Cognitive behavior therapy in pediatrics. Dec 16; 5mrks.

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 CBT is problem oriented treatment centered on correcting problematic patterns of thinking & behavior that leads to emotional difficulties and functional impairments.

Core components & characteristics:

1. 60-90min session per week for 6-12 weeks

2. Symptom measures are collected frequently

3. Rx is goal oriented & collaborative c pt as active participant

4. Rx is focused on changing current problematic thoughts & behaviour

5. Weekly home work is typically assigned

Focused on identifying &

1. Changing cognitive distortions

• Learned helplessness

• Irrational fears

2. Avoid distressing situations

3. Practice distress reducing behavior

Key tools to facilitate achieving CBT goals

1. Self monitoring

• Daily thought record

2. Self instruction

• Brief sentences, asserting thoughts that are comforting & adaptive

3. Self reinforcement

• Rewarding oneself

CBT has good quality evidence in treatment of Anxiety , Depression, OCD , Behavior disorder , substance abuse , insomnia

For many childhood psychiatric disorders CBT alone is comparable to psychotropic medication alone and the combination may have additional benefits in symptom & harm reduction.

Modified versions are CBT are used such as

1. Trauma focused CBT

2. Dialectical behavior therapy

Trauma focused CBT (TF-CBT):

First line of Rx in PTSD (post traumatic stress disorder)

It is a combination of

1. Psychoeducation

• Teaching effective relaxation

• Affective modulation

• Cognitive copying & processing skills

2. Engaging in trauma narrative

3. Mastering trauma remainders

4. Enhancing future safety & development

Dialectical behaviour therapy:

Targeted at emotional & behavioral dysregulation due to integration of seemingly opposite strategies of acceptance & change.

Skill modules

1. Mindfulness

• Practice of being fully aware & present in the moment

2. Distress tolerance

• How to tolerate emotional pain

3. Interpersonal effectiveness

• How to maintain self respect

• Effective communication in relationship to others

4. Emotion regulation

• How to manage complex emotions

Order of priority in treatment targets:

• Life threatening behavior ( suicidal & self injurious behavior) > 

• therapy interfering behaviors ( late to session, canceling appointments, non collaborative towards achieving goals) > 

• quality of life behavior (relationship, occupational, financial) > 

• skills acquisition to achieve Rx goals