Therapist-guided and self-guided internet-delivered behavioural activation for adolescents with depression: a randomised feasibility trial
Objective Access to effective treatments for adolescents with depression needs to improve. Few studies have evaluated behavioural activation (BA) for adolescent depression, and none remotely delivered BA. This study explored the feasibility and acceptability of therapist-guided and self-guided inter...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/12/e066357.full |
| _version_ | 1797198189272498176 |
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| author | David Mataix-Cols Eva Serlachius Fabian Lenhard Sarah Vigerland Hanna Sahlin Johan Åhlén Eva Henje Cecilia Månsson Maria Beckman Rebecca Andersson |
| author_facet | David Mataix-Cols Eva Serlachius Fabian Lenhard Sarah Vigerland Hanna Sahlin Johan Åhlén Eva Henje Cecilia Månsson Maria Beckman Rebecca Andersson |
| author_sort | David Mataix-Cols |
| collection | DOAJ |
| description | Objective Access to effective treatments for adolescents with depression needs to improve. Few studies have evaluated behavioural activation (BA) for adolescent depression, and none remotely delivered BA. This study explored the feasibility and acceptability of therapist-guided and self-guided internet-delivered BA (I-BA) in preparation for a future randomised controlled trial (RCT).Design A single-blinded randomised controlled feasibility trial.Setting A specialist outpatient clinic in Sweden.Participants Thirty-two adolescents with mild-to-moderate major depression, aged 13–17 years.Interventions Ten weeks of therapist-guided I-BA or self-guided I-BA, or treatment as usual (TAU). Both versions of I-BA included parental support. TAU included referral to usual care within child and youth psychiatry or primary care.Outcomes Feasibility measures included study take-up, participant retention, acceptability, safety and satisfaction. The primary outcome measure was the blinded assessor-rated Children’s Depression Rating Scale, Revised. The primary endpoint was the 3-month follow-up.Results 154 adolescents were screened and 32 were randomised to therapist-guided I-BA (n=11), self-guided I-BA (n=10) or TAU (n=11). Participant retention was acceptable, with two drop-outs in TAU. Most participants in TAU had been offered interventions by the primary endpoint. The mean number of completed chapters (total of 8) for adolescents was 7.5 in therapist-guided I-BA and 5.4 in self-guided I-BA. No serious adverse events were recorded. Satisfaction was acceptable in both I-BA groups. Following an intent-to-treat approach, the linear mixed-effects model revealed that both therapist-guided and self-guided I-BA (Cohen’s d=2.43 and 2.23, respectively), but not TAU (Cohen’s d=0.95), showed statistically significant changes on the primary outcome measure with large within-group effect sizes.Conclusions Both therapist-guided and self-guided I-BA are acceptable and potentially efficacious treatments for adolescents with depression. It is feasible to conduct a large-scale RCT to establish the efficacy and cost-effectiveness of I-BA versus TAU.Trial registration number ClinicalTrials.gov Registry (NCT04117789). |
| first_indexed | 2024-03-13T01:11:07Z |
| format | Article |
| id | doaj.art-d4555c1c0bfc4ca4adf310d1d35be98d |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-24T06:55:54Z |
| publishDate | 2022-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-d4555c1c0bfc4ca4adf310d1d35be98d2024-04-22T12:50:10ZengBMJ Publishing GroupBMJ Open2044-60552022-12-01121210.1136/bmjopen-2022-066357Therapist-guided and self-guided internet-delivered behavioural activation for adolescents with depression: a randomised feasibility trialDavid Mataix-Cols0Eva Serlachius1Fabian Lenhard2Sarah Vigerland3Hanna Sahlin4Johan Åhlén5Eva Henje6Cecilia Månsson7Maria Beckman8Rebecca Andersson9Stockholm Health Care Services, Region Stockholm, Stockholm, SwedenDepartment of Clinical Sciences, Child and Adolescent Psychiatry, Lund University, Lund, SwedenDepartment of Clinical Neuroscience, Karolinska Institutet, Stockholm, SwedenCentre for Psychiatry Research,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, SwedenStockholm Health Care Services, Region Stockholm, Stockholm, SwedenDepartment of Global Public Health, Karolinska Institutet, Stockholm, SwedenDepartment of Clinical Science, Child and Adolescent Psychiatry, Umeå Universitet, Umea, SwedenStockholm Health Care Services, Region Stockholm, Stockholm, SwedenCentre for Psychiatry Research,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, SwedenDepartment of Clinical Neuroscience, Karolinska Institutet, Stockholm, Region Stockholm, SwedenObjective Access to effective treatments for adolescents with depression needs to improve. Few studies have evaluated behavioural activation (BA) for adolescent depression, and none remotely delivered BA. This study explored the feasibility and acceptability of therapist-guided and self-guided internet-delivered BA (I-BA) in preparation for a future randomised controlled trial (RCT).Design A single-blinded randomised controlled feasibility trial.Setting A specialist outpatient clinic in Sweden.Participants Thirty-two adolescents with mild-to-moderate major depression, aged 13–17 years.Interventions Ten weeks of therapist-guided I-BA or self-guided I-BA, or treatment as usual (TAU). Both versions of I-BA included parental support. TAU included referral to usual care within child and youth psychiatry or primary care.Outcomes Feasibility measures included study take-up, participant retention, acceptability, safety and satisfaction. The primary outcome measure was the blinded assessor-rated Children’s Depression Rating Scale, Revised. The primary endpoint was the 3-month follow-up.Results 154 adolescents were screened and 32 were randomised to therapist-guided I-BA (n=11), self-guided I-BA (n=10) or TAU (n=11). Participant retention was acceptable, with two drop-outs in TAU. Most participants in TAU had been offered interventions by the primary endpoint. The mean number of completed chapters (total of 8) for adolescents was 7.5 in therapist-guided I-BA and 5.4 in self-guided I-BA. No serious adverse events were recorded. Satisfaction was acceptable in both I-BA groups. Following an intent-to-treat approach, the linear mixed-effects model revealed that both therapist-guided and self-guided I-BA (Cohen’s d=2.43 and 2.23, respectively), but not TAU (Cohen’s d=0.95), showed statistically significant changes on the primary outcome measure with large within-group effect sizes.Conclusions Both therapist-guided and self-guided I-BA are acceptable and potentially efficacious treatments for adolescents with depression. It is feasible to conduct a large-scale RCT to establish the efficacy and cost-effectiveness of I-BA versus TAU.Trial registration number ClinicalTrials.gov Registry (NCT04117789).https://bmjopen.bmj.com/content/12/12/e066357.full |
| spellingShingle | David Mataix-Cols Eva Serlachius Fabian Lenhard Sarah Vigerland Hanna Sahlin Johan Åhlén Eva Henje Cecilia Månsson Maria Beckman Rebecca Andersson Therapist-guided and self-guided internet-delivered behavioural activation for adolescents with depression: a randomised feasibility trial BMJ Open |
| title | Therapist-guided and self-guided internet-delivered behavioural activation for adolescents with depression: a randomised feasibility trial |
| title_full | Therapist-guided and self-guided internet-delivered behavioural activation for adolescents with depression: a randomised feasibility trial |
| title_fullStr | Therapist-guided and self-guided internet-delivered behavioural activation for adolescents with depression: a randomised feasibility trial |
| title_full_unstemmed | Therapist-guided and self-guided internet-delivered behavioural activation for adolescents with depression: a randomised feasibility trial |
| title_short | Therapist-guided and self-guided internet-delivered behavioural activation for adolescents with depression: a randomised feasibility trial |
| title_sort | therapist guided and self guided internet delivered behavioural activation for adolescents with depression a randomised feasibility trial |
| url | https://bmjopen.bmj.com/content/12/12/e066357.full |
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