Therapy for Teenage Depression: Understanding CBT, DBT, and Motivational Interviewing 

Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Motivational Interviewing (MI) Help Teens Live Life on Their Terms

If you’re the parent of a teen diagnosed with a depressive disorder, you know that depression can have a major impact on their day-to-day life. The symptoms of depression can be so severe they may cause a teen to lose the drive, desire, and ability to initiate or follow through with the most basic daily activities. From attending to personal hygiene, to engaging in family life, to meeting academic expectations and responsibilities, to participating in social events or extracurricular activities, a serious depressive disorder can be debilitating on all fronts.

One way to look at it is that a major depressive disorder can keep a teen from being a teen. That’s why you – or any parent of a teen with depression – want to help them rediscover what being a teen means for them. You want them to reconnect to the things that bring them joy, fulfillment, and hope for the future. And that’s why you want to find the best treatment and support for your teenager. Which means you need to know what types of therapy for teenage depression are proven effective by the latest scientific and clinical research.

There are several types of psychotherapy that reliable evidence shows are effective and can help adolescents successfully manage the symptoms of depression and live a life without significant daily disruption. The exact criteria for what makes a therapeutic technique effective and successful vary for each person. However, for the purposes of this article, we’ll define effective, successful therapy for teenage depression by assessing how well that therapy reduces the frequency, duration, and intensity of depressive symptoms for a teenager in treatment – and helps them reconnect with their vision of what being a teenager is all about.
We’ll start with the big picture:

Any treatment for depression will be more effective when it’s delivered in the context of the integrated treatment model.

Integrated Treatment and Teenage Depression

Research shows that integrated treatment, which includes a balance of individual therapy, group therapy, community support, lifestyle modifications, experiential therapies, and in some cases, medication, creates the optimal conditions for a successful recovery and ongoing, sustainable management of depressive symptoms.

This article will focus on the individual and group therapy component(s) of integrated treatment. Specifically, we’ll discuss the types of therapy we mention in the title:

• Cognitive Behavioral Therapy (CBT) for teen depression
• Dialectical Behavior Therapy (DBT) for teen depression
• Motivational Interviewing (MI) for teen depression

For an overview of the approaches common to integrated treatment programs, click here. To learn about community support for adolescents, click here. To learn about the role of lifestyle modifications in therapy for teen depression, click here. For more on the role of experiential approaches in depression treatment, click here for yoga, click here for qigong, click here for art therapy, and click here to learn about the origins of experiential education and experiential therapies in general.

The Role of Therapy in Depression Treatment

With regards to individual and group therapy for depression treatment, what we mean is what most people think of when they hear the word therapy: talk therapy. That’s the simplest way to put it. It’s not all talk, though. Sometimes it involves homework. Sometimes it involves role playing with therapists or peers. And sometimes it involves exercises or activities that go beyond sitting in a group or an office and talking.

With that said, talking things through with therapists and peers is the foundation of the three approaches to therapy we’ll discuss. Open and honest communication creates behavioral change. Because although talk helps, one important thing to understand is that it’s difficult to talk your way into recovery. Most experts agree that talk gets the ball rolling. But what’s essential is to act or behave your way into recovery.

Before we get into the details of CBT, DBT, and MI, we’ll outline the prevalence of diagnosed depression among teenagers in the U.S. This helps frame this discussion in two ways. First, it defines the scope of the issue: are we talking about hundreds, thousands, or millions of teens? Hint: it’s not hundreds or thousands. Second, it helps families and teens understand that when they choose to seek treatment and support for depression, they are not alone.

That means that you, the parent reading this, and your teen, diagnoses with depression, are not alone. There are families – right now, this very moment – working their way through a series of similar challenges and making decisions not unlike the one you’re working toward now. That’s the decision we want to help you with by explaining how CBT, DBT, and MI can help your teen.

But first, the statistics.

Depression in Teens: Facts and Figures

Here’s the data from the  2019 National Survey on Drug Use and Health (NSDUH) on rates of depression and mental health treatment. This is the latest available national data on depression among teens in the U.S. It’s based on data from 67,625 completed interviews with adolescents age 12-17. That sample size means that we can make reasonable generalizations – based on statistical analysis – that accurately reflect the rates of depression and depression treatment among teenagers in the U.S.

Prevalence of Teen Depression and Treatment: United States (2019)

• 3.8 million adolescents had major depressive disorder (MDD)
• 1.6 million adolescents got treatment for MDD
• 601,000 adolescents got treatment for an MDD with severe impairment

Prevalence of Teen Depression: United States (2019) By Age

• 13-14: 8.4%
• 15-16: 12.6%
• 17-18: 15.4%
• Females age 13-18: 15.9%
• Males age 13-18: 7.7%
• With severe impairment, female and male, age 13-18: 8.7%

The main takeaways from this data are that millions of teens each year are diagnosed with depression and that 25 percent of teens diagnosed with depression don’t get the treatment and support they need. That translates to about two million teens in need of treatment – which we call the treatment gap – but there’s a flipside to that. There are also at least six million teens each year who seek treatment for depression, which drives home a point we made above: if you’re seeking therapy for your teenager with depression, you yourself may be in uncharted territory, but the territory itself not uncharted.

The three therapies we’ll discuss next can be part of your teen’s roadmap to recovery.

Therapy for Adolescent Depression: Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Motivational Interviewing (MI)

We’ll start with CBT, then move to DBT, and finish with MI.

Cognitive Behavioral Therapy (CBT)

The National Alliance on Mental Illness (NAMI) describes CBT in this way:

“By exploring patterns of thinking that lead to self-destructive actions and the beliefs that direct these thoughts, people with mental illness can modify their patterns of thinking to improve coping.”

CBT’s core philosophy is that thought is connected to behavior. According to CBT, individuals subscribe to specific beliefs about themselves, others people, and events that may happen in the future. These preconceived notions result in automatic patterns of thought that arise in emotionally challenging or stressful situations. For a teenager with a depressive disorder, these automatic thoughts are frequently negative, maladaptive, or generally unhelpful.

In CBT, these automatic thought patterns are known as cognitive distortions.

Cognitive distortions may include the following:

• Catastrophizing
• Overgeneralizing
• Magnification (exaggerating the negative)
• Minimalization (minimizing the positive)

The CBT therapist’s job is to help teenagers replace cognitive distortions with more accurate and productive patterns of thought. The CBT philosophy, in summary, is that if you have embedded patterns of thought that make you feel and behave in ways that aren’t what you want, then the way to change your feelings and behavior is to change those patterns of thought. CBT connects thought, feeling, and behavior in a way that allows teens to make those changes and start the path to recovery.

Dialectical Behavior Therapy (DBT)

Created by Dr. Marsha Linehan in the 1980s, close to four decades of clinical and experimental data confirm the effectiveness of DBT as a therapy for teenage depression. Adolescent-specific DBT programs include five core modules that revolve around developing specific skills to help teens manage anxiety and depression.

The Core Modules of Adolescent DBT

1. Mindfulness. 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, including:
   • Accepting the world as it is, without judging or trying to change it.
   • Understanding it’s possible to see every situation from more than one point of view.
   • Validating other people’s point of view about a situation or circumstance.
   • Validating their own point of view about a situation or circumstance.
   • Believing 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 are the core pillars of DBT. Therapists use them during individual sessions, group sessions, and one-on-one coaching during crises. Dr. Linehan and the therapists and clinicians who use DBT in adolescent DBT programs around the world say the goal of DBT is to help adolescents create “A life worth living.”

Motivational Interviewing (MI)

Psychologists William Miller and Stephen Rollnick created MI in the early 1980s while treating patients with drug and alcohol addiction. In the 80s, clinicians often employed therapeutic approaches that are completely different than those that are common now. Many used an antagonistic, confrontational style of interaction with patients to convince them to change their behavior. However, Miller quickly discovered that empathy – as opposed to argumentation and confrontation – was a far more effective strategy for most of his patients.

If you’re the parent of a teenager, you probably know from personal experience that confrontation with a teenager can easily backfire and that if you find yourself arguing with your teenage child, that likely means you’ve already lost that argument – simply by allowing it to take place.

Empathy and understanding are far more effective tools of communication and led Miller and Rollnick to define four pillars that comprise the spirit of MI: partnership, acceptance, compassion, and evocation. In turn, those four pillars led to the four principles of MI: express empathy, develop discrepancy, roll with resistance, and support self-efficacy.

To read about the spirit of MI and the four pillars of MI in detail, please read this article here.

During therapy for teenage depression, a skilled MI clinician applies the MI process in four steps. The goal of the steps is to resolve any hesitancy about making the personal and behavioral changes necessary to overcome depression.

Here are the steps:

1. Engaging

The MI therapist and the teen build a relationship built on respect and trust. Without respect and trust, teens are unlikely to discuss their emotions freely. MI therapists intentionally create a safe and accepting environment. They avoid taking the attitude of an expert with perfect answers for all the problems or challenging emotions the teen faces.

2. Focusing

Next, the MI therapist and teen decide on the issue or issues they want to address. Together, they create a plan for the therapeutic process. A simple focus helps the therapist and teen maintain forward movement. An MI therapist will nudge a teen toward a particular area of change or suggest possible decisions about the issues they address. When teens know exactly what they want to work on or arrive at reasonable conclusions or solutions themselves, the MI therapist follows their lead.

3. Evoking

After the MI therapist and teen decide what to address, they shift to talking about why the teen needs to resolve the behavior or issue in question. The job of the therapist at this stage is to lead the teen toward change talk. MI therapists define change talk as “speech that favors movement in the direction of change.”

4. Planning

The final stage of MI therapy creating a roadmap for how the teen will implement change in their life. The therapist and teen collaborate on a change plan that’s achievable and includes measurable milestones. They set a goal for when they want the changes to happen. By this point in MI therapy, a teen is often fully motivated to implement the change plan.

Keys to Success: Agency, Empowerment, and Ownership

There’s a thread that unites these three different approaches to therapy for teenage depression: empowerment. Each technique – CBT, DBT, and MI – make the agent of change in the therapeutic process the teenager themselves. Therapists in each format guide a teenager, offer suggestions, teach techniques, and offer a menu of potential options for managing depressive symptoms. Some of the skills and concepts will work for some teens, while some will work for others. A one-size-fits-all cure for depression does not exist – and these three approaches acknowledge and embrace that fact. Each of these approaches allows a teen to build – by choice – an array of tools from which they can choose to meet each distinct challenge they face.

If you’re the parent of a teen, you know that when they have a say in what they do, have a voice in the important discussions about their lives, and have a choice among several options about how they will manage their lives, they’re more likely to agree on a plan and commit to making it happen. CBT, DBT, and MI allow your teen to do just that. All three will take work, it’s true. But if your teen is willing to do that work, they can change their lives for the better. Equipped with the skills and concepts they learn during these different therapies, your teenager can manage their depression and rebuild their lives according to their wants, needs, and their personal, distinct, and unique vision of the present and future.