JMIR Publications

ABSTRACT

Background:

Cognitive Behavioral Therapy (CBT) is an effective intervention to treat depressive disorders in youth. However, 50% of the adolescents still have depressive symptoms after treatment and 57% drops out during treatment. Online preventive CBT interventions have proven to be effective in reducing depressive symptoms and seem promising as treatment for depressed adolescents. However, combining online programs with face-to-face sessions seems necessary to increase the effectiveness and to monitor for suicide risk.

Objective:

In this study, we examine the effectiveness and cost-effectiveness of a blended CBT treatment protocol, a mixture of online and face-to-face CBT, as a treatment for clinically depressed adolescents.

Methods:

A pragmatic quasi-experimental controlled trial will be conducted to study the effectiveness of a blended CBT treatment protocol, in which blended CBT is compared to face-to-face CBT (N = 44) and treatment-as-usual (N = 44), the latter both collected in a previous RCT. The same in- and exclusion criteria are used: adolescents between 12 and 21 years old, with a clinical diagnosis of a depressive disorder, and referred to one of the participating mental health institutions. Assessments will be conducted at the same time points, namely before the start of the intervention, during the intervention (after 5 and 10 weeks), post-intervention, 6-month and 12-month follow-up.

Results:

Primary outcome is the presence of a depression diagnosis at 12-month follow-up. Several secondary outcomes will be measured, such as depressive symptoms, global functioning, and suicide risk. Further, moderating (age, gender, alcohol and drug use, parental depression and other psychopathology) and mediating effects (negative automatic thoughts, cognitive emotion regulation, attributional style) will be tested. Also, treatment characteristics will be studied, such as characteristics of the therapists, treatment expectancy, and therapeutic alliance. Furthermore, the drop-out rate and treatment characteristics will be measured in order to study feasibility of blended CBT.

Conclusions:

This study examines the effectiveness and cost-effectiveness of a blended CBT program in which depressed adolescents are treated in mental health care. Results of blended CBT will be compared to face-to-face CBT and treatment-as-usual. Further implications for implementation will be reviewed. Clinical Trial: The study is registered in the Dutch Trial Register (NTR6759).