Modular CBT for Youth with Complex Needs

In recent years, there has been increasing empirical support for a flexible, modular approach to treatment that may serve to address therapists’ concerns about the limitations of standard CBT treatment manuals. Researchers have specifically tested the modularized design’s capability in treating youths with multiple presenting problems and complex backgrounds and needs. Because modular CBT allows for the individualization and adaptation of CBT to address the specific needs of a client, it arms clinicians with the skills necessary to effectively treat child and adolescent depression in a range of community mental health settings.

The Research

Results from a study in 2004 by Chorpita, Taylor, Francis, Moffitt, and Austin provided preliminary support for the efficacy of the modularized design when used to treat anxiety disorders in youth. In 2006, a modular approach to depression was developed and compared to psychotropic medication treatment; the investigators found that the combined treatment of modular CBT and SSRI (Selective Serotonin Reuptake Inhibitor) medication was superior to pharmacological treatment alone (March, Silva, Vitiello, & TADS team, 2006).

Based on his work in emotion science, David Barlow and colleagues (2011) developed a unified protocol that offered a transdiagnostic set of principles that therapists can apply to their clients. They combined several core concepts found in all evidence-based treatments for emotional disorders, included key principles for change (research-supported mechanisms for change, such as motivational enhancement to improve treatment engagement), and developed a modular approach that allows clinicians greater flexibility than typical manuals.

Barlow and colleagues’ Unified Protocol for Transdiagnostic Treatment of Emotional Disorders is primarily used with adults with emotional disorders; however, this modular approach has also been developed for children and adolescents, particularly in the areas of how parent-child relational problems and the family unit impact the child’s emotional experiences.

In 2012, Weisz and colleagues provided a direct comparison between standard and modular designs of CBT in a randomized effectiveness trial with youths presenting with depression, disruptive behaviors, and anxiety. They randomly assigned a total of 84 community therapists to usual care, standard manual treatment, and modular treatment. The therapists worked at ten different community-based clinics in Hawaii and Massachusetts and provided individual treatment (with families involved in treatment as needed). Notably, the researchers found that the modular approach outperformed usual care and standard evidence-based treatments on multiple clinical outcome measures. Therefore, Weisz and colleagues suggested that the modular approach was a promising avenue to improve on the assets of evidence-based treatments in order to increase treatment effectiveness for practical application in real-world settings.

Further, using the modular approach to CBT can enhance a therapist’s engagement in evidence-based practice. Evidence-based practice is about outcomes—being able to clearly link treatment practices with specific positive outcomes for the client and the family. For instance, if a therapist implements cognitive behavioral therapy with a child who has a significant intellectual disability and severe language delays, then this implementation would not be considered evidence-based practice (given that the client’s needs and characteristics should have informed the therapist that CBT is not an appropriate treatment).

In true evidence-based practice, the client’s needs, values, and preferences are taken into consideration and integrated into treatment planning. And this is precisely the method of the modular approach: the therapist considers the child’s needs and preferences along with other factors, and then selects and sequences the specific modules in a flexible and individualized manner that can lead to targeted positive outcomes for the client and family.

For more about modular CBT for youth, check out Modular CBT for Children and Adolescents with Depression by Katherine Nguyen Williams, PhD, and Brent Crandal, PhD.

References

March, J., Silva, S., Vitiello, B., & TADS team. (2006). The Treatment for Adolescents with Depression Study (TADS): Methods and message at 12 weeks. Journal of the American Academy of Child & Adolescent Psychiatry, 45(12), 1393–1403.

Chorpita, B. F., Taylor, A. A., Francis, S. E., Moffitt, C. E., & Austin, A. A. (2004). Efficacy of modular cognitive behavior therapy for childhood anxiety disorders. Behavior Therapy, 35, 263–287.

Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Allen, L. B., & Ehrenreich-May, J. T. (2011). The unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. New York, NY: Oxford University Press.

Weisz, J. R., & Chorpita, B. F. (2012). Mod squad for child psychotherapy: Restructuring evidence-based treatment for clinical practice. In P. C. Kendall (Ed.), Child and adolescent therapy: Cognitive-behavioral procedures (Fourth Edition, pp. 379–397). New York: Guilford Press.