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Grudin R, Vigerland S, Ahlen J, Widström H, Unger I, Serlachius E, Engberg H. "Therapy without a therapist?" The experiences of adolescents and their parents of online behavioural activation for depression with and without therapist support. Eur Child Adolesc Psychiatry 2024; 33:105-114. [PMID: 36650254 PMCID: PMC9844942 DOI: 10.1007/s00787-023-02142-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023]
Abstract
Behavioural Activation (BA) is an established treatment for adults with depression, and research on BA for adolescents is promising. However, there is a knowledge gap in terms of the experiences of adolescents and their parents BA for depression delivered online. Furthermore, there have been no previous studies conducted on the experiences of respondents with regard to the role of the therapist in online treatment. Therefore, the primary aim of this study is to explore the experiences of online BA among adolescents with depression and how their parents experience supporting their adolescent through treatment. Second, the experiences of having online therapy with or without a therapist were explored. Semi-structured interviews were conducted with eight adolescents and nine parents (n = 17) who completed guided or self-guided online BA. Reflexive thematic analysis was used to identify aspects of the experience of treatment that were important to adolescents and their parents. Two main themes were generated: (1) opportunities or barriers to engaging in treatment and (2) parental involvement is valued and welcomed. This study contributes valuable information regarding user experiences of BA treatment, the importance of therapist support and parental involvement in treating adolescents with depression.Trial registration number: ClinicalTrials.gov Identifier NCT04117789, Date of registration: 07 October 2019.
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Affiliation(s)
- Rebecca Grudin
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Healthcare Services, Region Stockholm, Gävlegatan 22, 113 30, Stockholm, Sweden.
| | - Sarah Vigerland
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Healthcare Services, Region Stockholm, Gävlegatan 22, 113 30, Stockholm, Sweden
| | - Johan Ahlen
- The Centre for Epidemiology and Community Medicine, Region Stockholm, Box 45436, 104 31, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Hanna Widström
- Moment Psychology, Drottninggatan 99, 113 60, Stockholm, Sweden
| | - Irma Unger
- Wemind Psychiatry, Rehnsgatan 20, 113 57, Stockholm, Sweden
| | - Eva Serlachius
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Baravägen 1, 222 40, Lund, Sweden
| | - Hedvig Engberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynaecology, Karolinska University Hospital, Stockholm, Sweden
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A cognitive behavioural therapy smartphone app for adolescent depression and anxiety: co-design of ClearlyMe. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Abstract
Adolescence is associated with heightened vulnerability to symptoms of depression and anxiety. In-person and computerised cognitive behavioural therapy (CBT) are effective treatment options, yet uptake and engagement remain low. Smartphone delivery of CBT offers an alternative, highly accessible method of delivering CBT. However, there is no freely available CBT smartphone application (app) specifically designed to reduce depression and anxiety symptoms in adolescents. The aim of this study was to design a new CBT smartphone app (ClearlyMe) that targets depressive and anxiety symptoms in adolescents. We engaged in a rigorous co-design process with adolescents (n=36), parents (n=15), and mental health professionals (n=32). Co-design involved: (1) discovery of users’ needs, views and preferences by conducting focus groups, (2) defining app features through ideation workshops and user consultations, (3) designing therapeutic CBT content and visual features, and (4) testing prototypes. Users were involved at every step and the process was iterative, with findings carried forward to ensure continued refinement of concepts and features. We found a preference for vibrant, cheerful colours and illustrations and non-endorsement of gamification and chatbots, which contrasted with findings from other studies. Preferences were largely consistent between the three user groups. However, adolescents preferred an app that could be used autonomously without professional support, whereas mental health professionals desired a product for use as a therapy adjunct to support CBT skill development. The importance of co-design, and particularly the inclusion of all stakeholders throughout the entire co-design process, is discussed in relation to the design of ClearlyMe.
Key learning aims
(1)
To understand the co-design process that underpins the development of a new CBT smartphone app for youth with elevated symptoms of depression and anxiety.
(2)
To understand adolescent, parent and mental health professionals’ key preferences regarding the features and functionality of a CBT smartphone app for adolescents with elevated symptoms of depression and anxiety.
(3)
To understand how ClearlyMe has been designed as both a therapy adjunct and stand-alone program, and how it can be incorporated into day-to-day clinical practice.
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