Revising Computerized Therapy for Wider Appeal Among Adolescents: Youth Perspectives on a Revised Version of SPARX

Abstract

Background: The way in which computerized therapy is presented may be important for its uptake. We aimed to explore adolescents’ views on the appeal of a tested computerized cognitive behavioral therapy (CCBT) for depression (SPARX), and a revised version (SPARX-R). The versions were similar but while SPARX is presented explicitly as a treatment for depression, SPARX-R is presented as providing skills that could be useful for young people for when they were depressed, down, angry, or stressed. Methods: We held 9 focus groups with a total of 79 adolescents (13–19 years old; 47 females; 34 New Zealand European; 22 Māori or Pacific; 60 reported having experienced feeling down or low for at least several days in a row). Groups viewed the opening sequences of SPARX and SPARX-R (in random order), then took part in a semi-structured discussion and completed a brief questionnaire. Responses were analyzed using a general inductive approach. Results: Participants considered both SPARX and SPARX-R useful and considered the stated purpose of the program to be important. Four themes contrasted the two approaches. The first, “naming depression is risky”, referred to perceptions that an explicit focus on depression could be off-putting, including for adolescents with depression. The second theme of “universality” reflected preferences for a universal approach as young people might not recognize that they were depressed, and all would benefit from the program. In contrast, “validation” reflected the view of a significant minority that naming depression could be validating for some. Finally, the theme of “choice” reflected a near-unanimously expressed preference for both options to be offered, allowing user choice. In questionnaire responses, 40 (68%) of participants preferred SPARX-R, 13 (18%) preferred SPARX, while 10 (14%) “didn’t mind”. Responses were similar among participants who reported that they had experienced at least a few days of low mood and those who had not. Conclusions: The way a CCBT program is presented may have implications for its appeal. The potential population impact of CCBT programs explicitly targeting depression and those targeting more universal feelings such as being stressed or feeling depressed should be explored for varied user groups.

Young adolescents’ interest in a mental health casual video game

“…7,8 Earlier research with culturally diverse adolescents in New Zealand (NZ) has demonstrated that teens consider mental distress common and yet consider it normal to only seek help in crisis situations. 8,12,13 Consistent with international research, NZ adolescents reported that they face barriers to mental health support, including not recognising distress as a health need that they could get help for, feeling too hopeless, uncertain or embarrassed to seek help, and more external barriers such as lack of face-to-face treatment, delays in receiving help, or a poor fit with available therapists. 8,12,13 Youth centred research demonstrates that adolescents make use of a variety of digital tools to support their mental state, such as posting on social media and watching videos or playing video games.…”

Digital Social and Emotional Literacy Intervention for Vulnerable Children in Brazil: Participants’ Experiences

“…These can be adapted to digital formats, which offer a wider reach to large groups of children, as long as they can access online platforms, predominantly through their schools [57]. It has been shown that the appeal of digital interventions such as based on casual video games [58,59] increases children's engagement and uptake [60]. Co-design with young people enhances their appeal [61].…”

“…Co-design with young people enhances their appeal [61]. These interventions can be implemented in advance of stressful experiences such as exams [62] and in response to stressors [58,63].…”

Technology Matters: SPARX – computerised cognitive behavioural therapy for adolescent depression in a game format

“…However, adolescents have also expressed the need for a range and choice of digital and face‐to‐face supports. Indeed, recent analyses indicate that the inclusion of games or game elements will increase appeal among some users while decreasing appeal among others, highlighting that diverse approaches are necessary and ‘one size will not fit all’, even among those with similar demographic characteristics and similar mental health needs (Fleming, Stasiak, et al, 2019).…”

“…A revised version of SPARX (‘SPARX‐R’) was developed for universal use, for example in school health classes (Fleming, Stasiak, et al, 2019), and was shown to be effective in preventing the onset of depression in a large study in Australia (Perry et al, 2017). This is one of the first e‐therapy trials to show a depression prevention intervention effect (Perry et al, 2017).…”