Anxiety, Depression, and Somatic Distress: Developing a Transdiagnostic Internalizing Toolbox for Pediatric Practice☆
Highlights
► We review theory and literature on youth anxiety, depression, and somatic complaints. ► Rationale presented for transdiagnostic psychosocial intervention for these problems. ► Present development of two such transdiagnostic protocols, with case examples. ► Discuss protocols in relation to future research and clinical use.
Section snippets
Prevalence and Impact
Separately and in conjunction, youth anxiety, depression, and somatic symptoms are distressing, disabling, and prevalent (e.g., Campo, Bridge, et al., 2004, Bell-Dolan et al., 1990, Lewinsohn et al., 1993, Scharff, 1997, Walker et al., 1993). In the pediatric population, prevalence of anxiety is estimated to be as high as 20% (Bell-Dolan et al., 1990), depression estimates reach up to 25% (Lewinsohn et al., 1993), and rates of impairing somatic complaints vary from 7% to 25% (e.g., recurrent
Evidence for Transdiagnostic Processes From the Psychopathology Literature
The strong evidence for nonrandom associations between pediatric anxiety, depressive, and functional somatic distress raises questions about the nature of the observed comorbidity. Current theories of the development and maintenance of each of these problem areas focus on the interplay between (a) biological sensitivity to life stress, (b) heightened anticipation and experience of pain and emotional distress, (c) maladaptive cognitions and poor problem solving, and (d) behavioral inhibition and
Evidence for Transdiagnostic Processes From the Treatment Literature
Most evidence-based treatments for youth have been designed to treat specific, single disorders; however, even within this literature, there are glimmers of support for a transdiagnostic treatment approach. The best evidence comes from studies on the positive response of all three problems to cognitive behavioral therapy (CBT) and to selective serotonin-reuptake inhibitors (SSRIs).
Developing a Transdiagnostic Treatment Approach
In our work, we have begun developing a psychosocial internalizing toolbox to treat this cluster of related problems. In this next section, we briefly review our rationale for focusing on psychosocial treatment and our progress to date in manual development and pilot testing.
Clinical Case Examples1
Two cases are presented here to illustrate application of the above-described interventions in the pediatric primary care setting.2
Future Directions
In this report, we describe our group's efforts to develop an internalizing toolbox for youths struggling with anxiety, depression, and/or somatic symptoms. At this point, our work has coalesced into two parallel protocols—one targeting the “emotional cluster” of anxiety and depression, and one targeting the “physical cluster” of anxious arousal and somatic symptoms. This two-protocol distinction, however, hides considerable overlap in the practical implementation of our treatments. As
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2020, Journal of the American Academy of Child and Adolescent PsychiatryCitation Excerpt :Written assent and consent from youths and parents was obtained in accordance with procedures approved by the Institutional Review Boards of the University of Pittsburgh, Kaiser Permanente Southern California, and the San Diego State University Human Research Protection Program. As noted above, Brief Behavioral Therapy (BBT) is a transdiagnostic intervention designed to address depression, anxiety, and their co-occurrence.12,21 BBT consists of psychoeducation about depression and anxiety for parents and youths, “graded engagement” through exposure and behavioral activation to avoided (and consequential) activities, along with relaxation to manage somatic symptoms and problem-solving skills for stress management.
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Data collection and manuscript preparation were facilitated by support from the National Institute of Mental Health, the Robert Wood Johnson Foundation, and the William T. Grant Foundation. We gratefully acknowledge the following colleagues who aided in the conduct of these studies: Araceli Gonzalez, Carrie Fascetti, Jennifer Strohm, Sheree Shafer, Fallon Gallatin, Steve Savorelli, and Erin Warnick.