A Group Adaptation of Interpersonal Psychotherapy for Depressed Adolescents
Mufson, Laura, Gallagher, Trish, Dorta, Kristen Pollack, Young, Jami F., American Journal of Psychotherapy
This paper presents an overview of the adaptation of Interpersonal Psychotherapy for depressed adolescents (IPT-A) to be delivered in a group format (IPT-AG) for the treatment of depressed, nonbipolar outpatient adolescents, The model has been modified to address the challenges of working with several adolescents in a group context. It takes advantage of the group as a laboratory environment for experimenting with new ways of communicating and interacting with others. The IPT-AG manual, described in this paper, provides guidelines for working with multiple interpersonal issues and keeping the group discussion relevant to the group as a whole. These adaptations are discussed in the context of the interpersonal framework with respect to each phase of treatment. Preliminary data about the feasibility and acceptability of conducting IPT-AG are discussed.
Depression is one of the most commonly diagnosed disorders among adolescents with a conservative prevalence rate by age 18 of 1.6% to 8.9% (1). The impact of depression on adolescent development is considerable in terms of disrupted academic progress as well as impairments in social, career, and identity development. Specific impairments can include school failure, substance abuse, suicide attempts, and antisocial behavior (2). Depressed adolescents are a largely underserved population that faces multiple barriers to receiving treatment. There is a pressing need for more efficacious, cost-effective, and accessible treatments for adolescent depression. This paper presents a time-limited group treatment for adolescent depression. While two psychosocial treatments (3, 4) have been shown to be efficacious for treating adolescent depression, only one has been adapted for use in a group modality (5). It is important to know if IPT-A also can be efficacious if delivered in a more cost-effective group modality that provides an ideal context for adolescents to practice interpersonal skills and interact with peers with similar difficulties. This paper presents our group adaptation of IPT-A.
TREATMENTS FOR ADOLESCENT DEPRESSION
Two types of psychosocial treatments have been shown to be efficacious for the treatment of adolescent depression: cognitive-behavior therapy (CBT) and interpersonal psychotherapy (IPT-A). CBT has demonstrated efficacy as an individual (3) and group therapy treatment (5-7). Interpersonal psychotherapy has been demonstrated to be efficacious as an individual psychotherapy for depressed adolescents (4, 8). Medication, specifically selective serotonin reuptake inhibitors (9-12), also has been shown to be efficacious in treating adolescent depression.
Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) is a time-limited (12 session) individual weekly intervention adapted from interpersonal psychotherapy for depressed adults (13). The goals of IPT-A are to decrease depressive symptoms and improve interpersonal functioning by improving communication and other interpersonal skills. IPT-A posits that, regardless of etiology, depression occurs in an interpersonal context. Interpersonal problems can play a critical role in the development and sequelae of adolescent depression (14, 15). IPT-A has been efficacious for adolescents in part because it focuses on those issues most important to this developmental stage. Improving the interpersonal context will help change the course of the depressive episode and result in recovery. Interpersonal difficulties are conceptualized as fitting into one or two of four problem areas: grief, interpersonal role disputes, role transitions, and interpersonal deficits. The therapeutic focus is on the current interpersonal issues rather than intrapsychic events. The techniques most commonly used in IPT-A include psychoeducation, encouragement of affect expression, communication analysis, role playing, and interpersonal problem-solving.
Although there is a relative paucity of randomized controlled trials of group interventions to treat adolescent depression (16), group therapy is often believed to be an effective treatment. …