Hostname: page-component-8448b6f56d-sxzjt Total loading time: 0 Render date: 2024-04-17T16:53:00.085Z Has data issue: false hasContentIssue false
  • English
  • Français

Feasibility randomized controlled trial of a one-day CBT workshop (‘DISCOVER’) for 15- to 18-year-olds with anxiety and/or depression in clinic settings

Published online by Cambridge University Press:  20 May 2019

Christina E. Loucas Open the ORCID record for Christina E. Loucas [Opens in a new window] ,
Irene Sclare ,
Daniel Stahl  and
Daniel Michelson
Christina E. Loucas*
Affiliation:
Doctorate in Clinical Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, PO Box 78, 4 Windsor Walk, London SE5 8AF, UK
Irene Sclare
Affiliation:
Child and Adolescent Mental Health, South London and Maudsley NHS Foundation Trust, Mapother House, Maudsley Hospital, 1st Floor, De Crespigny Park, London SE5 8AZ, UK
Daniel Stahl
Affiliation:
Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, Box PO20, De Crespigny Park, London SE5 8AF, UK
Daniel Michelson
Affiliation:
School of Psychology, Pevensey Building, University of Sussex, Falmer, Brighton BN1 9QH, UK
*
*Corresponding author. Email: c.e.loucas@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

‘DISCOVER’ one-day cognitive behavioural therapy (CBT) workshops have been developed to provide accessible, developmentally sensitive psychological support for older adolescents experiencing emotional difficulties. Previous school-based evaluations of the DISCOVER model have shown positive outcomes.

Aims:

The current study aimed to test the model for clinically referred adolescents, in real-world settings.

Method:

A randomized controlled trial (RCT) assessed feasibility, acceptability and preliminary outcomes of the DISCOVER intervention, in comparison with usual care, for 15- to 18-year-olds with emotional difficulties. Participants were recruited from outpatient clinic waiting lists in UK child and adolescent mental health services (CAMHS). Research feasibility indicators included rates of recruitment, randomization, intervention participation (group workshops and individualized follow-up telephone calls), and data collection (at baseline and 8-week follow-up). Intervention acceptability was assessed using a structured service satisfaction questionnaire and semi-structured qualitative interviews with intervention participants. Preliminary clinical outcomes were explored using adolescent-reported validated measures of depression, anxiety and well-being.

Results:

n = 24 participants were randomized to intervention and usual care groups. Workshop attendance was good and high levels of treatment satisfaction were reported, although feasibility challenges emerged in recruitment and randomization. Trends were found towards potential improvements in anxiety and well-being for the intervention group, but the effect estimate for depression was imprecise; interpretability was also limited due to the small sample size.

Conclusions:

DISCOVER appears to be a feasible and acceptable intervention model for clinically referred 15- to 18-year-olds with emotional difficulties. A full-scale RCT is warranted to evaluate effectiveness; protocol modifications may be necessary to ensure feasible recruitment and randomization procedures.

Keywords

adolescentanxietyCBTdepressionRCT
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 48 , Issue 2 , March 2020 , pp. 142 - 159
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abdinasir, K. (2017). Stick With Us: Tackling Missed Appointments in Children’s Mental Health Services. London: The Children’s Society. Retrieved from: https://www.childrenssociety.org.uk/sites/default/files/stick_with_us_-_tackling_missed_appointments_in_children_s_mental_health_services.pdf Google Scholar
Abdinasir, K. and Pona, I. (2015). Access Denied: A Teenager’s Pathway through the Mental Health System. London: The Children’s Society. Retrieved from: http://www.childrenssociety.org.uk/sites/default/files/AccessDenied_final.pdf Google Scholar
Ahmed, S. P., Bittencourt-Hewitt, A. and Sebastian, C. L. (2015). Neurocognitive bases of emotion regulation development in adolescence. Developmental Cognitive Neuroscience, 15, 11–25. doi: 10.1016/j.dcn.2015.07.006 CrossRefGoogle ScholarPubMed
Balázs, J., Miklósi, M., Keresztény, A., Hoven, C. W., Carli, V., Wasserman, C., … Wasserman, D. (2013). Adolescent subthreshold-depression and anxiety: psychopathology, functional impairment and increased suicide risk. Journal of Child Psychology and Psychiatry, 54, 670–677. doi: 10.1111/jcpp.12016.CrossRefGoogle ScholarPubMed
Bearman, S. K. and Weisz, J. R. (2015). Review: Comprehensive treatments for youth comorbidity– evidence-guided approaches to a complicated problem. Child and Adolescent Mental Health, 20, 131–141. doi: 10.1111/camh.12092 CrossRefGoogle ScholarPubMed
Beck, J. S. (2011). Cognitive Behavior Therapy: Basics and Beyond (2nd edn). New York: Guilford Press.Google Scholar
Bernard, H., Burlingame, G., Flores, P., Greene, L., Joyce, A., Kobos, J. C., … Feirman, D. (2008). Clinical practice guidelines for group psychotherapy. International Journal of Group Psychotherapy, 58, 455–542. doi: 10.1521/ijgp.2008.58.4.455 CrossRefGoogle ScholarPubMed
Bradford, S. and Rickwood, D. (2012). Adolescent’s preferred modes of delivery for mental health services. Child and Adolescent Mental Health, 19, 39–45. doi: 10.1111/camh.12002 CrossRefGoogle Scholar
Braun, V. and Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. doi: 10.1191/1478088706qp063oa CrossRefGoogle Scholar
Brown, J. S. L., Cochrane, R. and Hancox, T. (2000). Large-scale health promotion stress workshops for the general public: a controlled evaluation. Behavioural and Cognitive Psychotherapy, 28, 139–151. https://www.cambridge.org/core/journals/behavioural-and-cognitive-psychotherapy/article/large-scale-health-promotion-stress-workshops-for-the-general-public-a-controlled-evaluation/91D41A622BACB46CEA853889A9CCA4C8 CrossRefGoogle Scholar
Browne, R. H. (1995). On the use of a pilot sample for sample size determination. Statistics in Medicine, 14, 1933–1940. doi: 10.1002/sim.4780141709 CrossRefGoogle ScholarPubMed
Brown, J. S. L., Blackshaw, E., Stahl, D., Fennelly, L., McKeague, L., Sclare, I. and Michelson, D. (2019). School-based early intervention for anxiety and depression in older adolescents: a feasibility randomised controlled trial of a self-referral stress management workshop programme (‘DISCOVER’). Journal of Adolescence, 71, 150–161. doi: 10.1016/j.adolescence.2018.11.009 CrossRefGoogle Scholar
Campinha-Bacote, D. and Dexter, D. (2012). Pre-group preparation in college counseling centers: through the use of an audio-visual aid (Electronic Thesis or Dissertation). Retrieved from: https://corescholar.libraries.wright.edu/cgi/viewcontent.cgi?article=2249andcontext=etd_all Google Scholar
Chapman, R., Loades, M., O’Reilly, G., Coyle, D., Patterson, M. and Salkovskis, P. (2016). ‘Pesky gNATs’: investigating the feasibility of a novel computerized CBT intervention for adolescents with anxiety and/or depression in a Tier 3 CAMHS setting. The Cognitive Behaviour Therapist, 9, e35. doi: 10.1017/S1754470X16000222 CrossRefGoogle Scholar
Children’s Commissioner for England (2016). Lightning Review: Access to Child and Adolescent Mental Health Services, May 2016. London: Children’s Commissioner for England. Retrieved from: https://www.childrenscommissioner.gov.uk/wp-content/uploads/2017/06/Childrens-Commissioners-Mental-Health-Lightning-Review.pdf Google Scholar
Chorpita, B. F. and Daleiden, E. L. (2009). Mapping evidence-based treatments for children and adolescents: application of the distillation and matching model to 615 treatments from 322 randomized trials. Journal of Consulting and Clinical Psychology, 77, 566–579. doi: 10.1037/a0014565.CrossRefGoogle ScholarPubMed
Chorpita, B. F., Taylor, A. A., Francis, S. E., Moffitt, C. and Austin, A. A. (2004). Efficacy of modular cognitive behavior therapy for childhood anxiety disorders. Behavior Therapy, 35, 263–287. doi: 10.1016/S0005-7894(04)80039-X CrossRefGoogle Scholar
Chorpita, B. F., Weisz, J. R., Daleiden, E. L., Schoenwald, S. K., Palinkas, L. A., Miranda, J., … Gibbons, R. D. (2013). Long-term outcomes for the Child STEPs randomized effectiveness trial: a comparison of modular and standard treatment designs with usual care. Journal of Consulting and Clinical Psychology, 81, 999–1009. doi: 10.1037/a0034200.CrossRefGoogle Scholar
Chorpita, B. F., Yim, L. M., Moffitt, C., Umemoto, L. A. and Francis, S. E. (2000). Assessment of symptoms of DSM-IV anxiety and depression in children: a revised child anxiety and depression scale. Behaviour Research and Therapy, 38, 835–855. doi: 10.1016/S0005-7967(99)00130-8 CrossRefGoogle ScholarPubMed
Chu, B. C., Temkin, A. B. and Toffey, K. (2016). Transdiagnostic Mechanisms and Treatment for Children and Adolescents: An Emerging Field. Oxford: Oxford Handbooks Online.CrossRefGoogle Scholar
Clark, D. M. (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: the IAPT experience. International Review of Psychiatry, 23, 318–327. doi: 10.3109/09540261.2011.606803 CrossRefGoogle ScholarPubMed
Clarke, A., Friede, T., Putz, R., Ashdown, J., Martin, S., Blake, A., … Stewart-Brown, S. (2011). Warwick-Edinburgh mental well-being scale (WEMWBS): validated for teenage school students in England and Scotland. A mixed methods assessment. BMC Public Health, 11, 487. doi: 10.1186/1471-2458-11-487 CrossRefGoogle Scholar
Costello, E. J. and Angold, A. (1988) Scales to assess child and adolescent depression: checklists, screens, and nets. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 726–737. doi: 10.1097/00004583-198811000-00011 CrossRefGoogle ScholarPubMed
Craske, M. G. (2012). Transdiagnostic treatment for anxiety and depression. Depression and Anxiety, 29, 749–743. doi: 10.1002/da.21992 CrossRefGoogle ScholarPubMed
Department of Health and NHS England (2015). Future in Mind: Promoting, Protecting and Improving our Children and Young People’s Mental Health and Wellbeing. London: Department of Health and NHS England. Retrieved from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/414024/Childrens_Mental_Health.pdf Google Scholar
Dong, Y. and Peng, J. (2013). Principled missing data methods for researchers. Springerplus, 2, 222. doi: 10.1186/2193-1801-2-222 CrossRefGoogle ScholarPubMed
Edbrooke-Childs, J., Calderon, A., Wolpert, M. and Fonagy, P. (2015). Children and Young People’s Improving Access to Psychological Therapies: Rapid Internal Audit, National Report. London: CYP-IAPT. Retrieved from: https://www.ucl.ac.uk/drupal/evidence-based-practice-unit/sites/evidence-based-practice-unit/files/pub_and_resources_project_reports_rapid_internal_audit_2015.pdf Google Scholar
Fernandez, E., Salem, D., Swift, J. K. and Ramtahal, N. (2015). Meta-analysis of dropout from cognitive behavioral therapy: magnitude, timing, and moderators. Journal of Consulting and Clinical Psychology, 83, 1108–1022. doi: 10.1037/ccp0000044 CrossRefGoogle ScholarPubMed
Foot, C., Naylor, C. and Imison, C. (2010). The Quality of GP Diagnosis and Referral. London: The King’s Fund. Retrieved from: https://www.kingsfund.org.uk/sites/files/kf/Diagnosis%20and%20referral.pdf Google Scholar
Frith, E. (2016). CentreForum Commission on Children and Young People’s Mental Health: State of the Nation. London: CentreForum. Retrieved from: http://centreforum.org/live/wp-content/uploads/2016/04/State-of-the-Nation-report-web.pdf Google Scholar
Gandhi, T. J., Sittig, D.F., Franklin, M., Sussman, A. J., Fairchild, D. G. and Bates, D. W. (2000). Communication breakdown in the outpatient referral process. Journal of General Internal Medicine, 15, 626–631. doi: 10.1046/j.1525-1497.2000.91119.x CrossRefGoogle ScholarPubMed
Green, H., McGinnity, A., Meltzer, H., Ford, T. and Goodman, R. (2005). Mental Health of Children and Young People in Great Britain, 2004. A Survey Carried Out by the Office for National Statistics on Behalf of the Department of Health and the Scottish Executive. Basingstoke: Palgrave Macmillan. Retrieved from: http://content.digital.nhs.uk/catalogue/PUB06116/ment-heal-chil-youn-peop-gb-2004-rep2.pdf Google Scholar
Goodyer, I. M., Reynolds, S., Barrett, B., Byford, S., Dubicka, B., Hill, J., … Fonagy, P. (2017). Cognitive behavioural therapy and short-term psychoanalytical psychotherapy versus a brief psychosocial intervention in adolescents with unipolar major depressive disorder (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled superiority trial. Lancet Psychiatry, 4, 109–119. doi: 10.1016/S2215-0366(16)30378-9 CrossRefGoogle ScholarPubMed
Guest, G., Bunce, A. and Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18, 59–82.CrossRefGoogle Scholar
Hagermoser Sanetti, L. M., Collier-Meek, M. A. and Fallon, L. M. (2016). Fidelity with flexibility: treatment acceptability and individualised adaptations of evidence-supported treatments. In Maltzman, S. (ed), The Oxford Handbook of Treatment Processes and Outcomes in Psychology: A Multidisciplinary Biopsychosocial Approach (pp. 289–308). New York: Oxford University Press.Google Scholar
Harper, B., Dickson, J. M. and Bramwell, R. (2014). Experiences of young people in a 16–18 Mental Health Service. Child and Adolescent Mental Health, 19, 90–96. doi: 10.1111/camh.12024 CrossRefGoogle Scholar
Higa-McMillan, C. K., Francis, S. E., Rith-Najarian, L. and Chorpita, B. F. (2016). Evidence base update: 50 years of research on treatment for child and adolescent anxiety. Journal of Clinical Child and Adolescent Psychology, 45, 91–113. doi: 10.1111/camh.12024 CrossRefGoogle ScholarPubMed
Hopkins, K., Crosland, P., Elliott, N. and Bewley, S. (2015). Diagnosis and management of depression in children and young people: summary of updated NICE guidance. BMJ, 350, h824. doi: 10.1136/bmj.h824 CrossRefGoogle Scholar
House of Commons Health Committee (2014). Children’s and Adolescents’ Mental Health and CAMHS: Third Report of Session 2014–15. House of Commons London: The Stationery Office Limited. Retrieved from: https://www.publications.parliament.uk/pa/cm201415/cmselect/cmhealth/342/342.pdf Google Scholar
Ioannidis, J. P. (2005). Why most published research findings are false. PLoS Medicine, 2, e124.CrossRefGoogle ScholarPubMed
Khanna, M. S. and Kendall, P. C. (2010). Computer-assisted cognitive behavioral therapy for child anxiety: results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 78, 737–745. doi: 10.1037/a0019739 CrossRefGoogle ScholarPubMed
Kim-Cohen, J., Caspi, A., Moffitt, T. E., Harrington, H., Milne, B. J. and Poulton, R. (2003). Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort. Archives of General Psychiatry, 60, 709–717. doi: 10.1001/archpsyc.60.7.709 CrossRefGoogle ScholarPubMed
Larsen, D. L., Attkisson, C. C., Hargreaves, W. A. and Nguyen, T. D. (1979). Assessment of client/patient satisfaction: development of a general scale. Evaluation and Program Planning, 2, 197–207. doi: 10.1016/0149-7189(79)90094-6 CrossRefGoogle ScholarPubMed
McGorry, P., Bates, T. and Birchwood, M. (2013). Designing youth mental health services for the 21st century: examples from Australia, Ireland and the UK. British Journal of Psychiatry, 202, s30–35. doi: 10.1192/bjp.bp.112.119214 CrossRefGoogle Scholar
Memarzia, J., St Clair, M. C., Owens, M., Goodyer, I. M. and Dunn, V. J. (2015). Adolescents leaving mental health or social care services: predictors of mental health and psychosocial outcomes one year later. BMC Health Services Research, 15, 185. doi: 10.1186/s12913-015-0853-9 CrossRefGoogle ScholarPubMed
Michelson, D., Sclare, I., Stahl, D., Morant, N., Bonin, E. M. and Brown, J. S. (2016). Early intervention for depression and anxiety in 16-18-year-olds: protocol for a feasibility cluster randomised controlled trial of open-access psychological workshops in schools (DISCOVER). Contemporary Clinical Trials, 48, 52–58. doi: 10.1016/j.cct.2016.02.003 CrossRefGoogle Scholar
Newby, J. M., McKinnon, A., Kuyken, W., Gilbody, S. and Dalgleish, T. (2015). Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clinical Psychology Review, 40, 91–110. doi: 10.1016/j.cpr.2015.06.002 CrossRefGoogle ScholarPubMed
Ng, M. Y., Eckshtain, D. and Weisz, J. R. (2016). Assessing fit between evidence-based psychotherapies for youth depression and real-life coping in early adolescence. Journal of Clinical Child and Adolescent Psychology, 45, 732–748. doi: 10.1080/15374416.2015.1041591 CrossRefGoogle ScholarPubMed
Persson, S., Hagquist, C. and Michelson, D. (2017). Young voices in mental health care: exploring children’s and adolescents’ service experiences and preferences. Clinical Child Psychology and Psychiatry, 22, 140–151. doi: 10.1177/1359104516656722 CrossRefGoogle ScholarPubMed
Plaistow, J., Masson, K., Koch, D., Wilson, J., Stark, R. M., Jones, P. B. and Lennox, B. R. (2014). Young people’s views of UK mental health services. Early Intervention in Psychiatry, 8, 12–23. doi: 10.1111/eip.12060 CrossRefGoogle ScholarPubMed
Pona, I., Royston, S., Bracey, C. and Gibbs, A. (2015). Seriously Awkward: How Vulnerable 16-17 Year Olds are Falling through the Cracks. London: The Children’s Society. Retrieved from: http://www.childrenssociety.org.uk/sites/default/files/seriously_awkward_youth-at-risk_full_online-final.pdf Google Scholar
Sclare, I. and Michelson, D. (2016). Innovations in CBT for young people: Improving access and outcomes for vulnerable youth. In Menzies, R. G., Kyrios, M., and Kazantzis, N. (eds), Innovations and Future Directions in the Behavioural and Cognitive Therapies (pp. 34–38). Samford Valley, Queensland: Australian Academic Press.Google Scholar
Sclare, I., Michelson, D., Malpass, L., Coster, F. and Brown, J. (2015). Innovations in Practice: DISCOVER CBT workshops for 16-18-year-olds: development of an open-access intervention for anxiety and depression in inner-city youth. Child and Adolescent Mental Health, 20, 102–106. doi: 10.1111/camh.12060 CrossRefGoogle Scholar
Shirk, S. R., DePrince, A. P., Crisostomo, P. S. and Labus, J. (2014). Cognitive behavioral therapy for depressed adolescents exposed to interpersonal trauma: an initial effectiveness trial. Psychotherapy, 51, 167–179. doi: 10.1037/a0034845 CrossRefGoogle ScholarPubMed
Smith, D., Roche, E., O’Loughlin, K., Brennan, D., Madigan, K., Lyne, J., … O’Donoghue, B. (2014). Satisfaction with services following voluntary and involuntary admission. Journal of Mental Health, 23, 38–45. doi: 10.3109/09638237.2013.841864 CrossRefGoogle ScholarPubMed
Southam-Gerow, M. A., Rodríguez, A., Chorpita, B. F. and Daleiden, E. (2012). Dissemination and implementation of evidence based treatments for youth: challenges and recommendations. Professional Psychology: Research and Practice, 43, 527–534. doi: 10.1037/a0029101 CrossRefGoogle Scholar
Stallard, P., Udwin, O., Goddard, M. and Hibbert, S. (2007). The availability of cognitive behaviour therapy within specialist child and adolescent mental health services (CAMHS): a national survey. Behavioural and Cognitive Psychotherapy, 35, 501–505. doi: 10.1017/S1352465807003724 CrossRefGoogle Scholar
Steinberg, L. (2005). Cognitive and affective development in adolescence. Trends in Cognitive Science, 9, 69–74. doi: 10.1016/j.tics.2004.12.005 CrossRefGoogle ScholarPubMed
Stewart, R., Soremekun, M., Perera, G., Broadbent, M., Callard, F., Denis, M., … Lovestone, S. (2009). The South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) case register: development and descriptive data. BMC Psychiatry, 9, 51. doi: 10.1186/1471-244X-9-51 CrossRefGoogle ScholarPubMed
Van Breukelen, G. J. (2006). ANCOVA versus change from baseline: more power in randomized studies, more bias in nonrandomized studies [corrected]. Journal of Clinical Epidemiology, 59, 920–925. doi: 10.1016/j.jclinepi.2006.02.007 CrossRefGoogle Scholar
Weersing, V. R., Jeffreys, M., Do, M.-C. T., Schwartz, K. T. G. and Bolano, C. (2017). Evidence base update of psychosocial treatments for child and adolescent depression. Journal of Clinical Child and Adolescent Psychology, 46, 11–43. doi: 10.1080/15374416.2016.1220310 CrossRefGoogle ScholarPubMed
Weersing, V. R., Rozenman, M. and Gonzalez, A. (2009). Core components of therapy in youth: do we know what to disseminate? Behavior Modification, 33, 24–47. doi: 10.1177/0145445508322629 CrossRefGoogle ScholarPubMed
Weisz, J. R., Kuppens, S., Ng, M. Y., Eckshtain, D., Ugueto, A. M., Vaughn-Coaxum, R., … Fordwood, S. R. (2017). What five decades of research tells us about the effects of youth psychological therapy: a multilevel meta-analysis and implications for science and practice. American Psychologist, 72, 79–117. doi: 10.1037/a0040360 CrossRefGoogle ScholarPubMed
Wolpert, M., Jacob, J., Napoleone, E., Whale, A., Calderon, A. and Edbrooke-Childs, J. (2017). Child- and Parent-Reported Outcomes and Experience from Child and Young People’s Mental Health Services 2011–2015. London: Child Outcomes Research Consortium (CORC). Retrieved from: http://www.corc.uk.net/media/1543/05052017_corc-report.pdf Google Scholar
Supplementary material: File

Loucas et al. supplementary material

Loucas et al. supplementary material 1

Download Loucas et al. supplementary material(File)
File 74.8 KB
Submit a response

Comments

No Comments have been published for this article.