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在临床环境中对 15 至 18 岁患有焦虑和/或抑郁的青少年进行为期一天的认知行为治疗(CBT)工作坊(“发现”)的可行性随机对照试验。

Feasibility randomized controlled trial of a one-day CBT workshop ('DISCOVER') for 15- to 18-year-olds with anxiety and/or depression in clinic settings.

机构信息

Doctorate in Clinical Psychology, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, PO Box 78, 4 Windsor Walk, London SE5 8AF, UK.

Child and Adolescent Mental Health, South London and Maudsley NHS Foundation Trust, Mapother House, Maudsley Hospital, 1st Floor, De Crespigny Park, London SE5 8AZ, UK.

出版信息

Behav Cogn Psychother. 2020 Mar;48(2):142-159. doi: 10.1017/S1352465819000286. Epub 2019 May 20.

Abstract

BACKGROUND

'DISCOVER' one-day cognitive behavioural therapy (CBT) workshops have been developed to provide accessible, developmentally sensitive psychological support for older adolescents experiencing emotional difficulties. Previous school-based evaluations of the DISCOVER model have shown positive outcomes.

AIMS

The current study aimed to test the model for clinically referred adolescents, in real-world settings.

METHOD

A randomized controlled trial (RCT) assessed feasibility, acceptability and preliminary outcomes of the DISCOVER intervention, in comparison with usual care, for 15- to 18-year-olds with emotional difficulties. Participants were recruited from outpatient clinic waiting lists in UK child and adolescent mental health services (CAMHS). Research feasibility indicators included rates of recruitment, randomization, intervention participation (group workshops and individualized follow-up telephone calls), and data collection (at baseline and 8-week follow-up). Intervention acceptability was assessed using a structured service satisfaction questionnaire and semi-structured qualitative interviews with intervention participants. Preliminary clinical outcomes were explored using adolescent-reported validated measures of depression, anxiety and well-being.

RESULTS

n = 24 participants were randomized to intervention and usual care groups. Workshop attendance was good and high levels of treatment satisfaction were reported, although feasibility challenges emerged in recruitment and randomization. Trends were found towards potential improvements in anxiety and well-being for the intervention group, but the effect estimate for depression was imprecise; interpretability was also limited due to the small sample size.

CONCLUSIONS

DISCOVER appears to be a feasible and acceptable intervention model for clinically referred 15- to 18-year-olds with emotional difficulties. A full-scale RCT is warranted to evaluate effectiveness; protocol modifications may be necessary to ensure feasible recruitment and randomization procedures.

摘要

背景

“发现”(DISCOVER)一日认知行为疗法(CBT)工作坊旨在为有情绪困扰的大龄青少年提供可及的、符合发展阶段的心理支持。先前基于学校的 DISCOVER 模式评估显示出积极的结果。

目的

本研究旨在现实环境中针对有临床转介的青少年测试该模式。

方法

一项随机对照试验(RCT)评估了 DISCOVER 干预措施在与常规护理相比时的可行性、可接受性和初步结果,纳入了有情绪困扰的 15 至 18 岁青少年。参与者从英国儿童和青少年心理健康服务机构(CAMHS)的门诊候诊名单中招募。研究可行性指标包括招募、随机化、干预参与(小组工作坊和个性化随访电话)以及数据收集(基线和 8 周随访)的比例。通过结构化服务满意度问卷和对干预参与者的半结构化定性访谈评估干预的可接受性。使用青少年报告的抑郁、焦虑和幸福感的验证性衡量标准探索初步临床结果。

结果

24 名参与者随机分配至干预组和常规护理组。工作坊的出席率较高,报告的治疗满意度也较高,但在招募和随机化方面出现了可行性挑战。干预组的焦虑和幸福感有潜在改善的趋势,但抑郁的效应估计不精确;由于样本量小,解释性也受到限制。

结论

对于有情绪困扰的临床转介的 15 至 18 岁青少年,DISCOVER 似乎是一种可行且可接受的干预模式。需要进行全面的 RCT 来评估其有效性;可能需要进行方案修改以确保可行的招募和随机化程序。

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