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Clinical case study: CBT for depression in a Puerto Rican adolescent: challenges and variability in treatment response
Author(s) -
Jiménez Chafey María I.,
Bernal Guillermo,
Rosselló Jeannette
Publication year - 2009
Publication title -
depression and anxiety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.634
H-Index - 129
eISSN - 1520-6394
pISSN - 1091-4269
DOI - 10.1002/da.20457
Subject(s) - suicidal ideation , dysfunctional family , depression (economics) , major depressive disorder , clinical psychology , anxiety , psychology , intervention (counseling) , psychiatry , cognitive behavioral therapy , psychological intervention , poison control , suicide prevention , medicine , cognition , environmental health , economics , macroeconomics
Background: There is ample evidence of the efficacy of cognitive‐behavioral therapy (CBT) for depression in adolescents, including Puerto Rican adolescents. However, there is still a high percentage of adolescents who do not respond to a standard “dose” of 12 sessions of CBT. This clinical case study explores the characteristics associated with treatment response in a Puerto Rican adolescent and illustrates the challenges and variability inherent in CBT treatment for major depressive disorder (MDD) in youth. Methods: The patient is a 15‐year‐old adolescent female who at pretreatment presented a diagnosis of MDD with severe depressive symptoms, high suicidal ideation, low self‐concept, and highly dysfunctional attitudes. CBT treatment consisted of 12 standard individual therapy sessions plus four additional sessions, and one family intervention. A case study method was used. Both qualitative and quantitative data for the case are presented using self‐report instruments, clinical case notes and recordings of therapy sessions. Results: Some of the characteristics she presented that have been associated with partial or no response to therapy were: increased severity of depressive symptoms, a prior MDD episode, co‐morbidity with other mental disorders, and significant parental conflict. At termination the patient presented decreases in depressive symptoms, dysfunctional attitudes, and suicidal ideation, as well as improvements in self‐concept. These improvements were maintained up to 1 year posttreatment. Conclusions : Cultural issues are discussed in terms of the potential for parental conflict to perpetuate the patient's depressive symptoms. Depression and Anxiety, 2009. © 2008 Wiley‐Liss, Inc.