Clinical Psychology Review, Vol. 19, No. 3, pp.

329–342, 1999
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PSYCHOSOCIAL TREATMENTS FOR

ADOLESCENT DEPRESSION
Peter M. Lewinsohn
Oregon Research Institute

Gregory N. Clarke
Kaiser Permanente Center for Health Research

ABSTRACT. Major Depressive Disorders affect between 2% and 5% of adolescents at any one
point in time. Depression in adolescence is associated with serious psychosocial deficits and has
negative effects on functioning during young adulthood. Starting with the pioneering work of Le-
nore Butler and her colleagues, many psychosocial interventions have been developed and stud-
ied, with generally positive results. On the basis of a meta-analysis of the existing cognitive-behav-
ioral therapy (CBT) studies we estimate an overall effect size of 1.27 and that 63% of patients
show clinically significant improvement at the end of treatment. It seems reasonable to conclude
that CBT has been demonstrated to be an effective treatment for depressed adolescents. In this ar-
ticle we describe these interventions, most of which are meant to addresss the problems shown by
depressed adolescents. The purpose of our article is to bring this literature to the attention of clini-
cians in a manner which quickly and clearly summarizes the key features of the interventions to
make it easy for clinicians to take advantage of this wealth of information and to avail them-
selves of the existing resources. We conclude by suggesting future directions and several addi-
tional areas of application for adolescent depression treatments. © 1999 Elsevier Science Ltd

SEVERAL RECENT studies have found that Major Depressive Disorder (MDD) is only
slightly less prevalent in adolescents than in adults, affecting between 2 and 5% of
general community adolescent samples at any one point in time (Fleming & Offord,
1990; MacDonald & Butler, 1974; Velez, Johnson, & Cohen, 1989). Data from the Or-
egon Adolescent Depression Project indicate that the cumulative prevalence of MDD
through age 18 is 28% (Lewinsohn, Rohde, Klein, & Seeley, (in press); Lewinsohn,

Correspondence should be addressed to Peter M. Lewinsohn, Oregon Research Institute, 1715

Franklin Boulevard, Eugene, OR 97403-1983.

329
330 P. M. Lewinsohn and G. N. Clarke

Hops, Roberts, Seeley & Andrews, 1993). Cumulative prevalence through age 18 was
35% for young women and 19% for young men. Consistent with adult findings de-
pression is approximately twice as prevalent among females as males (Amenson &
Lewinsohn, 1981; Kessler et al., 1994) and the female predominance is observable by
age 14 (Lewinsohn et al., 1993).
Depression in adolescence is not a benign or transient condition, but is associated
with serious psychosocial deficits during adolescence (Lewinsohn, Roberts, Seeley,
Rohde, Gotlib, & Hops, 1994) and can have negative effects on functioning during
young adulthood (Lewinsohn, Rohde, Seeley, Klein, & Gotlib, 1998). Experiencing an
episode of MDD during adolescence greatly increases the probability of becoming de-
pressed again or of developing substance abuse during young adulthood (Lewinsohn
et al., in press). There are other negative consequences. For example, young adults
(to age 24) who were depressed as adolescents are less likely to complete college, tend
to make less money, and are more likely to have become the unwed parent of a child,
and are more likely to experience stressful life events (Lewinsohn et al., 1998).
Given these negative sequelae, it would be clearly beneficial to have effective treat-
ments administered early in life to alleviate the depression before many of these nega-
tive consequences occur. Such interventions could help prevent the recurrence of de-
pression in those who have responded to treatment because the relapse rate is high
(Lewinsohn, Zeiss, & Duncan, 1989; Lewinsohn, Clarke, Seeley, & Rohde, 1994) and
prevent progression into more serious depression in those who are mildly depressed
(because mild depression is a strong risk factor for more serious depression [Clarke,
Hawkins, Murphy, Sheeber, Lewinsohn, & Seeley, 1995; Lewinsohn et al., 1994]).

TREATMENT EPIDEMIOLOGY
Many depressed adolescents receive treatment for their depression. In our commu-
nity study, 61% of community adolescents with MDD received some type of treatment
(Lewinsohn, Rohde, & Seeley, 1998a). However, our impression is that most of these
treatments are relatively unsystematic and brief, and do not clearly make use of recent
research developments in the cognitive-behavioral treatment of depression (Brent,
Roth, Holder, Kolko, Birmaher, Johnson, & Schweers, 1996; Hibbs & Jensen, 1996).
Treatment in this population has typically been quite brief; 22% of these depressed,
community-residing adolescents received one or two sessions, and 27% received three
to seven sessions. The modal length of treatment was seven or fewer sessions of outpa-
tient individual psychotherapy. Those who received treatment were as likely to relapse
into another episode of depression during young adulthood as those who had not re-
ceived treatment (Lewinsohn et al., 1998a). Some of this lack of treatment-mediated
relapse protection is probably due to severity/complexity differences between those
youth who sought treatment and those who did not.

RESEARCH ON ADOLESCENT DEPRESSION TREATMENTS

While lagging behind comparable research on adult depression treatments, the psy-
chosocial treatment of adolescent depression has become a very active area of clinical
research in recent years (Brent et al., 1996; Hibbs & Jensen, 1996). This field began
 Adolescent Depression Treatment 331

with the pioneering work of early investigators who recognized the existence and im-
portance of depression in young children and adolescents (Carlson & Cantwell, 1980;
Chess, Thomas, & Hassibi, 1983; Kovacs, 1985; Pozanski & Zrull, 1970; Weller, &
Weller, 1984; Weller & Weller, 1985; Weller, Weller, & Fristad, 1984). At the same
time, experienced clinicians began reporting use of cognitive-behavioral techniques
in a series of single case studies (Bornstein, Delamater, & Conner, 1980; Frame, Mat-
son, Sonis, Fialkov, & Kazdin, 1982; Petti, Bornstein, Delamater, & Conners, 1980). But-
ler, Miezitis, Friedman, and Cole (1980) conducted the first randomized trial of psy-
chosocial interventions for childhood depression. Since then there have been many
serious attempts to develop and test psychosocial treatments for depressed adoles-
cents, particularly in the cognitive-behavioral domain (Brent et al., 1997; Clarke,
Rohde, Lewinsohn, Hops, & Seeley, 1998; Clarke & Lewinsohn, 1989; Harrington,
1992; Kahn, Kehle, Jenson, & Clark, 1990; Lewinsohn, Clarke, Hops, & Andrews, 1990;
Reynolds & Coates, 1986).
The clinical sophistication of these attempts is impressive. While not all studies em-
ployed clinical trial methodology (e.g., random assignment to treatment conditions),
results have been positive. Because a comprehensive review of this research literature
is not the aim of this article, interested readers should see reviews by Asarnow and
Carlson (1988), Birmaher et al. (1996a), and Lewinsohn, Rohde, and Seeley (1998b).
One general conclusion from this body of work is that cognitive behavioral therapy
(CBT) appears to be an effective treatment for depressed adolescents, whether delivered
in individual or group formats. Other psychotherapy modalities, such as interpersonal
therapy (Mufson, Moreau, Weissman, & Klerman, 1993) and systems family therapy
(Brent et al., 1996; Diamond, Serrano, Dickey, & Sonis, 1996) show promise, but have
not yet been sufficiently tested to confidently conclude that they are effective treatments.
This body of research represents a serious attempt on the part of knowledgeable,
experienced, and competent clinicians to develop techniques to address the psycho-
social problems of depressed individuals. Most of the studies provide excellent de-
scriptions of the interventions they used, and in most instances they are available in
the form of books and manuals that can be easily obtained. Examples of intervention
techniques, most of which are meant to address the problems shown by depressed ad-
olescents, are listed in Table 1.

PURPOSE OF THIS ARTICLE

The purpose of this article is to bring this treatment literature to the attention of clini-
cians in a manner that quickly and clearly summarizes the key features of these inter-
ventions to make it easy for clinicians to take advantage of this wealth of information
and to avail themselves of the existing resources. Clinicians differ in their training,
their theoretical orientation, and the context in which they practice. However, we be-
lieve that from the available tested interventions, most practitioners can pick and
choose elements that will suit their practice and their clinical situation. Techniques
can be used as is, or, if needed, can be adapted to the context of individual clinical
practice or clinical setting (e.g., individual therapists, mental health clinics, managed
care, organizations, schools).
The remainder of the article describes those elements shared by many of the inter-
ventions, as well as those that are unique to each approach, to help clinicians decide
which treatments and/or components may be pertinent to their practice. We will also
332 P. M. Lewinsohn and G. N. Clarke

TABLE 1. Intervention Types Described in Adolescent Depression

Treatment Literature

Cognitive techniques (COG)

Constructive thinking (rational emotive therapy, cognitive therapy)
Positive self-talk
Being your own coach
Coping skills
Self-change skills (self-monitoring, goal setting, self-reinforcement)
Family context (FAM)
Conflict resolution
Communication skills
Parenting skills
Behavioral (BEH)
Problem-solving skills
Increasing pleasant activities
Social skills (assertiveness, making friendships, role modeling)
Affective education and management (AEM)
Relaxation
Anger Management

address future developments and areas of further application for adolescent depres-
sion treatments.

COMMON TREATMENT ELEMENTS

In our review of ongoing and completed studies of the treatment of adolescent/child-
hood depression, we have identified the following noteworthy features common to
most CBT approaches.

Specific Treatment Components

Each study offers different combinations of CBT techniques found useful with adults,
which were adapted for use with adolescents. Paralleling the types of problems shown
by depressed adolescents, these techniques target cognitive, behavioral, and affect
(mood) regulation deficits in the adolescents. Several also have a component that fo-
cuses on problems with parents.
The degree to which specific techniques need to address the clinical problems of a
particular patient is an interesting area of research. Historically, a common presump-
tion has been that the best treatment approach should address the patient’s presented
deficits (this is often called a “remedial” or “compensation” approach) (Rude & Rehm,
1991). For example, a depressed adolescent with good peer relations and realistic
(nondepressed) cognitions, but high family conflict, might be treated with a family
therapy approach aimed at conflict-reduction. The alternative approach, called “capi-
talization,” involves treatment techniques designed to amplify the patient’s best areas
of functioning. For the above-mentioned adolescent, one would choose cognitive or
social skills training interventions. Some research reviews based on studies with adults
 Adolescent Depression Treatment 333

favor the capitalization approach (Rude & Rehm, 1991), but more research is needed
to resolve this important question.

Limited Duration and Contacts

All CBT programs are limited with respect to duration or time course, and number of
sessions. Harrington’s protocol consists of five to eight sessions (Wood, Harrington, &
Moore, 1996), Brent’s version of CBT has 16 sessions (Brent et al., 1996), while
Clarke, Lewinsohn, and Hops’ (1990) group CBT model (Clarke & Lewinsohn, 1989)
consists of 16 sessions over 8 weeks. Stark and Kendall’s (1996) CBT program is 18 ses-
sions, twice weekly for the first 4 weeks, then once weekly thereafter.
The experience from these studies is that it is possible to provide effective help to
depressed adolescents in a relatively short period of time (1–2 months) and with a fi-
nite number of therapy sessions. The other advantage of this aspect of CBT is that the
duration of treatment is predictable, which is useful in larger treatment settings (e.g.,
community mental health centers, HMOs) for planning staffing availability, billing,
etc. Rapid and predictable treatment length is generally a laudable goal, with poten-
tial benefits for all stakeholders (patients, families, payers, providers). However, some
providers, families and child advocates may be concerned that an unintended effect
of the relatively brief nature of CBT is that financial (payor) interests may use the sci-
entific data to ratchet down the number of therapy sessions at the expense of lasting,
positive clinical outcomes. Unfortunately, there have been no controlled studies of
the relationship between number of therapy sessions, length of treatment, severity of
disorder and short- and long-term outcomes. Information of this type is needed to ad-
dress these concerns. However, it is probably safe to state that because treatments dif-
fering in length have achieved roughly comparable results, there is no one-size-fits-all,
optimal treatment duration for all depressed youth. Data from our most recent group
CBT treatment study (Clarke et al., 1998) indicate that depressed youth who had not
fully recovered at the end of 8 weeks of treatment received additional clinical benefit
(and in some cases, recovered) from continued monthly “booster” sessions, suggest-
ing the need for varying lengths of treatment, depending on recovery rate.

Structured and Directive Treatment Sessions

Sessions in each of the treatments are structured, albeit in varying degrees of pre-
scribed activity and scripting. Most CBT programs provide at least some agenda for
each treatment session or group of sessions, that spells out the primary objectives and
aims of the therapy and the content of the sessions, including suggested activities, and
homework. This characteristic of CBT interventions is the opposite of classical nondi-
rective, “here-and-now” treatment approaches (Rogers, 1957), and is related to the
time-limited nature of most CBT protocols. The active agenda setting and directive
nature of CBT is designed to facilitate the completion of the therapeutic tasks.
Which method is better? Directive or nondirective? The existing research does not
answer this question. However, most practitioners today have found it pragmatically
necessary to become more directive, given the financial pressures to complete therapy
in fewer sessions. Within this realistic constraint, the CBT approach provides an inter-
nally cohesive and empirically supported method for achieving limited but specific
 334

TABLE 2. Descriptive Characteristics of the Interventions

Treatment Components
No. of Duration Age Range
Developers COG BEH FAM AEM Sessions (Weeks) (Years) Modea Manual Maintenance Prevention

Beardslee et al., 1993 X X 6–10 6–10 8–14 I X X

Brent et al., 1997 X X X X 12–16 12–16 13–18 I X X
Butler et al., 1980 X X 16 2-hour 16 14–18 G X X X
Clarke et al., 1990 X X X X 16 2-hour 8 14–18 G X X X
Jaycox et al., 1994 X X 12 12 10–13 G X X

334
Kahn et al., 1990 X X X 10–14 G
Kaslow & Racusin, 1994 X X X X I
Mufson et al., 1993 X X 12 12 12–18 I X
Reynolds & Coates, 1986 X X X 10 14–18 G X
Rosselló & Bernal, 1996 X X X 13–19 I X
P. M. Lewinsohn and G. N. Clarke

Stark et al., 1996 X X X X 12 9–13 G X X

Vostanis & Harrington, 1994 X X 5–9 9–17 I X

Note. All sessions are 50 minutes to 1 hour, offered weekly, unless otherwise noted.
AEM 5 Affective education and management; BEH 5 behavioral; COG 5 cognitive techniques; FAM 5 family context.
a Mode: I 5 individual, G 5 group.
 Adolescent Depression Treatment 335

therapy goals. However, it is important to recognize that too much direction and
structure may be aversive, especially for adolescents who are in the process of emanci-
pating themselves from what they may consider authoritarian methods of parents,
teachers, and other adults. Probably the best approach is a judicious mixing of direc-
tive agenda setting, perhaps mutually negotiated between therapist and client, bal-
anced by some regular unstructured time.

Age Modifications
Because there are important differences in the mental abilities and learning styles of a
10-year-old, relative to a 16-year-old, treatments differ with regard to their target age
group. The suggested age range for each treatment model is shown in Table 2.
No one has reported controlled outcome studies with children under the age of 10,
although Ialongo, Kellam, and colleagues (Ialongo, Edelsohn, Werthamer-Larsson,
Crockett, & Kellam, 1993; Kellam, Rebok, Mayer, Ialongo, & Kalodner, 1994) have de-
veloped methods for assessing depression in young children. While our retrospective
data suggest that prevalence of depression in children under the age of 10 is very low,
clinical cases have been described in the literature (Chess et al., 1983; Kovacs, 1983;
Pozanski & Zrull, 1970). An important direction for the future might be to try to adapt
CBT techniques for use with very young children.

Group Versus Individual

Some treatments are designed to be used in an individual mode (Brent et al., 1997;
Mufson et al., 1993; Vostanis & Harrington, 1994). Others are intended for use in
small groups of 6 to 10 youth (Clarke & Lewinsohn, 1989; Jaycox, Reivich, Gillham, &
Seligman, 1994; Kahn, Kehle, Jenson, & Clark, 1990; Stark, Kendall, McCarthy, Stafford,
Barron, & Thomeer, 1996). Some advantages of individual therapy are that the thera-
pist can choose those techniques or skill modules that fit the individual patient’s pre-
sentation, allowing focus on that youth’s problems. On the other hand, group therapy
is probably more cost-effective (although this has not been tested at present), permits
role-play, modeling, and feedback opportunities with peers, provides opportunities
for vicarious learning, and social facilitation, especially for those youths who are un-
comfortable in a one-to-one relationship or who are more comfortable in the pres-
ence of other youngsters.
While no studies have developed or tested the adaptation of group treatments for
use with individual youth, or vice versa, our clinical experience (and the anecdotal
feedback from colleagues who use our model) is that group programs can relatively
easily be adapted for use with individuals. The adult version of our group CBT inter-
vention, the Coping with Depression Course (Lewinsohn, Antonuccio, Steinmetz, &
Teri, 1984) was adapted for use with individual depressed adults with good results (see
Brown & Lewinsohn, 1982; Teri & Lewinsohn, 1986). Rosselló and Bernal (1996) have
developed and tested an individual CBT intervention for Puerto Rican adolescents,
based on the Lewinsohn et al. (1984) and Muñoz and Ying (1993) group CBT pro-
grams for English-speaking and Hispanic adults, respectively.
Converting individual treatments to groups may take more effort. Clinicians trying
to modify these programs in one direction or the other may wish to contact the treat-
ment developers for assistance.
336 P. M. Lewinsohn and G. N. Clarke

Education Versus Therapy Orientation

Treatments differ in the extent to which they adopt an explicit psychoeducational
(e.g., Clarke, Lewinsohn, & Hops, 1990) or a more dynamic (traditional) stance (e.g.,
Mufson et al., 1993). The former explicitly defines the role of the therapist as teacher,
the patients as students, and the process as learning. Our group CBT program and
that of others (e.g., Stark & Kendall, 1996), simulates a classroom setting (i.e., a famil-
iar setting for youth). In fact, our intervention can and has been taught in school set-
tings.
Not all CBT interventions are so explicitly psychoeducational. Some treatments
(e.g., Brent et al., 1996; Wood et al., 1996) are clearly designed for use in clinical ther-
apy settings with emphasis on the roles of patient and therapist. In general, the group
CBT programs tend towards the psychoeducational orientation, while the individual
CBT interventions tend towards the more traditional patient–therapist model.

Acute Treatment Versus Continuation or Maintenance

All of the treatments listed in Table 2 aim to ameliorate depression. Only a few of
the more recent ones are also concerned with maintenance of treatment gains via
“booster” sessions, or continuation of treatment at a reduced level beyond the acute
treatment period (Brent et al., 1996; Lewinsohn, Clarke, Rohde, Hops, & Seeley,
1996; Wood et al., 1996), to address problems that may continue or arise during the
follow-up period.
We recommend that clinicians incorporate an explicit maintenance and/or contin-
uation component into their treatments. A maintenance component may be espe-
cially important when dealing with youths who have one or more of the risk factors for
MDD relapse/recurrence: history of one or more previous episodes of depression, his-
tory of suicide attempt, suicidal ideation, greater severity of first MDD episode, later
age of first onset, and shorter first episode duration (Lewinsohn et al., 1994). A con-
tinuation component will also be very important for those whose recovery at the end
of acute treatment is incomplete.

Prevention
Very few of the interventions have been developed or adapted for the prevention of
depression. Targeted prevention of depression in youth (i.e., aimed at those known to
be at elevated risk for future depression) has been attempted by several groups.
Clarke et al. (1995), Gillham, Reivich, Jaycox, and Seligman (1995), and Jaycox, et al.
(1994) have all developed interventions for youth with elevated but subsyndromal de-
pression symptoms. Clarke, Hornbrook, Polen, and Lynch (1998) are currently attempt-
ing to prevent depression among at-risk offspring of depressed parents, using a similar
group CBT intervention.
Other candidate groups for targeted depression prevention efforts include youth
suffering from a medical illness that is associated with functional impairment, for ex-
ample, a serious bone fracture (Lewinsohn, Seeley, Hibbard, Rohde, & Sack, 1996),
and pregnant teen mothers with a history of depression (O’Hara, 1995). The latter
group is not only at risk of future depression themselves, but once depressed may im-
part additional developmental risks to their infants or toddlers via an impaired child–
parent relationship (Cummings & Davies, 1994).
 Adolescent Depression Treatment 337

Parent Involvement
Not all depression treatment programs explicitly include parents, although some may
do so incidentally. Nadine Kaslow (Kaslow & Racusin, 1994) has been the most vocal
about the importance of including the family, and she has been a proponent for fam-
ily therapy that integrates cognitive-behavioral and interpersonal interventions for de-
pressed children and adolescents. Our program is perhaps typical of the way in which
group CBT interventions involve parents, with a specific therapist manual (Lewin-
sohn, Rohde, Hops, & Clarke, 1991b) and parent workbook (Lewinsohn, Rohde, Hops,
& Clarke, 1991a) for a parent group (eight, 2-hour sessions), which is meant to be ad-
ministered in tandem with the adolescent group. The parent treatment aims to inform
parents of the skills being taught to the adolescents so that they can be supportive of
the class learning. Parents are also taught the same negotiation and conflict resolu-
tion and communication skills that are being taught to the adolescents, to improve
joint problem-solving sessions.
Brent et al. (1997) also explicitly involve parents in their youth CBT intervention,
with a three session “family psycho education” program during which parents are
given a psychoeducational manual and invited to discuss questions and concerns
about the treatment of depression, with up to one treatment hour devoted to psycho-
educational issues. Stark and Kendall (1996) provide an 11-session parent group. Wil-
liam Beardslee is another investigator who takes a family cognitive restructuring ap-
proach in treating depressed offspring of depressed parents (Beardslee et al., 1997).
His approach may be especially useful with practitioners treating youth in families in
which the parents are depressed.

Results of Meta-Analyses
Recently, Reinecke, Ryan, and DuBois (1998) conducted a meta-analysis of six CBT
outcome studies reporting an overall effect size of 21.02 posttreatment. Our estimate
(averaged across the studies shown in Table 2) is 21.27 and 63% of the patients
showed clinically significant improvement at the end of treatment. Clearly, the treat-
ments have a large effect.

SUMMARY
This article is not meant to be an exhaustive review of the research literature on treat-
ment of depression in adolescents. Interested readers should look elsewhere for this
(Birmaher et al., 1996b; Hibbs & Jensen, 1996; Reynolds & Johnston, 1994). Instead,
this article is a summary of resources for mental health providers, permitting quick
comparisons of different adolescent depression treatments on key features. We hope
that this information will facilitate use of CBT techniques in clinical practice.
We believe that greater adoption and use of CBT in the treatment of depressed ad-
olescents is justified by the research conducted to date. While there is some variation
in the populations and outcomes examined in the efficacy research for these treat-
ments, there is consistency of positive treatment outcomes. Additional treatment re-
search is always needed, especially comparing different treatment methods (e.g., med-
ication vs. CBT), different modalities (group vs. individual), and different target
populations. However, we do not believe that this pending research should mute the
general conclusion that many of these efficacy-tested treatments are now ready for
338 P. M. Lewinsohn and G. N. Clarke

greater implementation in clinical practice settings. We agree with Hogarty, Schooler,

and Baker (1997), who argue that clinicians should adopt efficacy-tested treatments
(i.e., tested under relatively controlled conditions) instead of dismissing them while
waiting for effectiveness studies to be conducted.
Beyond using these interventions in acute treatment, clinicians should have an ex-
plicit strategy for maintaining treatment gains and for preventing relapse in depressed
children and adolescents. While we cannot make specific intervention recommenda-
tions due to the sparse research on the prevention of relapse/recurrence in depressed
youth, the problem is one that merits serious attention in clinical practice. At present,
the most reasonable guidance for practitioners lies in the established relapse preven-
tion research with depressed adults (e.g., Blackburn, Jones, & Lewin, 1986; Evans et
al., 1992; Hersen, Bellack, Himmelhoch, & Thase, 1984; Hollon, Shelton, & Loosen,
1991; Kovacs, 1981; McLean & Hakstian, 1990; Rush, Beck, Kovacs, & Hollon, 1977; Si-
mons, Murphy, Levine, & Wetzel, 1996) in which maintenance regimes of CBT, in-
terpersonal therapy, and/or antidepressant medication all show varying degrees of
promise in reducing relapse or recurrence. Hopefully, similar studies will soon be
conducted with depressed youth, which will provide more age-appropriate recom-
mendations.

FUTURE DIRECTIONS
We anticipate that over the next few years considerable effort will be expanded to
evaluate the need for interventions for depression in very young children (e.g., Ia-
longo et al., 1993). The evidence that (a) depression runs in families (Hammen,
1991) and (b) that depression in young mothers can have detrimental impact of the
development of their young children (Cummings & Davies, 1994) suggests potential
utilization of cognitive-behavioral techniques with ever-younger children to prevent
and/or reduce depression, and perhaps other mental disorders.
The amount of experience and knowledge that has been accumulating about use of
behavioral and cognitive techniques with young people makes it realistic to aim for
community-wide interventions of the type advocated by Seligman (1995).
An unmet need that badly needs to be addressed is the adaptation of the tech-
niques described in this article for use with African American, Native American, His-
panic, and other ethnic groups. The work of Rosselló and Bernal (1996) is an excel-
lent example of the feasibility of this endeavor and suggests that such attempts will be
successful.

Acknowledgment—This research was supported by National Institute of Mental Health

grant nos. MH41278 and MH40501.
The authors wish to express their appreciation to Dr. David Antonuccio for his valu-
able comments on this article.

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