Depression in adolescents concerns more than just a phase that every teenager goes through. It's a severe pandemic that has a much more catastrophic effect than many seem to comprehend. The United States National Survey on Drug Use and Health (n.d.) defines depression as an experience that causes an individual to lose interest in daily activities for an extended period. When teens are depressed, it goes beyond a mere or temporary change in their moods; in fact, many even suffer long-term effects that endure throughout their adulthoods.
For many of these teenagers, the story doesn’t end so well. Besides apparent surface-level mood changes, studies have shown that adolescents with depressive disorders tend to be at a higher risk of early pregnancy, substance abuse, hospitalization, and to an extend, suicide. In Liberia, out of 2744 students surveyed about having suicidal thoughts, about 738 of them, or 26.8% reported having contemplated suicide while 36.5% went to an even greater extent of planning the act (Quarshie et al, 2020). Quarshie et al (2020) explain that some reasons leading to the ideation of suicide include bullying, victimization, and food insecurity. These are concerning statistics that highlight a lot to be done in preventing suicide amongst adolescents in Liberia.
On a cognitive level, a typical characteristic adolescent with depression experience is negative thinking in many forms to include low self-esteem and low confidence. These thoughts can range from how they see themselves to how others perceive them, i.e., helpless or inadequate (Mcleod, 2020). Also, other characteristics include sudden mood changes that cause irritation and abrupt anger. The cognitive theory intervenes by developing these teenagers' thought processes, which enhances their thinking patterns about self and the world. The theory asserts that how we handle our thoughts can significantly impact how we handle challenging or unfortunate life events and our emotional reactions to such events. Therefore, adolescents need education on the power of the cognitive mind and how that can help regulate their thoughts to improve their overall self-image.
A strength of the cognitive theory is that it supports collaborating with the adolescent, allowing them to actively participate in their healing process. For depressed adolescents, it is vital to utilize a conversational approach and enable them to be equally engaged. As a coach, the goal is to collaborate with the teen to incorporate their input based on their current life conditions or situation. In doing so, the teen can also be educated about their presenting problem and instill a better understanding of the problem and work alongside to find coping mechanisms. Another strength of utilizing the theory is that it helps teens rationalize how adolescents process their thoughts, feelings, and behaviors. Therefore, adopting a way of thinking can help develop good thinking patterns, positively influencing their environmental inputs, allowing them to make sound judgments and react more rationally based on their experiences.
The approach's two primary techniques include a process known as Socratic questioning and cognitive restructuring—the Socratic questioning technique derived from the teachings of the great philosopher Socrates. The technique empowers clients to develop their solutions through a series of strategic questioning from social workers. The intent is to ask the client a series of questions until they can find self-inspired solutions to their problems. Some examples of such questions include "what were you thinking when…?" Or "how did you conclude that?" (Walsh, 2013). When appropriately asked, these questions can help the client reconsider their thinking and eventually help them set and reflect on long-term goals.
The second technique is cognitive restructuring which is used when a client's way of thinking is distorted. After understanding the adolescent’s presenting problem, the social worker then works with the client through several discussions and exercises to find other ways to cope with or face their problems. The technique uses the "ABC model" wherein "A" represents the client's problem, "B" is their belief or perception of said problem, and "C" being their reaction or behavior towards that, i.e., what causes or leads them to become depressed. The ABC model essentially helps the client identify what causes them to be stressed, which serves as the foundation for excellent problem-solving.
Most of the cognitive interventions, especially the ones discussed in this article, are established with significant consideration from the client by accounting for their input and feedback of their presenting problem. Therefore, evaluations of the practice are only valid when given by the client, or change in their behavior or thinking patterns become evident based on the goals set. Effectiveness can also be evaluated by using clear evaluation measures of the client's change. Such changes include the progress made in all previously conducted sessions considering the extent to which the initial agenda was met, progress made on assigned homework, and overall feedback from the client.
Resources:
Mcleod, S. (2020). Psychopathology. Retrieved from https://www.simplypsychology.org/a-level-psychopathology.html#cog
NIMH. (n.d.) Major Depression. Retrieved from https://www.nimh.nih.gov/health/statistics/major-depression.shtml#part_155032
Quarshie, E.NB., Onyeaka, H.K. & Oppong Asante, K. Suicidal behaviors among adolescents in Liberia. BMC Psychiatry 20, 572 (2020). https://doi.org/10.1186/s12888-020-02985-3
Walsh, J. (2013). Theories for direct social work practice.