Cognitive Behavioral Therapy for Children

It was really inspiring to hear from the Edison Learning team about their program. They developed an entire online learning system from the ground up, and they are still planning and implementing new ideas. With my own project for the class, I'm inspired to move beyond the summaries and readings, and take the next step into developing a solution.

To help clinically depressed children, I could focus on prevention by promoting activities like healthy eating and lots of outdoor exercise. Or I could develop a system for treating existing depression, based on established therapy techniques. In order to focus my project specifically on the marginalized population (children with depression), I'd like to tackle treatment options first, and see what I can find.

I wanted to take a look at cognitive behavioral therapy, or CBT, which is one of the most widely used treatment methods for clinical depression. In fact, CBT has been used successfully with children, and it is often recommended for various mental health disorders in young kids and adolescents. Although there is no specific protocol for CBT (it refers to a wide umbrella of treatments), it tends to rely on several key principles:

• Systematic and goal-oriented
• Time-limited treatments
• Focus on here and now
• Focus on alleviating symptoms

If you think about it, many of these characteristics make CBT a natural choice for mobile or web-based interfaces. Its goal-oriented nature can be channeled into games or directed puzzles, much as Edison's goal-oriented modules direct students toward understanding of a particular concept. Time limits are easily placed on computer-based activities, and many computer programs have a here-and-now focus. Plus, with an emphasis on alleviating symptoms, progress can be concrete and measurable.

In terms of the ABCD approach we learned in class, I found an interesting set of specific behavioral goals from the American Institute for Cognitive Therapy. After completing therapy, children should be able to:

• Recognize and modify irrational and self-deprecating thoughts.
• Adopt more appropriate and/or positive responses to their own and others’ thoughts and feelings.
• Improve listening, social, and problem-solving skills.
• Plan positive/pleasant individual and social activities.

Here are a few techniques used in CBT that could be easily translated to the web:

- Keeping a diary of events and feelings: The web is already a useful tool for journaling and recording thoughts, and it would be an interesting challenge to develop an online journaling system specifically for managing childhood depression.

- Questioning assumptions and beliefs: People learn many cognitive skills from the Internet, including critical thinking and questioning what they see. I could imagine a game based on rejecting beliefs that don't make sense, and accepting ones that do.

- Gradually facing avoided activities: People often use their mobile devices to set reminders for themselves or plan activities. Perhaps an application could be designed to systematically propose new activities (such as exercise or social interaction), gradually encouraging the child to try them for a reward.

- Relaxation, mindfulness, distraction: Stress management is a big part of both prevention and treatment for depression. There are hundreds of stress management programs online, and along with soothing video and audio collections designed to enhance relaxation. I wonder if I could design a web-based relaxation system especially for children.

As it turns out, there are already a few computer-based therapy programs, collectively referred to as Computerized Cognitive Behavioral Therapy (CCBT). These programs have the advantage of being less intimidating than talking to a therapist, less expensive than paying for sessions, and more accessible for people who would have trouble getting to a doctor's office. Children often fit these criteria very well, having little to no disposable income and not much personal freedom without their parents. The National Institute for Health and Clinical Excellence (NICE) has described a set of guidelines for using CCBT, and preliminary studies have suggested that it can be a successful supplement to existing treatment programs.

Computerized therapy initiatives have been developed for a number of mental disorders. Specifically for depression, NICE recommends a program known as "Beating the Blues," which consists of 8 sessions of self-help treatments. The program is described as follows:

"They work through cognitive modules which focus on the identification and challenge of automatic thoughts, thinking errors, distractions, core beliefs and attributional styles. Interwoven with these cognitive elements are problem directed behavioural components where patients can work on any two of activity scheduling, problem solving, graded exposure, task breakdown or sleep management according to their specific problems. The final module looks at action planning and relapse prevention."

Although I can't access Beating the Blues without making a payment and performing a screening over the phone, I might send an email to request access for my project, because I'm curious as to how the program works. There's also a free program called Mood Gym, which I'd like to check out as well.

To develop my next artifact, I'd like to take advantage of the principles of cognitive behavioral therapy to reach out to children, especially those who want help but aren't seeing a therapist yet. I'd like for my web-based system to emphasize education: teaching kids the skills they need to manage depression. Hopefully I can pull inspiration from Edison Learning and other online educational programs to make an effective treatment tool.