1. Psychosocial Intervention for Children and Adolescents with Depression Mr. PrafulPrabhuappaKapse

2. Outline Introduction - Psychosocial intervention Depression– common features Case vignette Assessment Intervention

3. What is meant by psychosocial intervention? Most basic level - psychosocial Psycho – psychological aspect of our experience. Refers to our feelings, thoughts, desires, belief, values and how we perceive ourselves and others. Social – refers to the our wider social experience i.e. our relationships, traditions and culture. Both aspects are closely intertwined and influence each other.

4. Psychosocial Intervention Psychosocial intervention is an approach aimed at improving people’s well-being. Acknowledges: Psychological well-being of the individual Knowledge and skills of the individual Social support Culture and values that influence individual’s experience

5. Depression – Common features Depressed or irritable mood most of the day, nearly every day Markedly diminished interest or pleasure in all activities Significant weight loss Trouble sleeping Restlessness Fatigue or loss of energy nearly every day Feelings of worthlessness or excessive guilt Recurrent thoughts of death, suicidal thoughts or suicide attempts

6. Case vignette Mr. A, 12 year old boy, from low-socioeconomic background, presented to NIMHANS, with the complaints persistent sad mood, death wishes, irritability, diminished daily activities, etc.

7. Assessment Temperament history Family environment Social environment Emotional environment Traumatic events Faulty adaptation

8. Psychosocial intervention Psycho education Cognitive & behavioral strategies Social skill training Sleep hygiene Interpersonal Psycho therapy Group therapy Rehabilitation

9. Psycho education Education about mental illness For their social support network To help them to understand and deal MI To prevent or plan relapse

10. Cognitive Behavioral Strategies Cognitive strategies Distraction Technique Counting Thoughts Behavioral Strategies Monitoring Activities Scheduling Activities Graded Assignment

11. Cognitive Behavioral Strategies Identifying Negative Automatic thoughts The self (I am useless) Current experience (nothing I do turn out right) The future (I will never get better) Testing Negative Automatic thoughts Verbal Challenging Behavioral Experiment Draw Conclusion

12. Evidence based practice in CBT Early studies with sub clinical populations by Show 1977; Taylor and Marchall 1977 and single case series by Rush, Khatami, and Beck in 1975 show the following results of cognitive behavioral therapy for depression Immediate effect of CBT Preliminary evidences show that interventions designed to reduce the frequency or intensity of depressing thoughts can have an immediate beneficial effect on mood. These include distraction and challenging (Teasdale and Reizin 1978; Deviws 1982 Fennel and Teasdale 1984; Blackburn and Bonham 1980)

13. Post treatment effect of CBT Studies assessing post treatment outcome reliably show cognitive behavioral therapy to be as effective in reducing depression (Rush, Beck, Kovacas, and Hallon 1977, Blackburn et al.1981 Hallon, Evans and DeRubbeis 1983) Long term effect CBT may be more effective in preventing relapse than anti-depressant drugs. (Kovacas et al. 1981; Hollon et al; Simons, Murphy, Levine and Wetzel, 1986)

14. Social skills training To help persons in relating to people Especially when they have difficulty in that Verbal skills Nonverbal skills Expression ability Understanding cues and contents

15. Components of Social Skills Nonverbal behaviors: eye contact, facial expression, posture, use of gesture, body orientation, interpersonal distance. Paralinguistic skill: loudness, tone, pitch, affect, rate of speech, clarity of speech, duration of utterance. Verbal content: verbal massage, choice of words, appropriateness of self disclosure. Interactive balance: smoothness of turn-taking, use of social reinforces (e.g. reflective listening skill), balance of time taking.

16. Techniques of Social Skills Instruction Role playing Feedback Reinforcement Back chaining

17. Interpersonal therapy Developed by Gerald Klerman, This therapy is based on two assumptions. current interpersonal problems are likely to have their roots in early dysfunctional relationships current interpersonal problems are likely to be involved in precipitating or perpetuating the current depressive symptoms

18. Evidence Study of interpersonal psychotherapy versus supportive psychotherapy for dysthymic patients Subjects with primary DSM-IV dysthymic disorder were randomly assigned 16 weeks of IPT. Patients in both treatments reported improved depressive symptoms Department of Psychiatry, Weill Medical College of Cornell University, New York, New York 10032, USA.

19. Group therapy Group psychotherapy is a treatment in which carefully selected persons who are emotionally ill meet in a group guided by a trained therapist and help one another effect personality change.

20. Evidence More than 300 depressed parents participated in group therapy sessions for eight weekly meetings. Through 90-minute group session Throughout the eight-month study, rates of new depressive episodes were lower among those receiving therapy compared to those in traditional care. – 21.4 percent vs. 32.7 percent, respectively. The Journal of the American Medical Association, 2009;301:2215-2224

21. Good Sleep Hygiene Protect your need for sleep Ensure that 7.5-8 hours set aside for sleep every day Keep regular sleep hours an irregular sleep schedule messes up biological clock and can make getting a full night’s sleep more difficult go to bed at the same time every night and get up at the same time every morning

22. Thank You