Research question development and methodology

Treatment of Conduct Disorder in CBT in Combination With CBT and Fluoxetine

In the first paper, this author discussed therapeutic processes (cognitive behavioral therapy (CBT) and pharmacotherapy) which could be employed as the best practices when working with individual adolescent males between the ages of 14-16 who exhibit conduct disorder. Since the approach previously centered around individuals, it would seem to be prudent to explore what type of group treatment modes have been found to be effective (best practices, evidence-based) for treating this population. This will include family therapy and a group therapy modality such as social skills therapy before considering pharmacological solutions. With regard to drugs, fluoxetine in combination with CBT holds great promise.

Literature Review

Obviously, in any treatment, a step-by-step progression needs to happen. We have already identified the advantages of CBT prior to pharmacotherapy. Frequently, in adolescent cases of conduct disorder, substance abuse issues are contributing factors. Logically, before one decides on a strategy for intervention, especially pharmacotherapy, substance abuse issues must be diagnosed and dealt with.

One of the most commonly abused substances is of course alcohol. The CBT treatment modality expands upon behavioral therapy by evaluating the effects of cognitive elements in addressing substance abuse issues. The CBT methodology is based upon social learning theories which emphasizes functional analyses. This is done by addressing alcohol or other substance abuse in the context of antecedents and consequences. The bread and butter of CBT are its recognition of high-risk situations and its emphasis upon the acquisition of social skills that are aimed at addressing high-risk situations that feed substance abuse. CBT was found to be effective in the treatment of CD (Deas, 2008, 5352). However, the pharmacological treatment of juvenile alcohol use disorders lagged behind than psychosocial treatments. Such medications are frequently used singly to counteract the adverse effects disorders. In other words, pharmacotherapy is a follow-on to be added to interventions only after the CBT intervention course is to be worked out (ibid, 5353).

Frequently, CBT is paired up with family therapy. While it has been considered clinically effective, there has previously been little systematic evidence that this is so. Therefore a randomized control trial was commissioned that had 72 patients from 9 -- 15 years located in one of two treatment groups. 74.3% of cases no longer exhibited clinical depression in the wake of individual therapy and

75.7% of cases were no longer clinically depressed following family therapy. So, there is a very marked decrease in the occurrence of depression if the family members are engaged in the therapeutic intervention as well (Trowell, 2007, 157) .

Since CBT is so made up so heavily of behavior modification via the learning of new social skills, the investigation of such social skills training in a group environment would be prudent. Social skills training (SST) therapy has not been very promising overall, but this may be due to methodological flaws, a long-standing resistance to introducing long-standing recommendations for enhancing the effectiveness of the therapy and a tendency to overgeneralize. Also, SST is many times delivered in a public school setting and the therapists frequently do not possess the expertise, resources, personnel or the inclination to effectively use the method (Maag, 2006, 14). For this reason, this approach might work better in a clinical setting.

Finally in a pharmacological vein, great progress has been made in using fluoxetine. According to an article in the Archives of Pediatric Adolescent Medicine, fluoxetine and CBT together did not have a greater effectives on both substance abuse and behavioral disorders and was also not associated with a greater decline in self-reported substance use or in CD symptoms. According to the study authors, the CBT may have contributed to the higher than expected treatment response and mixed effectiveness. Unfortunately, this limitation is problematic. Cases of self-reported drug use during CBT has been shown to be reliable among adolescents when the confidentiality is ensured and also when the participants know that the self-reports will be corroborated by urine screen results. However, the methodology may not have been sufficiently sensitive to capture clinically significant changes in substance use. Therefore, more study may need to be conducted with the drug.

Research Methodology for a Future Study