Cognitive-Behavioral Treatments for Depression in Children: The Impact of Case Formulation on Treatment Selection

Abstract

Cognitive-behavioral treatments are the most well-documented, and apparently most effective, treatments for childhood depression. Efforts to translate these findings to clinical practice are thwarted by the large number of strategies (and sessions) included in empirically supported treatment packages and a lack of guidance regarding differential selection of strategies. The aim of this study was to determine the impact of case formulation on the selection of individual treatments for childhood depression. Two hundred thirty-seven Ph.D.-level mental health professionals with knowledge of behavioral and/or cognitive behavioral theory and practice were recruited via e-mail to participate in this study. Candidates were asked to indicate the likelihood that they would select each of 9 cognitive-behavioral treatments based on one of twelve fictional vignettes. The vignettes were designed to represent children of ages 6, 10, and 14, and presenting with depression based on Cognitive Distortion, Social Skills Deficit, or Environmental Deficit etiologies. Three "Control" vignettes, in which the age of the child was varied but no case formulation was provided, were also included. Our results provide confirmation that case formulation is an important step in the treatment of childhood disorder. Participants successfully matched cognitive treatments to cognitive etiologies, social skills treatments to social skills deficit etiologies, and environmental treatments to environmental deficit etiologies of childhood depression. Differences in treatment selection were also noted with regard to age of the child being treated, in a manner consistent with developmental theory. Here, we have confirmed that the case formulation approach is useful in the differential selection of empirically supported cognitive-behavioral treatments for childhood depression.