The Internalizing Paradox – Youth Anxiety and Depression Symptoms

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In this Papers Podcast, Dr. John Weisz discusses his JCPP paper ‘Research Review: The internalizing paradox – youth anxiety and depression symptoms, psychotherapy outcomes, and implications for research and practice’ (

There is an overview of the paper, methodology, key findings, and implications for practice.

Discussion points include:

  • An explanation of what the internalizing paradox is.
  • The five different possible explanations for the internalizing paradox.
    • The differential comorbidities between anxiety disorders and depressive disorders.
    • Insight into ‘variegated nature of polythetic conditions’.
    • A definition of differential progress in the search for mechanisms of change.
    • How differential complexity of evidence-based psychotherapy protocols relate to the internalizing paradox.
    • The clinician’s challenge.
  • How the different perspectives suggest different treatment strategies and insight into these strategies.
  • The limitations of current research and the possible avenues for future work.
  • Implications for clinicians and how this research impacts interventions.
  • Messages for parents and carers and the importance of parents/carers partnering with clinicians with regards to interventions.

In this series, we speak to authors of papers published in one of ACAMH’s three journals. These are The Journal of Child Psychology and Psychiatry (JCPP)The Child and Adolescent Mental Health (CAMH) journal; and JCPP Advances.


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John Weisz
John Weisz

John Weisz’s research involves development and testing of interventions for these disorders and challenges, as well as meta-analyses to characterize and improve the science of youth mental health care. His most recent work involves building and testing, in randomized controlled trials, transdiagnostic approaches to youth psychotherapy that use modular design and empirically supported principles of change. His work integrates evidence-based practices with strategies for personalizing treatment to fit individual youth and family characteristics. His research also includes development and testing of brief digital interventions designed to maximize access by young people, and interventions delivered by lay-providers to adolescents in Africa. Weisz’s books include Psychotherapy for children and adolescents: Evidence-based treatments and case examples (Cambridge University Press), Evidence-based psychotherapies for children and adolescents (Co-edited with Alan Kazdin; Guilford Press), and Principle-guided psychotherapy for children and adolescents: The FIRST treatment program for behavioral and emotional problem (Co-authored with Sarah Kate Bearman; Guilford Press). Weisz’s awards include the Klaus-Grawe Award for the Advancement of Innovative Research in Clinical Psychology and Psychotherapy, from the Klaus-Grawe Foundation; the Sarah Gund Prize for Research and Mentorship in Child Mental Health, from the Scientific Research Council; and the James McKeen Cattell Lifetime Achievement Award from the Association for Psychological Science—described by APS as its highest honor—for work that “has had a profound impact on the field of psychological science over the past quarter century.”


Excellent 20 minutes surveying a surprising amount of material. Thank you.

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