Psychology Today article: Which Talk Therapies Work Best With Teens and Children?

Transcribed from my older blog, a post about my public interest writing debut.

I’m delighted to say I had the honor of publishing an article in Psychology Today during my intern year of residency:

https://www.psychologytoday.com/us/blog/psychoanalysis-unplugged/201808/which-talk-therapies-work-best-teens-and-children

This was partially inspired by reading I’d been doing related to the research group I’m working with at Mount Sinai (led by Dr. Rita Goldstein and former lab member Dr. Anna Zilverstand). Zilverstand and Goldstein are doing some fascinating work looking at cognitive reappraisal (an emotion regulation strategy I discuss in the Psychology Today article), while conducting simultaneous neuroimaging to try to understand neural correlates of this cognitive task, and importantly how these neural mechanisms might be disrupted in clinical populations (e.g. people struggling with addiction). The other inspiration for this article came from my experiences and work-related readings during my very first month of residency, where I rotated on the child psychiatry inpatient service at St. Luke’s Hospital (part of Mount Sinai), supervised by Dr. Rice.

Due to word count/space constraints, the final article on Psychology Today is considerably shorter than some of my original drafts, which went into more detail about the science that led to my perspective in the article.

In a nutshell, my perspective is that although cognitive reappraisal has a lot of evidence for efficacy in adults, it’s been less effective in children. Neuroimaging work has shown that cognitive reappraisal is associated with a particular pattern of brain activity in particular regions of the brain, at least one of which is the dorsolateral prefrontal cortex, which is one of the last brain regions to mature in typical development. More imaging work looking at cognitive reappraisal in kids shows that they struggle to mount the same pattern of brain activity in the same regions when asked to do cognitive reappraisal, which might be because those brain regions aren’t fully mature yet in kids. Therefore, using cognitive reappraisal for young kids might not necessarily be the best technique, if they don’t have the “brain hardware” ready for it yet. There are other psychotherapy techniques that seem to use brain regions that mature a bit earlier in development, and it might make sense to use those techniques in kids. One potential psychotherapy technique of this type might be psychoanalytic therapy focusing on implicit emotion regulation, another topic I discuss in further detail in my Psychology Today article above.

I wanted to make this post in part to celebrate my Psychology Today article (my first article in a more general-interest publication), and in part to provide the references I used for my article, which we couldn’t include in the official article due to space limitations:

Buhle et al., 2014. Cognitive reappraisal of emotion: a meta-analysis of human neuroimaging studies. Cerebral Cortex.

Goldin, P.R., McRae, K., Ramel, W., Gross, J.J., 2008. The neural bases of emotion regulation: reappraisal and suppression of negative emotion. Biol. Psychiatry.

Gross, J.J., 2002. Emotion regulation: affective, cognitive, and social consequences. Psychophysiology.

Gyurak et al., 2011. Explicit and implicit emotion regulation: a dual-process framework. Cogn Emot.

Kohn et al., 2014. Neural network of cognitive emotion regulation — An ALE meta-analysis and MACM analysis. Neuroimage.

McRae et al., 2012. The development of emotion regulation: an fMRI study of cognitive reappraisal in children, adolescents and young adults. Soc Cogn Affect Neurosci.

Nelson and Guyer 2011. The Development of the Ventral Prefrontal Cortex and Social Flexibility. Dev Cogn Neurosci.