Teen DepressionApril Bickoff, PsyD, ACT

Nancy Moran, LCSW, ACTBehavioral Health Clinicians

June 1, 2016

Agenda• Statistics• What is typical?• Signs & symptoms• Causes/triggers• Cognitive Behavioral Therapy (CBT)• Suicide Assessment/Self injury• What can parents do?• When to seek help?

Statistics• 10-15% of children have some symptoms of depression right

now

• 1/8 adolescents have clinical depression

• Mean duration of 7 to 9 months; vast majority remit within a few months

• Recurrence rate of 40%

• 35% Hereditability rate

Seligman, Martin (1995). The Optimistic Child. New York, NY: Harper Collins.Chansky, Tamar (2008). Freeing Your Child From Negative Thinking. Cambridge, MA: Da Capo Press.

Is this “typical” or is something wrong?

• Changes in social behaviors

• Conflicts with authority

• Increased stressors

• Changes in sleep

• Drug/Alcohol Experimentation

• It is normal to have some ups and downs with mood.

Diagnostic Criteria5 or more of the following during a two week period with at least symptom 1 or 2 present• 1. depressed mood nearly every day• 2. diminished interest or pleasure• 3. weight loss or gain of more than 5% when not trying to lose or gain

weight• 4. insomnia or hypersomnia nearly every day• 5. psychomotor retardation or agitation• 6. fatigue or loss of energy nearly every day• 7. feelings of worthlessness nearly every day• 8. diminished ability to think or concentrate• 9. recurrent thoughts of death, recurrent suicidal ideation (with or without

plan)

Signs/Symptoms that may be associated with Depression in Teens

• Frequent physical complaints (headaches and muscle aches)

• Frequent absences from school and/or a drop in grades

• Loss of pleasure in activities

• Social isolation

• Increased outbursts of shouting or crying

• Self-Harm

Causes/Triggers• Academic Pressure

• Relationship Issues (social or romantic)

• Sexuality Issues

• Peer Pressure

• Bullying/Peer Rejection

• Family history of depression

Causes/Triggers• Family Conflict

• Substance Abuse

• Abuse/neglect

• Chronic illness

• Loss of a loved one

Suicide AssessmentWho is at risk?

• Past attempts• Family history of mood disorders• Exposure to family violence• Impulsivity• Co-morbid psychiatric disorders• Parental history of suicide• Limited social supports• Substance Abuse

What should you do if you feel your child is at risk?

• Don’t be afraid to have an open conversation with your child.

• Ask your child about their thoughts.

• Identify if thoughts are passive versus active.

• Seek professional help.

• Seek immediate assistance if your child is actively thinking about suicide.

Remember: IS PATH WARM?

Ideation- thoughts or threats of suicideSubstance abuse- excessive or increased

Purposeless- no reasons for livingAnxiety- agitation, unable to sleep/sleeping all the timeTrapped- feeling there is no way out, resistance to helpHopelessness- about the future

Withdrawing- from friends, family, societyAnger- uncontrolled rage or seeking revengeRecklessness- risky acts, not thinking, impulsiveMood changes- dramatic, increased

Self-harm: How do I handle it?

Dos • Respond when you’re calm• Be willing to talk and listen• Share your feelings (“I want you

to know that I love you, and if these are self-inflicted wounds, I’m here to help you. I’m not here to be angry at you. I’m not here to punish you. I’m here for you to talk to me.”)

• Make an appointment with a professional

Don’ts • React before thinking it

through• Do all the talking• Share feelings of guilt• Punish, threaten, or criticize

Cognitive-behavioral Therapy (CBT) The Cognitive Model

Situations

The Cognitive Model • The way individuals feel and behave is influenced by the

way they view and think about situations/experiences.

Image from www.pedigreedatabase.com

The Cognitive Model for depression

Negative

Self

NegativeWorld FutureNegative

When Depressed• Negative Perception of Self

– I’m a loser– I’m a failure– I can’t do anything right

• Negative Perception of the World– It’s not fair– It always happens to me– People are better than me

• Negative Perception of the Future– Things will never get better– Nothing ever goes right– Why try it always comes out the same

Behavioral Activation/Activity Scheduling

• Schedule pleasant activities • Think out of the box• Encourage planning ahead• Give choices • Ask how involved you should be• Encourage your child to get out of bedroom

Neuroplasticity

Current understanding of neuroplasticity is that day to day behaviors can have measurable effects on brain structure and function. It can be affected by life experiences, behavior as well as thought patterns

What to Teach About Thoughts

1. We constantly have thoughts.

2. Just because we think something doesn’t mean it’s true or not true.

What to Teach About Thoughts

3. We don’t always realize thoughts are going through our mind.• Example: Tying a shoe

4. Our thoughts lead to our feelings/actions.• Example: Dog

Thoughts and Depression

How to Combat Negative Thoughts

• Evidence “for” and “against” a thought.

• What is the truth?

• Coping Statements

Fox, M & Sokol, L (2011). Think Confident, Be Confident, For Teens. Oakland, CA: New Harbinger Publications.

Finding the Truth or BalanceFinding more helpful thoughts...

– “Even though….the truth is….”– “It may be true that…however…”– “Even if it does happen…”

• Even though I wasn’t invited to Jessica’s party, it does not mean that I have no friends. I have been invited to a lot of other parties. I will invite Jill over after practice on Friday and we can hang out.

Autonomy

• Avoid “helicopter parenting”

• Allow your child/teen to make mistakes.

• Trust them to make certain decisions, even if they are not the ones you would make (i.e. when they should begin homework)

Autonomy• Allow for self-direction vs. management when appropriate.

• Teach the skill of self-direction– Management: Did you put your soccer shoes, change of clothes and water bottle in your

bag? – Self-Direction: Remember, you have practice today at 5:00.

• Without independence, teens may develop a belief about themselves that they are inadequate or not capable.

How to Praise

• Offer praise accurately. • Praise effort.• Avoid empty praises. – Offering empty praise too often can make it

difficult for teens to internally motivate themselves

Seligman, Martin (1995). The Optimistic Child. New York, NY: Harper Collins.

How to Praise• Empty Praise: – (After striking out at a baseball game) You did such a

great job today! You are such a good baseball player!

• Accurate Praise: – You put a lot of effort into the game today. I bet if you

keep practicing the way you have been you’ll keep improving!

Seligman, Martin (1995). The Optimistic Child. New York, NY: Harper Collins.

Criticize with Care

• Be Accurate!

• Avoid “permanent” and “across situation” criticism

• For example: “You never listen to anything I say, you’ll never amount to anything!” or “I will never trust you again.”

Seligman, Martin (1995). The Optimistic Child. New York, NY: Harper Collins.

Criticize with Care

• Strive for “temporary” and “one situation” criticism

– “I did not like that you cursed at me today. I was surprised since you are typically more respectful . I expect you won’t speak to me that way again.”

– “I felt really disappointed that you didn’t study more for your math exam. Next time, I expect you’ll start sooner.”

Seligman, Martin (1995). The Optimistic Child. New York, NY: Harper Collins.

When to Seek Help

• Thoughts of suicide• Self-harm• Low mood most days for a month or more• Difficulty/refusal with going to

school/activities• If your child asks for help

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCMmR-ZOox8gCFUIzPgodA1oHhA&url=http://biohealth.science.oregonstate.edu/frequently-asked-questions-faqs&psig=AFQjCNFGXuE9J2mswRdNk9CIE3vhpccuIA&ust=1445095762163934

References

If Your Adolescent Has Depression or Bipolar Disorder: An Essential Resource for Parents by Dwight L. Evans, M.D., and Linda Wasmer Andrews

Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, 5th edition

Cognitive Therapy: Basics and Beyond by Judith S. Beck

102 Strategies for Working with Depressed Children & Adolescents: A Practical Resource for Teachers, Counselors and Parents by Kaye Randall, Donna Strom, and Susan Bowman

Chansky, Tamar (2008). Freeing Your Child From Negative Thinking. Cambridge, MA: Da Capo Press.

Fox, M & Sokol, L (2011). Think Confident, Be Confident, For Teens. Oakland, CA: New Harbinger Publications.

http://www.about-teen-depression.com/teen-depression.html