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Introduction:

Depression in adolescents presents unique challenges due to a combination of developmental, psychological, and social factors. These factors include the ongoing development of their cognitive and emotional capacities, the influence of peer relationships and social media on their self-esteem, and the pressure to perform well academically and socially. However, cognitive-behavioral therapy (CBT) has been extensively studied and proven effective for treating adolescent depression, instilling confidence in its potential. This analysis examines the case study of a 15-year-old Puerto Rican adolescent with major depressive disorder (MDD), severe depression, high suicidal ideation, low self-concept, and highly dysfunctional attitudesthe study focuses on the effectiveness of the CBT treatment. The study also examines the application and variability in response to CBT.

Case Study Overview

The clinical case study presents a 15-year-old Puerto Rican adolescent experiencing depression. The study utilized CBT treatment for Puerto Ricans patient who at pretreatment presented a diagnosis of MDD with severe depressive symptoms. It is believed that the CBT treatment is not only practical but also adaptable to address the cultural and individual needs. The study highlighted the efficacy of CBT while acknowledging the challenges and variability in treatment response.

Background:

The patient, a 15-year-old Puerto Rican adolescent, participates in clinical trials, which offer promising new treatments and contribute to the advancement of medical knowledge. She struggled academically, failed several classes, and experienced social difficulties with her classmates. Her family was actively seeking a new school for her. She exhibited symptoms of frequent sadness and crying, increased appetite, overeating, guilt, and low self-concept. She also showed signs of anxiety, irritability, insomnia, hopelessness, and difficulty concentrating. Her interpersonal relationships were complex, and she had persistent negative thoughts about her appearance and scholastic abilities. She also felt guilty for her parents' marital problems.

Her medical record has shown that she has had asthma, uses eyeglasses, and is overweight. Her mother also stated that she had been diagnosed with MDD three years ago and was treated intermittently for two years with the support of psychotherapy and anti-depressants (fluoxetine and sertraline; no dosage information available). What triggered the first episode was a rejection by a boy for whom she had feelings. Her most recent episode appeared to be related to her parents' marital problems and academic and social difficulties at school. Despite these challenges, the patient has persistently sought help and participated in her treatment, instilling hope for her recovery.

Brief Discussion about the family dynamic:

According to the Study report, the family has had a history of conflict, which has impacted the patient's ability to function. During the last session of the CBT therapy, the client seemed to be getting better and responding to treatment, but she was still expressing a depressive mood and anger about her parent's long conflict. Per the client's report, she had witnessed her parenting using negative words. They were physically and emotionally abusing each other. The client has mentioned that she had endured this situation and several separations for over ten years. Both parents used the daughter as a message to convey negative words to each other. The patient's negative thoughts mainly related to the fear she had that her father may have leave and he will never look back. She fears that he may have create a new family and that she may be unable to go along with the new family. It's important to note the patient's courage in seeking therapy to address these issues. The therapist asked if she wanted to come with her parent for the next session to discuss their conflict and how it is impacting their daughter, and she agreed.

Evidence-Based Treatment: Cognitive-behavioral therapy (CBT)

CBT is a designed, time-limited psychotherapy that aims to modify dysfunctional emotions, behaviors, and thoughts through a goal-oriented, systematic procedure. Key components include cognitive restructuring, behavioral activation, and problem-solving skills. The study explained that the CBT treatment consisted of 12 sessions plus four additional sessions, and one family intervention. The therapist needed to be adaptable, modifying the treatment plan as needed based on the adolescent's progress and feedback. This might involve incorporating additional therapeutic techniques or addressing emerging issues during the therapy process. The study was aiming to explore variables that associated with partial or limited treatment response to CBT and illustrate the challenges and variability in CBT treatment for major depressive dis order in adolescence.

Critical Components of CBT Applied in the Case Study are:

1. Cognitive Restructuring: The adolescent was guided to identify and challenge negative thought patterns, replacing them with more realistic and positive thoughts.

2. Behavioral Activation: Activities were planned to increase engagement in positive and rewarding activities, counteracting the withdrawal often seen in depression.

3. Problem-Solving Skills: The adolescent was taught to systematically solve problems, which reduced feelings of helplessness and improved coping mechanisms.

Challenges in Treatment

1. Cultural Considerations: The cultural background of the adolescent required adaptations in the therapeutic approach. Understanding and integrating cultural values, family dynamics, and language nuances were crucial for effective treatment.

2. Variability in Treatment Response: Individuals' responses to CBT can vary significantly. Factors such as the severity of depression, comorbid conditions, and external stressors, also family conflict and school pressure can influence treatment outcomes.

Recommendations:

CBT is a well-established, evidence-based treatment for adolescent depression, demonstrating significant efficacy. However, it's important to remember that treatment must be personalized to individual needs, particularly in culturally diverse populations. This underscores the importance of tailoring the treatment. Therefore, the treatment should include interpersonal psychotherapy (IPT), attachment-focusedpsychotherapythat centers on resolving interpersonal problems, and symptomatic recovery. Cognitive-behavioral focusing on separation anxiety, exposure, post-traumatic disorder therapy, and lifestyle changes may be suggested.

References:

Diagnostic and statistical manual of mental disorders: FITFH edition, text revision: DSM-5-TR. (2022). . American Psychiatric Association Publishing.

Geller, J., & Dunn, E. C. (2011). Integrating motivational interviewing and cognitive behavioral therapy in the treatment of eating disorders: Tailoring interventions to patient readiness for change. Cognitive and Behavioral Practice, 18(1), 5-15. https://doi.org/10.1016/j.cbpra.2009.05.005

Jimnez Chafey, M. I., Bernal, G., & Rossell, J. (2009). Clinical case study: CBT for depression in a Puerto Rican adolescent: Challenges and variability in treatment response. Depression and Anxiety, 26(1), 98-103. https://doi.org/10.1002/da.20457

Stein, J., Vhringer, M., Wagner, B., Stammel, N., Nesterko, Y., Bttche, M., & Knaevelsrud, C. (2023). Exposure versus cognitive restructuring techniques in brief internet-based cognitive behavioral treatment for Arabic-speaking people with posttraumatic stress disorder: Randomized clinical trial. JMIR Mental Health, 10. https://doi.org/10.2196/48689