In the first part of this series, we explored the various types of mental health providers and their roles in supporting children, teens, and young adults. Now that we have a clearer understanding of who provides care, it’s time to focus on the treatments themselves. In this post, we’ll dive into five evidence-based mental health treatments proven to be effective for young people. These approaches are grounded in research and can make a significant difference in managing anxiety, OCD, and other mental health concerns. Let’s take a closer look at how these therapies work.
- Cognitive-behavioral therapy or CBT: CBT is a present-focused therapy that teaches individuals to first make connections between their thoughts, feelings, and behaviors and, second, to challenge thoughts and behaviors that contribute to unhealthy life patterns. CBT has become much more popular in the past few decades as more universities and residencies train providers, relying on abundant research that shows it works. Several research studies provide support for that. (Walkup et al., 2008; Higa-McMillan, Francis, Rith-Najarian, & Chorpita, 2016).
CBT can be helpful for many mental health disorders, particularly anxiety and depression. Exposing a person to the triggers of their fears makes up a key component of CBT for anxiety disorders. The exposure strategy helps to reduce the physical part of anxiety. It also teaches patients that the triggers of their anxiety are not dangerous. Ultimately, patients develop ways to handle the triggers and the anxiety: they learn to cope. For example, suppose a child or teen is afraid to drive. In that case, exposure might start with them watching car videos or observing other people drive and then move to have them drive short distances with other passengers near their home and then build to having them drive longer distances independently).
- Exposure and Response Prevention or ERP: ERP is widely known as the most effective approach to managing and overcoming obsessive-compulsive disorder. Obsessive-compulsive disorder involves having repetitive, upsetting thoughts (i.e., obsessions) and then using rituals to neutralize the upset so the thoughts temporarily go away (i.e., compulsions). The exposure component (the E) targets obsessive thoughts. It has the patient slowly come into contact with the things or situations they fear, including sometimes continuing to think about these ideas without distracting the mind. The response prevention component (the RP) then has the patient gradually decrease and eventually completely stop the ritual behaviors. For example, if a children or teens have the thought, “I won’t be able to focus on anything else if my room is not the way I like it right now,” ERP might focus on disturbing the order of their room and having them not clean up or re-organize while sitting in the room for perhaps 45 minutes with all attention on the messiness of the room.
- Habit Reversal Therapy or HRT: HRT provides help for tic disorders and other actions focused on parts of the body like repetitive hair-pulling (trichotillomania) and skin-picking (excoriation). Tics are involuntary movements that may be physical (such as eye blinking) or vocal (repeating phrases from a TV character). Additional examples of motor tics include shoulder shrugging or facial grimacing. Vocal tics can include humming, repetitive swearing, or throat clearing). Typically, individuals who experience tics know they are coming through feelings like body tension. Body-focused repetitive behaviors commonly involve an urge to pull hair or pick the skin before doing so. Habit reversal therapy teaches someone to do a different behavior that “competes” with the pulling or picking right when they start to have the urge to pull or pick. The “competing” behavior makes pulling hair or picking the skin difficult. For example, a competing response for shoulder shrugging might be pulling your shoulders down or crossing your arms behind your back.
- Dialectical Behavior Therapy, or DBT: DBT focuses on managing intense emotions and behaviors and improving relationships with others. It teaches skills for managing those emotions and unhealthy behaviors. It has been particularly successful in treating issues with intense, hard-to-regulate emotions, unstable feelings, and self-harming behaviors (such as cutting oneself). The term “dialectical” highlights that there is often a tension between two opposing things (e.g., it is possible to be trying your best and have room to do better at the same time), and those seemingly opposite things can both be true simultaneously. A “dialectical” underlying belief can be used to develop a new, self-accepting perspective and find a middle path (for example, between emotional thinking and logical thinking, accepting both as a wiser way of looking at things). DBT focuses on accepting things as they are and affirming an individual’s point of view and emotions, using skills such as mindfulness (focusing on the present moment rather than the past or future), doing the opposite of what you feel (talking to your parents rather than feeling like isolating), communicating your needs more clearly (rather than shutting down or yelling at someone). DBT typically consists of one-on-one meetings with a therapist and participation in a group to learn and practice skills like managing emotions, communicating needs, and staying present in the moment.
- Acceptance and Commitment Therapy or ACT: ACT (said like the verb “to act”) is a newer type of CBT that takes a different approach to thoughts and behaviors. ACT focuses on being flexible in your thinking rather than directly challenging thoughts. ACT also works on committing to act in ways aligned with what’s important to you (i.e., your values). ACT also uses exposure to encourage patients to gradually do the things they fear, especially when doing those things means living according to what matters most to them. For example, a children or teens who fear public speaking but wants to teach others about important issues might give speeches at school to act in ways consistent with their commitment to their values. ACT also uses skills like mindfulness to promote acceptance of things as they are and to keep patients focused on the present moment. ACT accepts that fear might exist while acting in ways consistent with your values.
Lumate provides cognitive behavioral therapy for anxiety, OCD, and related disorders in children, teens, and young adults, with a focus on evidence-based treatments built on 30+ years of clinical experience. According to research, even when many providers say they are doing CBT, many of them do not use evidence-based strategies, such as exposure, which less than 1/3 of therapists report using. It’s as if patients believe they are paying for expensive designer eyewear without the prescription lens that helps them see better. Lumate wants to make sure you know what you’re getting and that your teen feels empowered to manage their anxiety as soon as possible. If you want to learn more about our treatment models and approach to anxiety and related disorders, please reach out and speak to one of our experts.