Levelling Up: Computerised therapy for depression among adolescents alienated from mainstream education

Abstract

Background Adolescents in alternative schooling programmes for those alienated from mainstream education (‘adolescents in alternative schooling’) have high rates of depression and yet seldom receive treatment. Computerised Cognitive Behavioural Therapy (cCBT) is effective for depression among adults and has the potential to increase the availability of psychotherapy. There have been few adolescent specific cCBT programmes, little investigation of cCBT for adolescents, and no investigation of the potential of cCBT among adolescents in alternative schooling. Aims To explore the acceptability, effectiveness and feasibility of cCBT for symptoms of depression among adolescents in alternative schooling. Methods Methods 1) An adolescent specific cCBT programme for symptoms of depression was developed with a multidisciplinary team, and with youth and expert input. 2) Semi structured interviews and focus groups were held with 40 youth service providers who work closely with adolescents alienated, or at risk of being alienated, from mainstream schooling. 3) Focus groups were carried out with 39 adolescents (29 male; 19 Maori; 10 Pacific Island; 10 New Zealand European/other; all 13-16 years old) in alternative schooling. 4) A pragmatic randomised controlled trial of cCBT (SPARX) with students in alternative schooling. Participants (32 with symptoms of possible depression and 12 without symptoms; 30 male; 17 Maori; 14 Pacific Island; 13 New Zealand European/other; all 13-16 years old) were randomised to immediate or delayed cCBT. Effectiveness was tested for students with depressive symptoms at baseline. 5) Semi-structured 5) Semi-structured interviews with 39 trial participants (30 with symptoms of possible depression; 24 male; 15 Maori; 12 Pacific Island; 12 New Zealand European/other), a staff member at each participating site and 10 parents or caregivers of adolescents who had participated in the trial. Results A cCBT programme ‘SPARX’, utilising a bi-centric frame of reference, a game like interface and incorporating common elements of therapy and CBT content, was developed. Youth service providers were interested in utilising cCBT; many would wish to do so with all the young people in their programmes. Some were concerned that cCBT might displace human support. Adolescents considered that hurting oneself or others were common ways of responding to depression and that asking for help was very unlikely. They were interested in cCBT, especially if this could be provided without the need for them to be identified as having a problem. Among the 30 students with symptoms of depression who began treatment as randomised and provided 5 week data, significant differences were found between cCBT and wait groups on the Children’s Depression Rating Scale-Revised (primary outcome measure) (baseline to 5 week mean change -14.7 vs. -1.1, p<.001), remission (78% vs. 36%, p = 0.047) and the Reynolds Adolescent Depression Scale 2nd edition (-4.6 vs. +3.2 p=0.05), but not on other psychological functioning scales. Gains were maintained at 5 week follow up. Participants with and without depressive symptoms considered cCBT helpful, often because it helped with anger, fighting or relationships. Most considered that cCBT would increase help-seeking and thought it should be offered to all students. Parents and providers were satisfied with SPARX, although providers considered the support from the researcher important in implementation. Conclusion Computerised CBT holds promise for use with adolescents in alternative schooling.