that includes individual therapy and skills groups. DBT for adolescents includes sessions with parents and their child learning skills together.
Interpersonal psychotherapy (IPT)
Social relationships can sometimes influence and even maintain depression. When a person is depressed, their relationships can also suffer. Interpersonal therapy addresses a child’s relationships to make them more healthy and supportive. In this therapy, children learn skills for better communicating their feelings and expectations, they build problem-solving skills for handling conflicts, and they learn to observe when their relationships might be impacting their mood.
IPT has been adapted for adolescents with depression to address common teen relationship concerns, including romantic relationships and problems communicating with parents or peers. Called IPT-A, this specialized form of interpersonal therapy is typically a 12- to 16-week treatment. Parents will be asked to participate in some of the sessions.
Mindfulness-based cognitive therapy (MBCT)
While its efficacy is still being measured in adolescents, mindfulness-based cognitive therapy is another treatment that has been shown to work for young adults and adults with depression.
MBCT works by combining cognitive behavioral therapy (CBT) methods with mindfulness. Mindfulness teaches people to be fully present in the moment and observe their thoughts and feelings without judgment. This can help them interrupt undesirable thought patterns that can maintain or lead to a depressive episode, like being self-critical or fixating on negative things in ways that are not constructive.
MBCT was initially developed to help people with recurring episodes of depression, but it can also be used for treating a first episode of depression.
Acceptance and commitment therapy (ACT)
Acceptance and commitment therapy, or ACT, is an offshoot of CBT that has also been effective for older kids with depression. CBT is about recognizing negative thoughts and then changing them. But in ACT, you observe negative thoughts and accept them as valid so you can work past them.
“Acceptance” here means accepting that you have negative thoughts and feelings. You accept that they don’t need to be avoided or changed, but they don’t need to stop you from doing what you need to meet your goals. “Commitment” means agreeing to take concrete steps to make positive changes in your life towards those goals.
With ACT, teens learn to be aware of uncomfortable or painful emotions without allowing themselves to get caught up in them. That allows them to keep the focus on their values — what matters to them — and take positive steps that move them closer to their goals.