Computerized CBT (Think, Feel, Do) for Depression and Anxiety in Children and Adolescents: Outcomes and Feedback from a Pilot Randomized Controlled Trial

Background: Research has demonstrated the effectiveness of computerized cognitive behaviour therapy (cCBT) for depression and anxiety in adults, but there has been little work with children and adolescents. Aims: To describe the development of a cCBT intervention (Think, Feel, Do) for young people, and preliminary outcomes and feedback from a pilot randomized controlled trial. Method: Twenty participants aged 11 to 16 with depression or anxiety were randomized to receive cCBT immediately or after a delay. Standardized measures were used to assess self-reported anxiety, depression, self-esteem and cognitions, as well as parent rated strengths and difficulties. A feedback form was also completed to assess young people's views of the programme. Results: A total of 15 participants completed the pre and post assessments in the trial, and 17 provided feedback on the intervention. Paired samples t-tests demonstrated significant improvements on 3 subscales in the control condition, compared to 7 subscales in the cCBT condition. Feedback showed moderate to high satisfaction for participants. Conclusions: This study provides encouraging preliminary results for the effectiveness and acceptability of cCBT with this age group.

[1]  Y. Sakano,et al.  Cognitive Behavioural Therapy for Anxiety Disorders in Children and Adolescents: A Meta-Analysis. , 2007, Child and adolescent mental health.

[2]  Sarah A. Mustillo,et al.  Prevalence and development of psychiatric disorders in childhood and adolescence. , 2003, Archives of general psychiatry.

[3]  Surinder Kaur,et al.  Primary‐care patients’ expectations and experiences of online cognitive behavioural therapy for depression: a qualitative study , 2009, Health expectations : an international journal of public participation in health care and health policy.

[4]  Joshua Fogel,et al.  Randomized Clinical Trial of an Internet-Based Depression Prevention Program for Adolescents (Project CATCH-IT) in Primary Care: 12-Week Outcomes , 2009, Journal of developmental and behavioral pediatrics : JDBP.

[5]  R. Jacobs,et al.  Cognitive-behavioral therapy for adolescent depression: a meta-analytic investigation of changes in effect-size estimates. , 2007, Journal of the American Academy of Child and Adolescent Psychiatry.

[6]  P. Birleson The validity of depressive disorder in childhood and the development of a self-rating scale: a research report. , 1981, Journal of child psychology and psychiatry, and allied disciplines.

[7]  S. Gilbody,et al.  Barriers to the uptake of computerized cognitive behavioural therapy: a systematic review of the quantitative and qualitative evidence , 2008, Psychological Medicine.

[8]  S. Pilling,et al.  Post-traumatic stress disorder (PTSD): The management of PTSD in adults and children in primary and secondary care , 2005 .

[9]  Alexander Bystritsky,et al.  Computer‐assisted delivery of cognitive behavioral therapy for anxiety disorders in primary‐care settings , 2009, Depression and anxiety.

[10]  P. Stallard,et al.  The Development and Preliminary Evaluation of a Schema Questionnaire for Children (SQC) , 2004, Behavioural and Cognitive Psychotherapy.

[11]  P. Cuijpers,et al.  Online cognitive behavioral therapy and problem-solving therapy for depressive symptoms: Exploring mechanisms of change. , 2010, Journal of behavior therapy and experimental psychiatry.

[12]  M. Reger,et al.  A meta-analysis of the effects of internet- and computer-based cognitive-behavioral treatments for anxiety. , 2009, Journal of clinical psychology.

[13]  P. Stallard Cognitive Behaviour Therapy for Children and Families: Cognitive behaviour therapy with prepubertal children , 2004 .

[14]  R. Gerrits,et al.  Master your mood online: A preventive chat group intervention for adolescents , 2007 .

[15]  K. Cavanagh,et al.  The role of computer-aided psychotherapy within an NHS CBT specialist service , 2008 .

[16]  H. Christensen,et al.  Effects of a Cognitive‐Behavioural Internet Program on Depression, Vulnerability to Depression and Stigma in Adolescent Males: A School‐Based Controlled Trial , 2006, Cognitive behaviour therapy.

[17]  S. Reynolds,et al.  Cognitive Behaviour Therapy for Children and Families: Frontmatter , 2004 .

[18]  P. Stallard,et al.  The Availability of Cognitive Behaviour Therapy Within Specialist Child and Adolescent Mental Health Services (CAMHS): A National Survey , 2007 .

[19]  R. Goodman The Strengths and Difficulties Questionnaire: a research note. , 1997, Journal of child psychology and psychiatry, and allied disciplines.

[20]  T. Richardson,et al.  Clinicians' Attitudes Towards the Use of Computerized Cognitive Behaviour Therapy (cCBT) with Children and Adolescents , 2010, Behavioural and Cognitive Psychotherapy.

[21]  S. Spence,et al.  The efficacy of an internet-based cognitive-behavioral therapy intervention for child anxiety disorders. , 2009, Journal of pediatric psychology.

[22]  Christopher Williams,et al.  The impact of a novel computerized CBT CD-Rom (overcoming depression) offered to patients referred to clinical psychology , 2007, European Psychiatry.

[23]  H. Merckelbach,et al.  Anxiety and depression as correlates of self-reported behavioural inhibition in normal adolescents. , 2001, Behaviour research and therapy.

[24]  G. Andersson,et al.  An open study of the effectiveness of Internet treatment for panic disorder delivered in a psychiatric setting , 2009, Nordic journal of psychiatry.

[25]  I. Marks,et al.  Psychotherapy by computer , 2000 .

[26]  Heleen Riper,et al.  Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis , 2006, Psychological Medicine.

[27]  S. Spence,et al.  Psychometric properties of the Spence Children's Anxiety Scale with young adolescents. , 2003, Journal of anxiety disorders.

[28]  A. Barak,et al.  A Comprehensive Review and a Meta-Analysis of the Effectiveness of Internet-Based Psychotherapeutic Interventions , 2008 .

[29]  R. Plomin,et al.  The measurement of temperament using parental ratings. , 1981, Journal of child psychology and psychiatry, and allied disciplines.

[30]  William Yule,et al.  Computerized CBT for adolescent depression ("Stressbusters") and its initial evaluation through an extended case series. , 2009, Behavioural and cognitive psychotherapy.

[31]  P. McGrath,et al.  Online psychological treatment for pediatric recurrent pain: a randomized evaluation. , 2006, Journal of pediatric psychology.

[32]  N. Titov,et al.  Shyness 1: Distance Treatment of Social Phobia Over the Internet , 2008, The Australian and New Zealand journal of psychiatry.

[33]  Gerhard Andersson,et al.  Computer‐Aided Psychotherapy for Anxiety Disorders: A Meta‐Analytic Review , 2009, Cognitive behaviour therapy.

[34]  D. J. Lee Society and the Adolescent Self-Image , 1969 .

[35]  C. Roberts,et al.  Systematic review of the efficacy of cognitive behaviour therapies for childhood and adolescent anxiety disorders. , 2004, The British journal of clinical psychology.

[36]  G. Andersson,et al.  Internet-based self-help for depression: randomised controlled trial , 2005, British Journal of Psychiatry.

[37]  R. Rapee,et al.  The Cool Teens CD-ROM , 2008 .

[38]  H. Meltzer,et al.  The British Child and Adolescent Mental Health Survey 1999: the prevalence of DSM-IV disorders. , 2003, Journal of the American Academy of Child and Adolescent Psychiatry.

[39]  Ricardo Araya,et al.  Therapist-delivered internet psychotherapy for depression in primary care: a randomised controlled trial , 2009, The Lancet.

[40]  H. Christensen,et al.  Internet-based mental health programs: a powerful tool in the rural medical kit. , 2007, The Australian journal of rural health.

[41]  Graham Martin,et al.  Australian e-Journal for the Advancement of Mental Health , 2005 .

[42]  S. Spence,et al.  A measure of anxiety symptoms among children. , 1998, Behaviour research and therapy.

[43]  M. Rosenberg Society and the adolescent self-image , 1966 .

[44]  O. Lipp,et al.  The feasibility and outcome of clinic plus internet delivery of cognitive-behavior therapy for childhood anxiety. , 2006, Journal of consulting and clinical psychology.

[45]  T. Richardson,et al.  Computer Use and Attitudes Towards Computerised Therapy Amongst Young People and Parents Attending Child and Adolescent Mental Health Services. , 2010, Child and adolescent mental health.

[46]  T. Richardson,et al.  Computerised Cognitive Behavioural Therapy for the Prevention and Treatment of Depression and Anxiety in Children and Adolescents: A Systematic Review , 2010, Clinical child and family psychology review.

[47]  R. Goodman,et al.  Psychometric properties of the strengths and difficulties questionnaire. , 2001, Journal of the American Academy of Child and Adolescent Psychiatry.