History of Cognitive-Behavioral Therapy in Youth

Patterns of insecure attachment are associated with psychopathology but the mechanisms involved remain poorly understood. Cognitive science proposes that attachment patterns are influenced by the autobiographical memory system and in turn influence its ongoing functioning. Disturbances in autobiographical memory represent cognitive risks for later emotional difficulties. We systemically reviewed 33 studies (in 28 articles) examining the association between attachment patterns and autobiographical episodic memory (AEM) in individuals from the age of 16 (i.e., from young to older adulthood). Attachment patterns were associated with key areas of AEM phenomenology, including intensity and arousal; detail, specificity, and vividness; coherence and fragmentation; and accuracy and latency. These associations appeared to be moderated by contextual and individual factors; mediated by emotional regulation and schema-based processing; linked to mental health outcomes. Attachment patterns may also influence the impact of certain AEM-based manipulations. We conclude by providing a critical discussion and a research agenda for bringing together attachment, memory, and emotion, with a view to promote mechanism-driven treatment innovation in clinical psychology.

Despite being recognized for millennia, disorders of mental health still cause fear and stigma in the 21st century. The Global Burden of Disease study also highlights the significant morbidity and mortality associated with mental disorders. On a global basis, disability-Adjusted Life Years (DALYs) for cardiovascular diseases, cancers, and neonatal disorders are higher than mental disorders. On the other hand, DALYs for mental disorders are higher than diabetes and kidney diseases, unintentional injuries, and respiratory diseases. Although those not specializing in this field view mental disorders with a degree of pessimism, there have been major advances in the use of psychotherapies to treat these conditions. The present chapter briefly reviews the burden of disease caused by mental disorders and then focuses on the research conducted on cognitive behavioral therapy (CBT). As a result, although it is clear that therapeutic nihilism is unwarranted, significant factors relevant to disorders of mental health and psychotherapies such as CBT remain unknown.

Mental disorders can occur at any time from childhood to seniority. However, select individuals may be highest risk of developing certain mental disorders at specific points in their life span. These points include adolescence, pregnancy, and later adulthood (ageing). Substantial data indicate the significant incidence of mental disorders in young people and various life events and the disability associated with this. The present chapter reviews the burden of disease caused by mental disorders across the life span. Many have a pessimistic view of the outcome of mental disorders in these patient groups. Yet, though this is not warranted, many of the nuances relevant to the mental disorders in young or pregnant patients, for example, remain largely unknown.

Cognitive-behavioral therapy is an empirically supported treatment for youth with a range of disorders (e.g., anxiety, depression, trauma, chronic pain) and is widely practiced and taught in training programs. Cognitive-behavioral therapy is an integration of multiple theoretical approaches, including behavioral, cognitive, and developmental, that targets potential areas of vulnerability in each domain. Existing research has established its efficacy and supports its effectiveness, yet future research must further these gains through treatment personalization and implementation research.

Cognitive-behavioral therapy (CBT) is the gold-standard psychotherapeutic treatment for pediatric negative valence disorders. However, some youths do not respond optimally to treatment, which may be due to variations in neural functioning.

We systematically reviewed functional magnetic resonance imaging studies in youths with negative valence disorders to identify pre- and post-treatment neural correlates of CBT response.

A total of 21 studies were identified, of overall weak to moderate quality. The most consistent findings across negative valence disorders consisted of associations of treatment response with pre- and post-treatment task-based activation and/or functional connectivity within and between the prefrontal cortex, the medial temporal lobe, and other limbic regions. Associations of CBT response with baseline and/or post-treatment activity in the striatum, precentral and postcentral gyri, medial and posterior cingulate cortices, and parietal cortex, connectivity within and between the default-mode, cognitive control, salience, and frontoparietal networks, and metrics of large-scale brain network organization, were also reported, although less consistently.

The poor quality and limited number of studies and the important heterogeneity of study designs and results considerably limit the conclusions that can be drawn from this literature.

Despite these limitations, these findings provide preliminary evidence suggesting youths presenting certain patterns of brain function may respond better to CBT, whereas others may benefit from alternative or augmented forms of treatment.