Modern Teen Depression Treatment: The Medical Model and Integrated Treatment

To understand the latest developments in depression treatment for teenagers, it’s helpful to understand the history of depression treatment. We won’t go back far, because evidence-based treatment for mental health disorders, as we know it, is a relatively new field. Most people understand that what we think of as modern psychotherapy began in the 1890s with the legendary work of Sigmund Freud and figures like his student, Carl Jung. They pioneered the idea that talking about emotions, relationships, and significant life events – especially events and relationships from childhood – can help a person with mental, behavioral, or emotional health issues resolve those issues, heal, and move forward with their lives.

Between the beginning of the 20^th century and now – two decades into the 21^st – psychotherapy and treatment for mental health disorders have come a long, long way. We lived through the basic behaviorism developed by BF Skinner in the 1920s. We saw the rise of cognitive – a.k.a. rational, thinking-based – approaches and their derivatives around midcentury. Beginning in the 60s, scientists and medical professionals saw the value of combining behavioral and cognitive approaches, which led to the formation of CBT around the 1970s.

Developments in the latter half of the 20^th century included the incorporation of family systems theory, groups systems theory, mindfulness techniques, and expressive therapies into mainstream approaches to mental health treatment. However, the real revolution in mental health treatment is still in progress. It’s the slow transformation from seeing mental health disorders such as depression or anxiety as a personal weakness, failure, or shortcoming, and instead understanding them as medical conditions that respond to evidence-based treatment.

That transformation is directly related to the stigma surrounding mental health treatment. As our understanding of the science of mental health grows, the stigma surrounding mental health disorders fades.

The Medical Model and Integrated Treatment: How They Help

The phrases medical model and integrated treatment denote overall treatment philosophies rather than specific treatment techniques. With that understood, it’s not an overstatement to say that these two philosophies have completely changed how we view mental health treatment. The philosophical sea-change informed treatments for depression in teenagers and therapeutic techniques at youth outpatient treatment centers, residential treatment centers, and various youth treatment programs worldwide.

As revolutionary as they were, initially, in practical application, they mean as much now for the reduction of stigma around mental health as they did for the treatment itself when they first became mainstream.

Here’s how they help the treatment and understanding of mental health disorders such as depression in adolescents and adults alike:

• The medical model replaced the old thinking that a mental health disorder is a personal failure or moral weakness. The medical model teaches that a mental health disorder is like a physical disorder. First, anyone can develop a mental health disorder, just as anyone can develop a physical disorder. Second, a mental health disorder responds well to evidence-based treatment, just like a physical disorder does.
• The integrated approach teaches that when we view a disorder in isolation, we miss things that help to heal. For instance, an integrated approach to treating a heart condition involves medication and lifestyle changes. The lifestyle changes involve not only things like diet and exercise, but an awareness of the impact of social and environmental factors on the condition, such as family life, work stress, and home environment. The same is true for a mental health disorder: when treatment is planned and situated in the greater context of an individual’s life, the treatment has a greater chance of success.

That’s the big picture update. We’ll now talk about the latest treatments available at high-quality depression centers for teens.

What’s New in Teen Depression Treatment: Dialectical Behavioral Therapy (DBT), Motivational Interviewing (MI), Mindfulness, and Expressive Therapies

We need to clarify something before we continue.

The words new and latest operate differently in the medical world than they do in the regular world. The medical world and real world are not separate things, of course, but this is an important point: out in the regular world, something new – like a smartphone, the flavor of a soft drink, a movie, or a type of car – does not undergo the same type of safety verification process a medication or a medical treatment does. Therefore, when we say new or latest in reference to treatment or therapy, it’s likely that what we’re talking about has been around for over a decade, but has only recently met the stringent criteria set by licensing bodies and the medical community for the safe and appropriate application and use.

It takes time to verify data and evidence – and that’s a good thing. It keeps us safe and prevents people in the medical world from making mistakes in their enthusiasm to do good and heal people.

That’s the end of the clarification.

Now we’re reading to give you an overview of four approaches to depression treatment in teens that many of the highest-quality, cutting-edge teen treatment centers use every day:

• Dialectical Behavior Therapy (DBT)
• Motivational Interviewing (MI)
• Mindfulness
• Expressive Therapies

We’ll start with DBT.

Dialectical Behavior Therapy (DBT)

Dr. Marsha Linehan created DBT in the 1980s to help patients who did not respond well to cognitive behavioral therapy (CBT). Over the past forty years, clinical and experimental data confirm the effectiveness of DBT as a therapy for teenage depression. Cognitive behavioral therapy (CBT) is an effective treatment for adolescents and adults, but evidence shows that DBT is more effective for people with depression characterized by high emotional reactivity, intrusive thoughts, and high levels of suicidality.

We mention CBT because DBT comes from CBT: Dr. Linehan was a trained CBT therapist when she developed DBT, and it’s important to understand her frame of reference. Whereas CBT helps people understand the dynamic relationship between thoughts and behavior, Dr. Linehan realized there was a missing piece: emotion. That’s where DBT comes in. DBT helps people understand the complex web of relationships between emotion, thought, and behavior. For adolescents with depression, making sense of how emotion affects thought and behavior can be a significant step on the path to healing.

Adolescent-specific DBT programs include five core modules that teach practical skills to help teens manage anxiety and depression.

The Core Modules of Adolescent DBT

1. Teens learn to increase awareness of and focus on the present moment
2. Emotion Regulation. Teens learn to manage turbulent and disturbing emotions
3. Interpersonal Effectiveness. Teens learn to manage family, school, and peer relationships
4. Distress Tolerance. Teens learn to tolerate difficult, stressful, and challenging situations
5. Walking the Middle Path. Teens learn to apply ideas and techniques derived from mindfulness practices, such as yoga, meditation, guided relaxation, tai chi, and chi kung.

We’ll talk more about mindfulness in teen depression treatment below. In the context of DBT, specifically the 5^th module, Walking the Middle Path, mindfulness helps teens with depression:

• Accept the world as it is, without judging or trying to change it.
• Understand it’s possible to see every situation from more than one point of view.
• Validate other people’s points of view about a situation or circumstance.
• Validate their own point of view about a situation or circumstance.
• Believe that action creates change and that they can change how they react both internally (emotions and thoughts) and externally (speech and behavior) to any situation or circumstance they face.

These skills – including the mindfulness skills – are the foundation of DBT treatment. Clinicians in outpatient and inpatient treatment centers for teen depression teach DBT skills during individual counseling, group counseling, and one-on-one coaching sessions. The goal of adolescent DBT – in the words of Dr. Linehan – is to help adolescents create “A Life Worth Living.”

Next, we’ll talk about Motivational Interviewing (MI).

Motivational Interviewing (MI)

Motivational interviewing was created by psychologists William Miller and Stephen Rollnick in the early 1980s. They specialized in treating people with severe alcohol and drug use problems. They found that the antagonistic, confrontational approach to treatment common in the 80s – where therapists worked to convince their patients to embrace change – was often completely ineffective. Soon, they learned that empathy was a far more effective strategy than confrontation or logical argumentation.

Parents of teens get this right away because they understand that with teens, confrontation rarely helps improve anything. Empathy and understanding are more effective. That’s why they’re at the root of the four pillars of MI: partnership, acceptance, compassion, and evocation. Those four pillars lead to the four principles of MI: express empathy, develop discrepancy, roll with resistance, and support self-efficacy.

MI clinicians apply the MI process in four steps. The goal of the steps is to resolve hesitancy about treatment and encourage the teen to make the commitment to the personal and behavioral change necessary to manage depression.

Here are the four steps:

1. Engaging

Therapist and the teen build a relationship built on respect and trust. MI therapists avoid taking the attitude of an expert with perfect answers for all the problems or challenging emotions a teen with depression faces and instead create an atmosphere of openness and acceptance.

2. Focusing

Therapist and teen choose the issue(s) they want to address. A clear plan helps them build and keep forward momentum. Therapists might nudge a teen or suggest potential solutions to the issues they work on. When the teen knows where they want to focus their energy, or arrive at a reasonable solution to an issue themselves, an MI therapist will follow their lead.

3. Evoking

Next, therapist and teen begin a dialogue about why the teen needs to work on the issue(s) in question. At this stage, the MI therapist works to move the teen toward what MI therapists call change talk. Change talk is “speech that favors movement in the direction of change.”

4. Planning

Last, therapist and teen formulate a plan for how the teen will make change happen. They collaborate on a change plan with elements that are measurable and achievable. The change plan often has a timeline, which works to move the teen in the desired direction: behavioral change.

One reason MI helps teens with depression is the word in its name: motivation. It applies to teens almost more than any other demographic: if they’re on board and excited about the plan, they’re more likely to give it all their attention, energy, and focus. All three help create the change needed to manage depression.

Now we’re ready to talk about mindfulness.

Mindfulness in Depression Treatment for Teens

Mindfulness practices include a wide variety of activities. The central principle of mindfulness is full awareness of the present moment. Here’s how the most well-known mindfulness figure in the world, Thich Nhat Hahn, describes mindfulness:

“Mindfulness is our ability to be aware of what’s going on both inside us and around us. It is the continuous awareness of our bodies, emotions, and thoughts.”

Mindfulness also stresses awareness of the present without judgment. This is crucial for a teen who needs to learn to manage an emotional disorder like depression. Therapists and counselors ask teens in treatment for depression to examine themselves, their behavior, and their emotions.

That’s where mindfulness awareness helps. A teen in the middle of a severe, depressive episode may feel they have no control over their thoughts and emotions. Mindful awareness teaches teens to step back and observe everything going on in their minds and bodies – without judgment. The most effective way to achieve that is with the type of breathing exercises and meditation strategies you learn in basic mindfulness activities.

When a teenager with depression learns to slow down and pay attention, one thing they discover is freedom. They learn they’re neither at the mercy of their own thoughts nor a victim of their own emotions. Mindfulness activities – including yoga, meditation, self-directed relaxation, and more – give teens the power to react to their thoughts and emotions in the manner of their choosing. This, in turn, helps them manage the emotions related to depression, which are often overwhelming, debilitating, and prevent full recovery.

We’re now ready to talk about the last topic in this article: expressive therapies in depression treatment for teens.

Expressive Therapies for Depression Treatment

Expressive therapies in teen mental health treatment can help teens access difficult or uncomfortable emotions through an alternative route. Teens spend a great deal of time in treatment talking, which is an essential component of the therapeutic process. However, it’s important to recognize that speech is a left-brain activity. We use the rational, logical part of our brain to talk. Traumatic memories, on the other hand, are stored in the right hemisphere of the brain – the same hemisphere that’s responsible for artistic expression.

Therefore, expressive therapies can help teens encounter and enter into a dialogue with those emotions when talking is either insufficient or too painful. Teens in depression treatment will often participate in the following activities:

Drawing, painting, or other visual arts.

When teens draw or paint, they may express emotions or memories they didn’t know were there, which gives them a chance to explore those emotions.

Creative Writing.

Creative writing can help teens work out narratives from their lives in a fictional context: they often report the distance gives them clarity.

Music/Dance.

Music and dance have their own power to heal, boost mood, and reduce stress. A teen with severe depression may not have danced or enjoyed music in months. When they encounter music and dance in treatment, it can be like reuniting with an old friend.

Drama.

Exercises like role-playing, improvisation, and live storytelling can be cathartic for a teenager in treatment for depression. They may experience an emotional release while watching a peer act out a situation they understand completely, or they may develop a greater capacity for empathy when they act out a role they’re not familiar with. Both lessons help them learn and grow in recovery.

Another thing about expressive therapies is that they’re fun and rarely feel like work. And if we’re honest, therapy often feels like work because it is work. Expressive therapies allow teens to relax, let loose, and have fun while developing real recovery skills and gaining valuable insight about life in general and their mental health in particular.

Treatment for Teen Depression Works

Treatment for depression has come a long, long way in the past several decades. We’ve gone from stigmatizing people with mental health disorders like depression to understanding that the best way to approach a mental illness is the same way we approach a physical illness: with evidence-based treatment that’s customized to their specific needs and circumstances. It doesn’t make sense to shun people who get a physical illness, and it doesn’t make sense to shun a person who develops a mental illness.

What we do now – rather than stigmatize or shun – is seek to understand the person, their disorder, and how it developed. Then we identify the elements of their life that may contribute to the disorder. Then we address those when we develop a treatment plan. That’s the essence of the medical model as applied in the integrated treatment of mental health disorders. In a high-quality treatment program for teen depression, this approach helps teens manage their depression, heal, and move forward. The therapeutic modalities we identify – dialectical behavior therapy (DBT), motivational interviewing (MI), mindfulness, and expressive therapies – all help teens create a life of their choosing, rather than one dominated by the symptoms of depression.

Finding Help

If you’re seeking inpatient depression treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

The American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.