Anxiety and depression are highly prevalent and frequently comorbid classes of disorder associated with significant impairment in youth. While current transdiagnostic protocols address a range of potential anxiety and depression symptoms among adult and adolescent populations, there are few similar treatment options for school-aged children with symptoms of these emotional disorders. Such a protocol could be of particular benefit to children experiencing emergent anxiety and depressive symptoms prior to adolescence, as these youth may be at risk for a more severe and protracted course of illness. For this reason, Emotion Detectives, a cognitive behavioral group treatment program, was developed as a downward extension of existent transdiagnostic protocols for emotional disorders in older populations (e.g., Barlow et al., 2010; Ehrenreich et al., 2008) for use with children ages 7 to 12 and their families. This paper will discuss the theoretical basis for Emotion Detectives and provide a description of its 15-session protocol, its unique and developmentally sensitive features, and case studies of 2 children enrolled in an ongoing open trial.
Youth anxiety and depression are a growing public health concern. Estimates indicate that as many as 10% to 22% of youth experience clinical levels of anxiety, while the prevalence of depression among children and adolescents is between 2% and 6% (Costello et al., 2006, Dadds et al., 1997 and Muris et al., 2000). In addition to the high prevalence of these emotional disorders, anxiety and depression are frequently experienced together throughout the lifespan. The frequency of this comorbidity in youth may be as high as 70% (Axelson and Birmaher, 2001 and Birmaher et al., 1996). While anxiety and depressive disorders cause impairment and distress individually, deleterious effects may be confounded when such disorders are experienced concurrently (Kessler et al., 1996 and Wittchen et al., 1994). Moreover, the development of a treatment protocol that effectively addresses a range of internalizing disorders may be of benefit to children with emergent anxiety and depression symptoms prior to adolescence, as these youth may be at particular risk for a more severe and protracted course of illness (Franco et al., 2007, Masi et al., 2000 and O'Neil et al., 2010).
Transdiagnostic or “unified” treatments are intervention protocols that enlist a core set of treatment principles to address a range of psychiatric disorders. Typically, a transdiagnostic intervention targets common factors that produce symptoms in related classes of disorder, such as anxiety and depression. The flexibility and convenience of being able to offer one treatment protocol to individuals experiencing a range of disorders, combined with the added benefits of concurrently addressing multiple concerns within an individual, make effective transdiagnostic treatment protocols attractive intervention options for both clinicians and researchers alike (Addis et al., 1999 and McEvoy et al., 2009).
While there is preliminary evidence demonstrating that transdiagnostic treatment protocols may be effective in addressing a range of emotional disorders in adults and adolescents, little research has examined the utility of extending transdiagnostic treatment approaches to children prior to adolescence. This paper will describe the theoretical basis for one such transdiagnostic, cognitive behavioral group protocol—Emotion Detectives—for the treatment of children experiencing anxiety disorders and co-occurring depression symptoms. The Emotion Detectives protocol is based on a preexisting intervention for individual adolescents with emotional disorders, The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders in Youth ( Ehrenreich et al., 2008) and the Unified Protocol for adults ( Barlow et al., 2010). The effort to create and implement this protocol in a manner that is maximally responsive to the emotional and social development of children between the ages of 7 to 12 years and the initial application of Emotion Detectives with two cases will be discussed.
