Depression among adolescents is a rising problem in the United States. The National Institute of Mental Health reports that about 11 percent of children suffer from a depressive disorder by the time they are 18, and it often goes undetected unless the child loses control. Depression is also the leading cause of disability worldwide and statistically affects more women globally than men. Treating depression and teaching teens positive coping skills early in life is key to reversing this unfortunate trend. Some common behaviors that depressed teens exhibit are:
- Running away from home more than once
- Uncontrollable rage and aggression
- Rebelliousness and disobedience
- Substance abuse (alcohol and drug)
- Sexual encounters
- Poor grades/school relationship
- Self destructive behavior
- Overwhelming fear
- Withdrawal from people
- Weight gain or loss
- Insomnia or excessive sleep
- Constant fatigue
- Lack of emotions
- Concentration problems
The prescription of antidepressant drugs to individuals under the age of 18 and the increased use of complementary and therapeutic modalities has spurned a significant amount of scholarly reflection on these principles. There are clear advantages in creating an integrative plan that is grounded in the structure of the traditional counseling framework and that weaves in alternative modalities. The movement towards holistic healing is one that embraces all of the multifaceted layers of the human psyche, while simultaneously considering the adolescent as a whole person. This holistic integrative model will allow for the most effective combinations of physical, mental, emotional, and spiritual treatment options for adolescents experiencing varying stages of depressive symptoms.
Prevention is Key
A current review of treatment programs for depression has shown that currently, preventative measures to treat depression are the most effective. There are traditionally two different approaches to preventative programs for depression; universal programs and selective prevention programs.
A universal program is typically implemented in a school setting and uses large group presentation. This approach allows a large number of adolescents to be reached for a minimal cost. A selective prevention program has been proven to be more effective overall due to screening for applicants. Selective preventative programs screen teens and target high risk groups such as: female adolescents, adolescents with a depressed parent, adolescents exhibiting depressive symptoms, adolescents living in poverty, or adolescents with exposure to stressors such as divorce or a death.
An ideal prevention program addresses negative thinking identification, interpersonal and intrapersonal relationships and stress management with relaxation exercises, emotion focused coping, goal setting and decision making. A prevention program should also focus on family environment. Education and counseling should be available to parents in areas of stress management, information on adolescent development and strategies to promote balance and harmony in the home. Ideally, a depression prevention program should investigate different combinations of modalities that address the cognitive, behavioral, emotional, physical, cultural and spiritual layers of the adolescent and the parents.
Cognitive Behavioral Therapy
At the heart of Cognitive Behavioral Therapy is a systematic plan to learn and understand cognitive and behavioral responses and reactions. Many CBT programs call for an initial evaluation using a diagnostic tool such as the Beck Depression Inventory. After this evaluation the program generally follows anywhere from 5-18 weekly sessions in which the therapist practices with the client skills such as mastering behavioral symptoms, taking action on procrastination, mastering feelings and symptoms, negative thought stopping, challenging beliefs, practice and planning for the future. In each session the client talks with the therapist, learns and possibly practices new techniques. Homework is assigned for each session that the client is expected to complete. The goal of these sessions is to be free of symptoms and to gain the skills for the future to prevent the feelings and behaviors that cause depression.
This approach serves as an excellent framework upon which to integrate alternative modalities. There have also been several CBT – based programs to treat youth with depression that all address the parental role and integrate relaxation training, anger management and social skills training. Interventions are held in individual and group formats and often include the family. Several methods are used in the parenting portion of the program; parents are taught effective forms of discipline, anger management, and negative thought stopping. Interventions also take place with the entire family and includes negotiation, conflict resolution skills and family communication. The successes of these programs indicate the strength of a program that addresses the adolescent holistically. The alternative modalities below have been selected to support and strengthen the skeletal framework of the cognitive behavioral therapy approach.
There has been revolutionary work done in emotional clearing and transformation using energy psychology and these approaches are non-invasive and have no side effects. This work is built upon the underlying principles of quantum healing. The word quantum describes a, “discrete jump from one level of functioning to a higher level”. Quantum Healing is an approach that examines the role of consciousness in the healing process. Quantum Healing is a holistic approach that asserts that we have a mind of many layers that includes our overall personality, subconscious, attitudes and deepest beliefs in addition to our cognitive and behavioral processes. Quantum healing suggests that this it is this multilayered mind, that all of our dis-ease stems from. Energy psychology examines this multilayered mind and the energy that is within it and that surrounds it as a way to therapeutically treat individuals with depression.
Energy psychology originated in the 1980’s as a way to apply the principles of acupuncture to psychology. The science of acupuncture stems from ancient Chinese healing systems that determined that we all have unseen meridians of energy running through out entire body. These meridians all hold points of release for both physical and emotional stuck energy. Energetic practices use less invasive procedures such as tapping or massaging specific points on the surface of the skin. Energy psychology builds upon and can be used in combination with conventional psychotherapies. This is because every emotion we experience causes a reaction in a specific part of our brains. If we recognize a similarity between a distressing situation from the past and what is occurring in the moment, even if there is no current danger, the same feelings can arise. These emotional reactions can often seem overwhelming and unexplainable. These old emotional reactions that are triggered in a present situation are at the heart of the negative thoughts that feed depression. It is in this place of understanding that it is possible to teach individuals to shift the energies of their emotions. Our bodies are part of of an invisible field of energy that travel through pathways and energy centers is connected to every cell and organ in our body, and in turn connected to our thoughts and emotions. Energy psychology shows how one can stimulate certain points on the skin to send electromagnetic impulse to your brain that you can then harness to shift your brain’s response to the situation. These acupressure points can also be stimulated and used therapeutically to help increase positive thoughts and goal setting.
Hypnosis has been effectively integrated with cognitive behavioral therapies for the treatment of depression. The very nature of adolescence is the unfolding of how the body and mind work together. The clinical use of hypnosis bridges both the physiological and psychological layers of the adolescent’s psyche. Through the use of suggestion to the subconscious chemical patterns begin to change in the brain. Hypnosis can be used as a tool to bring this awareness to the adolescent and lead them to their own understanding of what is happening to them and how to feel better. In current hypnotherapy programs that treat depression, adolescents are taught self-hypnotic and self-regulation techniques to regulate anxiety, insomnia, and depressive thoughts. Hypnotic techniques are taught that help the adolescent to identify and characterize their feelings and behaviors and to promote the self efficacy necessary for maturation. Pacing is important with this approach, meeting the adolescent where he or she is and letting them know that they are exactly where they need to be. These techniques need to be utilized with careful observation and attention to verbal and nonverbal cues such as breathing, body movements and facial expressions.
Teachers of ancient spiritual wisdom have always known that meditation is the cure to many ailments within our physical, mental and spiritual bodies. However, western science has only recently began to research meditation as a possible piece of the wellness puzzle. Recent studies have pointed to meditation as an effective treatment for many of the symptoms of depression. Students who were enrolled in a six week meditation class exhibited less physiological stress when presented with a stressful situation then students who were not enrolled in the class.
Giving Teens Control
These holistic modalities strengthen an internal locus of control. Research demonstrates that coping skills and resilience are improved when a child feels as though they have an internal locus of control. As therapists, parents and teachers we must take a leap of faith and trust that each adolescent has within them everything they need in order to heal themselves completely. We must trust that each adolescent has an internal guidance system, that, when they can learn how to listen to, can be a tool for transformative physical, mental and emotional self-healing. Teaching and modeling these holistic modalities gives adolescents with depression a new center to focus on. Once a therapist, the school and parents have stepped in to help to treat the depression, in many ways, the power has been taken from the adolescent. They feel that they do not have control over the depression; the depression has control over them. The locus of control is externalized. This causes a loss of self efficacy and alienation. Through the introduction of holistic modalities adolescents can regain that internal locus of control, reconnect with their internal guidance system and start to guide themselves in the direction of happiness.
In order to insure this happiness is supported in the home life of the adolescent, parental involvement in the process is instrumental. Developmentally, adolescents need to continue to increase their autonomy as they grow older. Therefore, working with the parents of adolescents in a therapeutic setting requires the therapist to understand the importance of the parent’s role in letting their child become the master of their own emotions, behaviors and actions. This is extremely important, because parental reminders, nagging and over involvement negates the autonomy that is necessary for the habits of self-efficacy and self-regulation to develop.
The common co-occurring disorders such as anxiety disorder, disruptive behavior disorders, and substance abuse disorder as well as anger management, stress management, and conflict resolution can all be addressed using a holistic treatment program for depressed adolescents using similar structures.
At this time the most effective approach to treating this mental health epidemic in our county is to embrace a combination of therapeutic theories, strategies and techniques that consider the multiple layers of energy that make up all human beings. It is also essential to educate the mainstream population about these alternative healing modalities.
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Overcoming depression: A cognitive-behavior protocol for the treatment of depression; Emery, G.
The Promise of Energy Psychology: Revolutionary Tools for Dramatic Personal Change; Feinstein, D, Eden, D., Craig, G.
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The Greater Good Science Center at the University of California Berkley