Research Review: The internalizing paradox - youth anxiety and depression symptoms, psychotherapy outcomes, and implications for research and practice.
Children
adolescents
anxiety
depression
internalizing
psychotherapy
youth
Journal
Journal of child psychology and psychiatry, and allied disciplines
ISSN: 1469-7610
Titre abrégé: J Child Psychol Psychiatry
Pays: England
ID NLM: 0375361
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
accepted:
28
03
2023
pmc-release:
24
11
2024
medline:
29
11
2023
pubmed:
24
5
2023
entrez:
24
5
2023
Statut:
ppublish
Résumé
Youth anxiety and depression have long been combined within the empirically derived internalizing syndrome. The two conditions show substantial comorbidity, symptom co-occurrence, and overlap in treatment procedures, but paradoxically diverge in psychotherapy outcomes: strong, positive effects for anxiety and weak effects for depression. Drawing on recent research, we examine candidate explanations for this paradox to help identify strategies for addressing it by improving outcomes for youth depression. Candidate explanations include that youth depression, compared with youth anxiety, has more varied comorbidities and more heterogeneous symptom combinations, has greater uncertainty regarding mediators and mechanisms of change, is treated with more complex and potentially confusing protocols, and has characteristics that may impede client engagement. Candidate strategies for shrinking the psychotherapy effectiveness gap include personalizing through transdiagnostic modular treatment, simplifying therapy by focusing on empirically supported principles of change, developing effective strategies for engaging family members as intervention allies, using shared decision-making to inform clinical decisions and boost client engagement, capitalizing on youth-friendly technological advances, and shortening and digitizing treatments to enhance their accessibility and appeal. Recent advances suggest explanations for the internalizing paradox, which in turn suggest strategies for shrinking the youth anxiety-depression psychotherapy outcome gap; these form an agenda for a promising new era of research.
Sections du résumé
BACKGROUND
BACKGROUND
Youth anxiety and depression have long been combined within the empirically derived internalizing syndrome. The two conditions show substantial comorbidity, symptom co-occurrence, and overlap in treatment procedures, but paradoxically diverge in psychotherapy outcomes: strong, positive effects for anxiety and weak effects for depression.
METHODS
METHODS
Drawing on recent research, we examine candidate explanations for this paradox to help identify strategies for addressing it by improving outcomes for youth depression.
RESULTS
RESULTS
Candidate explanations include that youth depression, compared with youth anxiety, has more varied comorbidities and more heterogeneous symptom combinations, has greater uncertainty regarding mediators and mechanisms of change, is treated with more complex and potentially confusing protocols, and has characteristics that may impede client engagement. Candidate strategies for shrinking the psychotherapy effectiveness gap include personalizing through transdiagnostic modular treatment, simplifying therapy by focusing on empirically supported principles of change, developing effective strategies for engaging family members as intervention allies, using shared decision-making to inform clinical decisions and boost client engagement, capitalizing on youth-friendly technological advances, and shortening and digitizing treatments to enhance their accessibility and appeal.
CONCLUSIONS
CONCLUSIONS
Recent advances suggest explanations for the internalizing paradox, which in turn suggest strategies for shrinking the youth anxiety-depression psychotherapy outcome gap; these form an agenda for a promising new era of research.
Identifiants
pubmed: 37222162
doi: 10.1111/jcpp.13820
pmc: PMC10667566
mid: NIHMS1901389
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1720-1734Subventions
Organisme : NIMH NIH HHS
ID : F31 MH127862
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH124965
Pays : United States
Organisme : NIMH NIH HHS
ID : R21 MH126394
Pays : United States
Organisme : NIMH NIH HHS
ID : 1R21MH126394-01
Pays : United States
Organisme : NIMH NIH HHS
ID : 1R21MH126394-01
Pays : United States
Organisme : NIMH NIH HHS
ID : F31 MH127862
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH124965
Pays : United States
Organisme : TWCF
Pays : United States
Informations de copyright
© 2023 Association for Child and Adolescent Mental Health.
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