There is increasing recognition that the transition from childhood to adulthood is a period with an increasingly widening timeframe. Children are beginning adolescence earlier, whether defined biologically, psychologically, or societally. Adults are emerging later, as defined by psychological, intellectual, or financial independence, or indeed brain development. Adolescence, previously often thought of as the âteenâ phase, is now more frequently defined as the period between around 10 until 25 years of age (see Chapter 2).
There is also increasing recognition that this decade and a half is a time of intense difficulty and a time when young people frequently require help. As a result, specialist youth mental health projects and services are beginning to develop across the world; programmes and international conferences are flourishing.
Despite growth in this area and increasing provision of services specifically for adolescents and young adults, there is a relative lack of literature tailored to this age range. The majority of literature categorises itself as either for adults or for children and their families.
This treatment manual aims to provide clinicians with a guide to CBT targeted specifically at those aged between 10 and 25. The book begins with a detailed outline of adolescent and early adult development and provides a context for the remainder of the book (Chapter 2).
Cognitive behavioural therapy (CBT) is an intervention that has developed over the past 50â60 years with a clear foundation in empiricism and testing out each new development. As a result of this, CBT is now the psychological therapy with most evidence for the widest variety of difficulties (Chapter 3). The evidence base for CBT across the age range is also strong. As a result of this, demand for CBT is high and clinical services across the world are stretched. Clinicians are working within settings that place a high value on turnover and have high expectations of the numbers of sessions that can be undertaken. The space for stopping and thinking, reading and learning is squeezed. As a result, clinicians find it difficult to keep up with the evidence and to provide treatment in a manner most consistent with what is most effective (see Chapter 4).
Alongside this, the evidence base for CBT is growing and there are ever-increasing numbers of models for different presenting problems or problems with slightly different foci, depending on their authors. For obsessive-compulsive difficulties, for example, clinicians can choose between five different models (see Chapter 4).
Working as a clinician in everyday practice has therefore become increasingly difficult, and there is little time to research the evidence base for each slightly different presentation, or to effectively keep up with the vast array of different models that are provided within the discipline of CBT. The risk of this situation is that, while the models, when implemented by their proponents in specific populations, might be increasing in effectiveness, the practice of CBT on the ground suffers and its effectiveness declines (see Chapter 4).
This treatment manual aims to provide clinicians with a limited number of discrete, simple, models that they can use to cover the majority of presentations seen in everyday practice with adolescents and young people. It brings together research and evidence in ways that are designed to be clear and easy to understand, so that clinicians can become experts in a few models that they can tailor and apply to the majority of their clients, directing them towards clear, evidence-based interventions.
Increased recognition of difficulty for adolescents and young adults has produced a wide variety of response. Schools, colleges, employers, and other institutions are increasingly providing information about psychiatric disorders as part of âmental healthâ or âemotional wellbeingâ programmes and there are national programmes designed to increase awareness of mental health difficulties.
These kinds of programme are often thought of as unquestionably helpful and yet the evidence is not so positive. The diagnostic model is not as valid or reliable as is often assumed, it tends to decontextualize difficulties, increase stigma, reduce agency, and has a negative impact on identity development (Chapter 4). That the predominant model offered to adolescents and young adults to understand their emotions is an illness model, may well be an important contributory factor to the apparent increase in âillnessâ in this population. One of the main aims of this book is to provide an alternative framework through which adolescents and young adults can understand their emotions and their difficulties with emotions.
This fresh approach is outlined in Chapter 5, where adolescents and young adults are given the opportunity to understand their difficulties and receive intervention without having to view themselves as âdisorderedâ or âillâ. CBT is separated from the diagnostic model and is grounded instead in emotion science. The chapter outlines the theoretical basis before detailing the five principles of the approach: what emotions are, what emotions are for, how emotions are regulated, adolescent development, and the hand brain. Each of these principles is based on evidence from a variety of different disciplines, including academic psychology, neuroscience, and applied psychology. These five principles inform the rest of the book, which is a practical treatment guide for clinicians working with adolescents, young adults, and their families.
Subsequent chapters look at specific emotions: Fear (Chapter 6), Sadness (Chapter 7), Anger (Chapter 8), and Emotion dysregulation (Chapter 9). Each of these chapters explores the emotion in detail, looking at its causes, the impact it has on different aspects of the emotional experience, and then outlines a trap that provides a detailed understanding of what can go wrong. Each chapter contains an intervention section, taking clinicians through exactly what to do and how to do it, with illustrative material. There is a section outlining how these treatment models relate to the evidence base at the end of each chapter. There are two brief chapters on Disgust (Chapter 10) and Guilt and shame (Chapter 11), which look at how these emotions might interact with the traps outlined earlier.
The last chapter is Happiness (Chapter 12). Happiness is not usually included in treatment manuals, but is often a desired outcome for treatment. This chapter outlines what causes happiness, what it is (and isnât), and its functions. It then outlines the happiness wheel and brings together the interventions, the majority of which are already covered in other parts of the book, that are shown to help adolescents and young adults move towards a life characterised by happiness, wellbeing, and flourishing.
While broad, this book does not aim to cover everything. It specifically neglects:
âą Psychosis. This book does not specifically cover psychosis or psychotic phenomena. However, the book does cover many of the difficulties experienced alongside psychosis, for example sadness or social fears.
âą Trauma work. This book begins predominantly from a here-and-now perspective. Trauma is included in longitudinal formulations and informs the traps and difficulties in this book, but work designed to support the processing of trauma memories using techniques such as reliving or rescripting is not covered.
âą Medication. This is a psychological volume designed for psychologically training clinicians and so medication is not covered.
In summary, this book aims to achieve a number of related objectives:
âą Provide a detailed guide to treatment tailored specifically for adolescents and young adults, rather than children or adults.
âą Ground treatment in models of psychological development and emotion rather than disorders and illness.
âą Provide clinicians with clear, concise CBT formulations and evidence-based treatment plans, all illustrated with case material.
âą Cover the full range of different presentations seen in âeverydayâ clinical practice.
Throughout the book, example case material is used to illustrate the concepts and ideas. In addition, a number of different adolescents and young adults whose therapy has been based on the ideas of this book have provided quotes that are used at the beginning of the chapters. Each individual involved has provided consent for their words to be used for this purpose.