Assessing Fidelity to and Satisfaction with the “Adolescent Coping with Depression Course” (ACDC) Intervention in a Randomized Controlled Trial

Keles, Serap; Bringedal, Görel; Idsøe, Thormod

doi:10.1007/s10942-021-00427-x

Cited by 4 publications

(2 citation statements)

References 22 publications

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“…Smartphone-based DTx are particularly well suited for adolescents given their technological literacy, ubiquitous cell phone use, and privacy preferences [22,29,31,32]. DTx are also easily scalable, can serve as adjunct to standard care, improve treatment fidelity [33][34][35], are cost-effective [36]. These technologies have been shown to be preliminarily effective in treating adolescents with a variety of mental health concerns including attention-deficit/hyperactivity disorder [37], sleep disorders, eating disorders, and anxiety [38].…”

Section: Introductionmentioning

confidence: 99%

Preliminary Efficacy of a Digital Intervention for Adolescent Depression: Randomized Controlled Trial

Peake,

Miller,

Flannery

et al. 2024

J Med Internet Res

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Background Adolescent depression is a significant public health concern; however, access to effective mental health care is limited. Digital therapeutics (DTx) can improve access to evidence-based interventions; however, their efficacy in adolescents is sparsely documented. Objective This study aims to examine the efficacy of a mobile app DTx versus an active control as an adjunct treatment for adolescent depression symptoms. Methods An internet-based open-label randomized control trial was conducted nationwide with a partial crossover design, and 168 adolescents aged 13 to 21 years with symptoms of depression were recruited between November 2020 and September 2021. Participants were randomized (1:1) to the cognitive behavioral therapy–based treatment app (Spark) or to a psychoeducational control app (control), which they would use for a duration of 5 weeks. The primary outcome was a between-group (Spark vs control) difference in the change in depression symptoms from baseline to postintervention, as measured by the Patient Health Questionnaire-8 (PHQ-8) using a linear mixed-effects analysis. The PHQ-8 ranges from 0 to 24, with scores of 5 to 9 indicating mild depression symptoms, scores of 10 to 14 indicating moderate symptoms, scores of 15 to 19 indicating moderately severe symptoms, and scores of 20 to 24 indicating severe symptoms. A minimal clinically important difference (5-point reduction between baseline and postintervention) in the Spark arm and group differences in remission and treatment response rates based on the PHQ-8 at postintervention were also investigated. Results A total of 160 participants were randomized, 80 in the Spark arm (mean age 16.89, SD 2.5 y) and 80 in the control arm (mean age 16.79, SD 2.59 y). Data from 121 participants (Spark: n=63; control: n=58) with moderate to severe (PHQ-8≥10) symptoms at baseline were included in the primary analyses following a modified intention-to-treat principle. A linear mixed-effect analysis revealed a nonsignificant difference between the study arms in depression symptom change over the intervention period. The Spark arm met a minimal clinically important difference threshold (mean −5.08, 95% CI −6.72 to −3.42). The remission rate in the Spark arm was significantly higher than that in the control arm (11/63, 17% vs 2/58, 3%; χ21=6.2; P=.01; false discovery rate–adjusted P=.03). The treatment response rates were not significantly different between the study arms (P=.07; false discovery rate–adjusted P=.16). Post hoc analyses including participants with mild to severe (PHQ-8 score ≥5) symptoms at baseline revealed promising evidence that Spark is effective in those with mild to severe symptoms. Conclusions There is initial evidence that a self-guided, cognitive behavioral therapy–based DTx intervention may effectively treat mild to severe depression symptoms in adolescents. DTx may improve access to mental health care for adolescents or serve as an important adjunct to the standard of care. Trial Registration ClinicalTrials.gov NCT04524598; https://clinicaltrials.gov/study/NCT04524598

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Section: Introductionmentioning

confidence: 99%

Preliminary Efficacy of a Digital Intervention for Adolescent Depression: Randomized Controlled Trial

Peake,

Miller,

Flannery

et al. 2024

J Med Internet Res

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“…Other research has described using a multi-pronged approach to measuring CBT fidelity, through examining study design, training, intervention delivery, receipt of the intervention, and enactment of intervention skills ( Keles et al, 2021 ). As observational methods of recording fidelity with trained raters are considered the gold standard, research processes generally include the selection of raters familiar with therapy practices, double coding of recorded sessions (i.e., two raters per session), and a process to achieve inter-rater reliability through regular research team meetings and the calculation of reliability metrics ( Rodriguez-Quintana et al, 2021 ).…”

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confidence: 99%

Assessing the Fidelity of an Affirmative Cognitive Behavioral Group Intervention

Craig

Pascoe

Iacono

et al. 2022

Research on Social Work Practice

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Purpose Support implementation fidelity in intervention research with lesbian, gay, bisexual, transgender, queer, and sexual and gender diverse (LGBTQ+) populations, this study explores the systematic development of a fidelity process for AFFIRM, an evidence-based, affirmative cognitive behavioral therapy group intervention for LGBTQ+ youth and adults. Method As part of a clinical trial, the AFFIRM fidelity checklist was designed to assess clinician adherence. A total of 151 audio-recorded group sessions were coded by four trained raters. Results Adherence was high with a mean fidelity score of 84.13 ( SD = 12.50). Inter-rater reliability was 81%, suggesting substantial agreement. Qualitative thematic analysis of low-rated sessions identified deviations from the manual and difficulties in group facilitation, while high-rated sessions specified affirmative and effective clinical responses. Discussion Findings were integrated into clinical training and coaching. The fidelity process provides insights into the challenges of implementing social work interventions effectively with LGBTQ+ populations in community settings.

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Association between Intention to Quit School and Youth Depression: A Cluster Randomized Controlled Trial of the Effects of a Group CBT Course

Sætre

Keles

Idsøe

2023

Scandinavian Journal of Educational Research

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Assessing Fidelity to and Satisfaction with the “Adolescent Coping with Depression Course” (ACDC) Intervention in a Randomized Controlled Trial

Cited by 4 publications

References 22 publications

Preliminary Efficacy of a Digital Intervention for Adolescent Depression: Randomized Controlled Trial

Preliminary Efficacy of a Digital Intervention for Adolescent Depression: Randomized Controlled Trial

Assessing the Fidelity of an Affirmative Cognitive Behavioral Group Intervention

Association between Intention to Quit School and Youth Depression: A Cluster Randomized Controlled Trial of the Effects of a Group CBT Course

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