A brief early intervention for adolescent depression that targets emotional mental images and memories: protocol for a feasibility randomised controlled trial (IMAGINE trial)

Victoria Pile,Elizabeth G Ryan,Simon E Blackwell,Dominic Stringer,Richard Meiser-Stedman,Patrick Smith,Mary Leamy,Jennifer Y F Lau,Emily A Holmes,Barnaby D Dunn

doi:10.1186/s40814-018-0287-3

Abstract

BackgroundAdolescent depression is common and impairing. There is an urgent need to develop early interventions to prevent depression becoming entrenched. However, current psychological interventions are difficult to access and show limited evidence of effectiveness. Schools offer a promising setting to enhance access to interventions, including reducing common barriers such as time away from education. Distressing negative mental images and a deficit in positive future images, alongside overgeneral autobiographical memories, have been implicated in depression across the lifespan, and interventions targeting them in adults have shown promise. Here, we combine techniques targeting these cognitive processes into a novel, brief psychological intervention for adolescent depression. This feasibility randomised controlled trial will test the feasibility and acceptability of delivering this imagery-based cognitive behavioural intervention in schools.Methods/designFifty-six adolescents (aged 16–18) with high symptoms of depression will be recruited from schools. Participants will be randomly allocated to the imagery-based cognitive behavioural intervention (ICBI) or the control intervention, non-directive supportive therapy (NDST). Data on feasibility and acceptability will be recorded throughout, including data on recruitment, retention and adherence rates as well as adverse events. In addition, symptom assessment will take place pre-intervention, post-intervention and at 3-month follow-up. Primarily, the trial aims to establish whether it is feasible and acceptable to carry out this project in a school setting. Secondary objectives include collecting data on clinical measures, including depression and anxiety, and measures of the mechanisms proposed to be targeted by the intervention. The acceptability of using technology in assessment and treatment will also be evaluated.DiscussionFeasibility, acceptability and symptom data for this brief intervention will inform whether an efficacy randomised controlled trial is warranted and aid planning of this trial. If this intervention is shown in a subsequent definitive trial to be safe, clinically effective and cost-effective, it has potential to be rolled out as an intervention and so would significantly extend the range of therapies available for adolescent depression. This psychological intervention draws on cognitive mechanism research suggesting a powerful relationship between emotion and memory and uses imagery as a cognitive target in an attempt to improve interventions for adolescent depression.Trial registrationISRCTN85369879

Highlights

This psychological intervention draws on cognitive mechanism research suggesting a powerful relationship between emotion and memory and uses imagery as a cognitive target in an attempt to improve interventions for adolescent depression
Two promising new treatment targets are mental imagery and autobiographical memory specificity. These targets are suggested from evidence that people with depression frequently experience past distressing images, struggle to imagine positive events in their future and do not recall memories in detail [11,12,13,14,15]
Adolescence is a key period to target these processes, given that depressive symptoms commonly begin in adolescence, cognitive factors are likely to stabilise during this time and adolescents may harness imagery techniques more readily than verbal approaches

Summary

Introduction

We combine techniques targeting these cognitive processes into a novel, brief psychological intervention for adolescent depression. This feasibility randomised controlled trial will test the feasibility and acceptability of delivering this imagery-based cognitive behavioural intervention in schools. Two promising new treatment targets are mental imagery and autobiographical memory specificity These targets are suggested from evidence that people with depression frequently experience past distressing images, struggle to imagine positive events in their future and do not recall memories in detail [11,12,13,14,15]. Adolescence is a key period to target these processes, given that depressive symptoms commonly begin in adolescence, cognitive factors are likely to stabilise during this time and adolescents may harness imagery techniques more readily than verbal approaches

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