Department of Psychology, Harvard University, Cambridge, MA, USA.
Department of Psychology, Florida International University, Miami, FL, USA.
J Child Psychol Psychiatry. 2023 Dec;64(12):1720-1734. doi: 10.1111/jcpp.13820. Epub 2023 May 24.
Youth anxiety and depression have long been combined within the empirically derived internalizing syndrome. The two conditions show substantial comorbidity, symptom co-occurrence, and overlap in treatment procedures, but paradoxically diverge in psychotherapy outcomes: strong, positive effects for anxiety and weak effects for depression.
Drawing on recent research, we examine candidate explanations for this paradox to help identify strategies for addressing it by improving outcomes for youth depression.
Candidate explanations include that youth depression, compared with youth anxiety, has more varied comorbidities and more heterogeneous symptom combinations, has greater uncertainty regarding mediators and mechanisms of change, is treated with more complex and potentially confusing protocols, and has characteristics that may impede client engagement. Candidate strategies for shrinking the psychotherapy effectiveness gap include personalizing through transdiagnostic modular treatment, simplifying therapy by focusing on empirically supported principles of change, developing effective strategies for engaging family members as intervention allies, using shared decision-making to inform clinical decisions and boost client engagement, capitalizing on youth-friendly technological advances, and shortening and digitizing treatments to enhance their accessibility and appeal.
Recent advances suggest explanations for the internalizing paradox, which in turn suggest strategies for shrinking the youth anxiety-depression psychotherapy outcome gap; these form an agenda for a promising new era of research.
青少年焦虑和抑郁长期以来一直被合并为经验衍生的内化综合征。这两种情况存在大量的共病、症状同时出现以及治疗程序的重叠，但在心理治疗结果上却存在矛盾：焦虑的治疗效果显著且积极，而抑郁的治疗效果较弱。
借鉴最近的研究，我们考察了导致这种矛盾的候选解释，以帮助确定通过改善青少年抑郁治疗效果来解决这一问题的策略。
候选解释包括，与青少年焦虑相比，青少年抑郁具有更多样化的共病和更多样化的症状组合，对于中介和变化机制的不确定性更大，治疗方案更复杂且可能令人困惑，并且具有可能阻碍客户参与的特征。缩小心理治疗效果差距的候选策略包括通过跨诊断模块治疗实现个性化，通过关注经验支持的变化原则来简化治疗，制定有效的策略让家庭成员作为干预盟友参与，利用共同决策来告知临床决策并提高客户参与度，利用适合年轻人的技术进步，以及缩短和数字化治疗以提高其可及性和吸引力。
最近的进展为内化矛盾提供了解释，这反过来又为缩小青少年焦虑-抑郁心理治疗效果差距提供了策略；这些为一个充满希望的新研究时代形成了一个议程。
