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Bandura's theory of self-efficacy can be a useful tool in developing theory based therapeutic recreation interventions. This case report used Bandura's theory as a basis for designing a therapeutic recreation intervention for a 15 year-old female with severe depression and oppositional defiant disorder (ODD) in a long term residential treatment facility for adolescents. Cross-country skiing was used as a modality to facilitate an increase in self confidence. The intervention also aided her in discovering positive ways to manage her anger by helping her make stronger efficacy judgments about herself. These outcomes seemed to generalize to improved relations with family members.
KEY WORDS: Cross-Country Skiing, Depression, Learned Helplessness, Oppositional Defiant Disorder, Self-Efficacy Theory, Theory Based Programming
Adolescent depression and oppositional defiant disorder (ODD) are major concerns among those who treat America's youth. "By one estimate, mild to severe depression effects 36.3% of adolescents" (Hodgman & McAnarney, 1992, p. 73). Kovacs (1989) indicated that the effects of adolescent depression are now thought to be longer lasting than originally suspected, and Blackman (1995) reported that more than 30% of adolescents attending psychiatric clinics have been diagnosed with depression. Yet this illness is under diagnosed in the adolescent population according to Hodgman and McAnarney.
ODD is characterized by frequently losing one's temper, being argumentative with adults, actively defying or refusing adult requests, blaming others for their mistakes, becoming easily annoyed, being angry, annoying people deliberately, and/or being spiteful and vengeful. This list of behaviors makes young people with ODD difficult to deal with, especially by their parents (Home & Sayger, 1990; Riley, 1997). Unfortunately there may be as many as 5-8% of adolescents who have this disorder (Barkley & Benton, 1998).
The incidence of depression in the adolescent population is of great concern as effective treatment interventions seem to elude professionals. Combinations of therapy and medication are commonly used to treat depression in adults. The use of medications to treat adolescents, however, is controversial (National Institute of Mental Health [NIMH], 2000). Tricyclic antidepressants have not demonstrated long term effectiveness with adolescents and have been deemed appropriate only in cases where there has been no response to psychotherapy according to NIMH. The NIMH further states that selective use of serotonin reuptake inhibitors has been shown safe and effective;...