J Rat-Emo Cognitive-Behav Ther DOI 10.1007/s10942-014-0182-7

To Infinity and Beyond!: Introduction to the Special Issue Micaela A. Thordarson • Robert D. Friedberg

Ó Springer Science+Business Media New York 2014

Disney/Pixar character, Buzz Lightyear’s audacious exclamation, ‘‘To infinity and beyond,’’ captures the exciting developments in CBT with children and youth. The articles in this special issue balance the historical roots, current traditions, and future innovations in CBT spectrum approaches for youth. Each contribution reflects the dynamic nature of treatment development, application, and refinement. The articles translate the basic research finding to direct clinical practice. Moreover, the papers offer rich and diverse perspectives on CBT with youth. In the initial article, Friedberg, Hoyman, Behar, Tabbarah, Pacholec, Keller, and Thordarson celebrate the empirical, theoretical, and clinical advances achieved by CBT over the years. From newborn practice, to a powerful player on the field, CBT ‘‘came a long way.’’ The article tracks the various steps CBT took to become a vital modality and then detail recent advances that work to sustain its prestigious status. Instead of rigidly sticking with traditional roots, CBT continues to evolve with current progress by partnering with neuroscience, restructuring into a flexible modular system to be applied to a wider number of youth, and capitalizing on technological advances. CBT developers also adapt practices to increase cultural salience. Friedberg, Hoyman and colleagues emphasize the importance of staying current and relevant during changing eras. Rialon-Berry and Lai provide an informative summary of use of technology to supplement and transform conventional delivery of CBT. Most youth embrace technology and are able to access the internet and mobile devices. Rialon-Berry and Lai review the current available computer- and internet-based programs noting the gains youth make in these programs. Mobile applications available for download to devices help youth generalize skills or improve self-monitoring; this technology allows for easy-to-track outcomes that are likely more reliable. Rialon-Berry and Lai caution that technological advances come with some warnings: these new tools M. A. Thordarson
R. D. Friedberg (&) Center for the Study and Treatment of Anxious Youth, Palo Alto University, Palo Alto, CA, USA e-mail: [email protected]

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flirt with the bounds of clinician competence; many of the platforms available are currently difficult to individualize; and privacy is a concern when confidential details are being recorded and possibly transmitted electronically. Zack, Saekow, Kelly, and Radke offer a thorough review of the construct of mindfulness and various CBT packages that incorporate the concept. Mindfulness springs from the blending of Eastern and Western traditions. Accordingly, Zack and colleagues evaluate the ramifications of this fusion as they apply to treatment with young patients. In particular, the focus of treatment shifts away from ‘‘reducing bad’’ and centers on ‘‘enhancing good.’’ The entire clinical picture is taken into account, rather than simple diagnostic remission. Zack et al. also draw attention to the potential developmental fit of mindfulness based interventions to young patients while offering apt suggestions for aspects that clinicians may find less appropriate for some ages. In the next contribution, Curry and Hersh provide an in-depth evaluation of the development of practice and research of CBT specifically for depressed adolescents. They critically review results from major investigations, including multi-site trials comparing CBT with psychopharmacological interventions, and explain the implications of the varying results. Curry and Hersh incorporate compelling clinical examples to illustrate use of CBT techniques with teens struggling with depressive symptoms. They also discuss various ways CBT evolved to treat more acute populations by integrating strategies from ‘‘third wave’’ paradigms to more precisely address risk issues bridging the often cited efficacy/effectiveness gap. Finally, Curry and Hersh demonstrate the ways in which CBT matured since its inception to be able to successfully treat youth with increasingly severe depressive symptoms. Peris and Piacentini review the status of pediatric OCD CBT treatment with a keen eye on family involvement. Often in pediatric OCD, family members accommodate and/or exacerbate a youth’s symptoms. Thus, inclusion of the family in treatment is a logical benefit. Standard family roles in OCD treatment are peripheral and treatment rarely directly addresses family accommodation or high conflict family dynamics despite the fact that Peris and Piacentini cite these as predictors of poor treatment outcome. Peris and Piacentini describe pilot data from a new intervention in development that specifically targets family skills and interactions to enhance treatment response. This highly individualized family modality is intended to supplement a youth’s individual CBT treatment. Peris and Piacentini provide a case example to animate their noteworthy summary. Tompkins describes trichotillomania (TTM) in youth and the approach to treatment using CBT techniques. TTM, similar to many other disorders, must be regarded with multiple developmental considerations as the symptoms manifest differently in young children than they do in adolescents. He places significant emphasis on a comprehensive functional analysis of the hair pulling behavior. Tompkins further breaks down the components of CBT for TTM into modules and provides a thorough description of procedures for each intervention pod. Treatment interventions in each module are tailored particularly to the youth’s distinct hairpulling rituals, triggers, and gains. His article is chock full of creative clinical

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strategies to use with young patients that clinicians can easily tailor to their appropriate developmental level. Laugeson and Park describe the innovative PEERS program developed at UCLA to treat social deficits in adolescents and transitional age youth diagnosed on the Autism Spectrum. The PEERS program is grounded in CBT theory and practice yet is designed to very precisely target difficulties in social contexts and interactions. The PEERS program is delivered in small group format so every contact represents practice in social interaction. Most notably, PEERS emphasizes ecologically valid social skills training so patients learn skills that are genuinely useful in real life contexts. Laugeson and Park discuss various other aspects of PEERS that differ from traditional social skills training programs that likely account for the empirical success PEERS enjoys. They stress that PEERS is an active program where social concepts are made explicit and concrete then role played. Additionally, parents participate actively in treatment as social coaches. Laugeson and Park’s compelling work serves to further underscore the wide applicability of CBT spectrum approaches. Transdiagnostic treatments offer the solution to the common criticism that manuals are overly specific and inefficient in their approaches. Seager, Rowley, and Ehrenreich-May present a detailed outline of the need for transdiagnostic intervention given the common processes that stretch across the major disorders that affect youth. Regardless of diagnosis, youth battling depression or anxiety experience information processing deficits, interpretation biases, recall biases, attention biases, emotion regulation difficulties as well as behavioral and cognitive avoidance. The Unified Protocol for Adolescents (UP-A) strategically utilizes CBT techniques to concurrently target these common psychopathological pathways rather than focusing on specific depressogenic or anxiogenic thoughts and behaviors. Seager and colleagues explain the modules of the UP-A, and then illustrate them with a robust clinical case study replete with a case formulation, synopsis of treatment, and outcome data. The Affordable Care Act is now law in the United States and Friedberg, Thordarson, Paternostro, Sullivan and Tamas consider the ways in which this legislation will transform the landscape of healthcare. Friedberg, Thordarson et al. discuss roles for doctoral level psychologists as a result of these changes and provide recommendations for training to meet this reform head-on. In the not-toodistant-future, psychologists will be predominantly responsible for program development, consultation, supervision, and direct care only mainly for the most challenging young patients. This article emphasizes the critical necessity for strong theoretical and technical foundation in CBT so that psychologists encompass abilities to practice effectively and adapt to the health care revolution. We feel privileged to serve as guest editors for this special issue and equally proud to introduce these compelling articles to the readers of the Journal of Rational Emotive and Cognitive Behavior Therapy. We are confident these contributions will propel theory, research, and practice forward. Finally, we hope these articles will inspire rational emotive and cognitive behavioral therapists to reach for infinity and beyond in their care for vulnerable youth and their families.

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