14 With respect
to depression, three commercially-produced computerised packages available to the National Health Service (NHS) were considered—Beating The Blues, Cope and Overcoming Depression. Of these, only one adult intervention, Beating The Hedgehog Pathway Blues, best suited to those aged 25 and over, had been evaluated in a randomised controlled trial by its developers.13 An internet package, MoodGYM, used with adults has been evaluated in a general adolescent population but 70% of young people did not complete the programme.15 The CCBT package Stressbusters, (developed by a team from Manchester, The Institute of Psychiatry, London and Australia), combining expertise in CBT and computer-based delivery was specifically developed for use in an adolescent population. The programme has had a very encouraging case series where the programme was successfully used with over 30 adolescents, 70% of whom completed the full eight sessions.16 At initial assessment, 95% of the sample met diagnostic criteria for a depressive disorder, with a high group mean score (34.48, SD 9.84) on the Moods and Feelings Questionnaire (MFQ). Post-treatment, this figure had fallen to 22% with the group mean score on the MFQ falling significantly below clinical cut-off (20.32, SD 11.75). These gains were maintained at 3-month follow-up. While computer-based approaches have demonstrated positive results for adolescents
with anxiety (eg, Coolteens17; BRAVE18),
there are as yet no trials of computerised CBT for adolescents with depression. The use of CCBT to treat depression is therefore a potentially effective and efficient way of enhancing access to psychological therapies in an adolescent population. However, this is an unevaluated technology. Since there is a paucity of published research evidence on the use of CCBT for adolescent depression, a feasibility study is required to establish: the willingness of clinicians to recruit participants and the willingness of participants to be randomised; the acceptability and utility of a range of outcome measures; recruitment rates; attrition rates and an estimation of sample size needed for a fully powered RCT. We also explored the acceptability of CCBT to adolescents, Entinostat including their satisfaction and compliance with the programme and venue. This feasibility study is necessary preparatory work for a fully powered definitive RCT and will produce important research evidence to inform the care of young people in the UK NHS. Methods and analysis Participants and recruitment Our target population is 12–18-year-olds with low mood. Currently in our local CAMHS patch (York and Selby) all referrals go through a sectorised primary mental health worker (PMHW) system, with 8 PMHWs covering 2–3 secondary schools, all the feeder primary schools and local General Practitioner (GP) surgeries.