Feasibility study of a new behavioural activation programme for young people with depressed mood

Abstract

Background: Behavioural activation (BA) is effective in adults with depression but the evidence for young people (YP) is less clear. We therefore developed and tested a new coproduced BA programme. Method: In phase one (2014 to 2015 inclusive), we codeveloped with young people attending specialist child and adolescent mental health service (CAMHS) an 8-session BA workbook. In Phase two (2019 to 2020 inclusive), we ran an uncontrolled feasibility study in two specialist CAMHS, with BA being offered to YP by less specialised staff.Results: In phase one, we tested the workbook with 15 YP with depression and other comorbidities. Satisfaction was good from both YP and staff, and 9 YP reported improvement in mood. In phase two, 51 YP were offered BA; 15 declined to take part. 36 consented with three dropping out after consent. 33 YP (mean age 14.6, 12 males, 24 females) continued treatment attending a mean of 6.6 sessions. At the end of treatment, youth-rated Mood and Feeling Questionnaire (MFQ) mean score decreased from 43.2 to 27.6, difference 14.6 (95% CI 8.7 to 20.2; n = 28), and Clinician Global Assessment Score (CGAS) mean score increased from 52.3 to 69.8, difference 18.0 (95% CI 11.9 to 24.2; n = 29). Of the 33 YP who participated in therapy, 12 (36%) recovered and were discharged. Conclusions: This programme demonstrated preliminary evidence for effectiveness and utility. Less specialised staff were able to use BA, and this may reduce secondary waits for more specialist therapy. More research is needed about the role of BA in specialist CAMHS.

Exploring barriers and facilitators for mental health professionals delivering behavioural activation to young people with depression: qualitative study using the Theoretical Domains Framework

“…Full details of patients included are published in the outcome paper. 20 In brief, 33 young people aged 12–17 years were involved; 11 were male (33%) and 22 were female (67%); and patients were of mixed (White and Asian) ( n = 2), Asian ( n = 2), Black (African) ( n = 1) or White British ( n = 28) ethnicity.…”

“…It was part of a wider feasibility study. 20 This study adds to the limited research that has used the TDF to investigate barriers and facilitators to implementing psychological therapies, 9 , 43 and, to our knowledge, is the first study to specifically investigate the implementation of a behavioural activation intervention. A strength of this study is that it demonstrated how the novel TTT can be used to systematically identify and link TDF domains to evidence-based BCTs, which can be used to overcome barriers and support facilitators of implementing a new intervention into clinical practice.…”

“…The wider feasibility study details, fidelity measures and participant outcomes are reported in full elsewhere. 20,21 In brief, seven MHPs delivered eight sessions of manualised behavioural activation to 33 young people aged 12-17 years, over 10 months (July 2019 to April 2020), in two specialist NHS CAMHS sites within the North-West of England. CAMHS are the UK NHS mental health services for children and young people, delivering evidence-based psychological therapies to help ameliorate affective or behavioural problems.…”

“…The wider feasibility study details, fidelity measures and participant outcomes are reported in full elsewhere. 20 , 21 …”

Barriers and enablers for young people, parents and therapists undertaking behavioural activation for depression: A qualitative evaluation within a randomised controlled trial

“…Only one study has interviewed parents/carers of young people with depression undertaking BA (Dubicka et al, 2022) and very few studies sought feedback from young people who have experienced support and therapist preconceptions against manualised therapy or BA. Conclusions: Manualised BA for young people requires flexibility and adjustment to meet individual and family needs.…”