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Review: How has cognitive behaviour therapy been adapted for adolescents with comorbid depression and chronic illness? A scoping review.
Morey, Alice, Loades, Maria E · Child and adolescent mental health · 2021 · DOI
Quick Summary
This review looked at how therapy called cognitive behaviour therapy (CBT) has been modified to help teenagers with both depression and long-term illnesses like diabetes, chronic fatigue syndrome, and inflammatory bowel disease. The researchers found that CBT is often adapted by helping young people think differently about their illness, do activities they enjoy while managing their condition, and involving their family. However, there is still limited research showing how well these adapted treatments actually work for this group.
Why It Matters
For ME/CFS patients—particularly adolescents—this review is important because it identifies one case study of ME/CFS included in CBT research and documents how psychological interventions are being adapted for young people with long-term illnesses and depression. Understanding these adaptations can inform better treatment approaches and highlight that ME/CFS deserves more dedicated research attention in this vulnerable age group.
Observed Findings
Twelve studies met inclusion criteria, representing seven chronic illness conditions including one ME/CFS study.
Common CBT adaptations included cognitive restructuring focused on illness-related thoughts, behavioural activation balancing illness and enjoyable activities, and psychoeducation about illness-depression links.
Parental or familial involvement was a frequent adaptation in CBT delivery.
CBT was typically delivered by trained professionals with adolescent expertise working under supervision.
Diabetes (n=3) and inflammatory bowel disease (n=3) had the most research representation.
Inferred Conclusions
CBT is commonly adapted for adolescents with comorbid chronic illness and depression, with adaptations tailored to how each specific illness presents.
The cognitions and behaviours targeted in CBT typically depend on the particular features and demands of the chronic illness.
There is a significant evidence gap and need for more rigorous efficacy and effectiveness research in this vulnerable population.
Family involvement and professional expertise in adolescent mental health are important components of adapted CBT delivery.
Remaining Questions
Which specific CBT adaptations are most effective for different chronic illnesses in adolescents?
What This Study Does Not Prove
This review does not establish that CBT is effective for treating depression in adolescents with chronic illness, as the authors explicitly state there is 'relatively little evidence to date.' It also does not prove which specific adaptations work best, nor does it demonstrate efficacy specifically in ME/CFS populations—only one ME/CFS study was identified.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
How does CBT efficacy compare between adolescents with different chronic illnesses and depression?
What is the optimal level and type of parental or familial involvement in CBT for this population?
Why is ME/CFS underrepresented in the research literature on adolescent depression and chronic illness, and what are effective psychological interventions specifically for ME/CFS?