Harvard Mental Health Letter

In Brief: Treating depressed children: Limits of psychotherapy

In Brief

Treating depressed children: Limits of psychotherapy

The largest pooled analysis of controlled studies so far has found that psychotherapy for childhood depression is only moderately and often temporarily successful, and that cognitive therapy is not more effective than other approaches.

The authors believe they have improved on previous meta-analyses that came to more optimistic conclusions. They included more clinical trials, 35 all together. They contacted investigators repeatedly and persuaded them to provide more information. And they say their statistical techniques were more accurate.

On average, psychotherapy had moderate effects immediately after treatment on both depression and anxiety, but not on "externalizing" behavior problems like attention deficit disorder and conduct disorder. About half of the studies included follow-ups, which suggested that differences resulting from psychotherapy persisted for a while but disappeared after a year. It did not matter whether the treatment was group or individual therapy, whether patients were recruited from advertisements or referred by a clinician, whether therapy took place in a clinical or a research setting. The time devoted to a child (more or less than 12 hours of psychotherapy) and the child's age did not influence the outcome either. Cognitive therapy, which stresses the correction of self-defeating and unrealistic thoughts, was not superior to interpersonal therapy (concentrating on personal relationships and life transitions) or to purely behavioral methods like social skills training and behavioral family therapy.

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