RECHARGE: A Behavioural Regulation Program for Young Persons with Depression

The main objective of this study is to evaluate whether a behavioural regulation program called RECHARGE that targets desynchrony in circadian rhythms can reduce depressive symptoms in young persons with depression. Specifically, this study will aim to restore circadian rhythm synchrony using RECHARGE, and improve depression as a result of restored circadian rhythm synchrony. For this pilot phase of the study, we aim to recruit 20 participants. This small sample size was chosen to study the success of this novel behavioural regulation program as a pilot for a future study with a larger sample size. Before the commencement of the study, participants will be asked to wear a wrist activity and light monitor, called an actigraphy watch. This is like a small watch worn on your non-dominant wrist, and will be worn for approximately 14 days before the beginning of the program. Participants will also be asked to complete a series of questionnaires and tests of mental and physical health. After two weeks of wearing the watch, the 8-week behavioural regulation program will begin. At Week 1 of the program, participants will attend a 2 hour introductory group learning and training workshop. This group workshop (four persons) will involve engaging in an interactive educational session about the 24 hour body clock, how it can become “desynchronised”, and strategies you can use to resynchronise it. Following this, training will be given on how to operate the iPhone application, “Recharge”, which will be used across the course of the study. This application creates a personalised six-week program to help resynchronise the 24 hour body clock, and monitors daily progress and provides participants with feedback over the six weeks. “Recharge” includes the development of a personalised day and night activity schedule, alarm clock that triggers fun activities to get you up and out of bed, reminders and tips to increase your exposure to daylight in the early hours of the day, physical exercise games to get you moving across the day, wellbeing guidebook providing information and tips on sleep basics, mood, exercise, eating well, and light exposure, daily check-ins to track mood, energy, exercise, and sleep, and graphs and charts to help monitor progress. At the end of the workshop, participants will be asked to wear the actigraphy watch for a further two weeks of monitoring. At Week 3, participants will attend a 1 hour individual behavioural regulation session with the research investigator. This will involve a personalised analysis of the results from the “Recharge” app and actigraphy watch from the previous 14 days. Currently used behavioural regulation strategies (including those learnt in the initial group workshop) will be discussed for effectiveness and suitability, and novel personalised strategies will be taught depending on the “Recharge” app and actigraphy watch results. Finally, personalised goals for sleep, wake, exercise, and light exposure will be set for the following two weeks. At the end of the session, participants will be asked to wear the watch for a further two weeks of monitoring. At Week 5, participants will attend a second 1 hour individual behavioural regulation session with the research investigator. Like the first individual session, this will involve a personalised analysis of the results from the “Recharge” app and actigraphy watch. Currently used behavioural regulation strategies will be discussed, and appropriate novel strategies will be taught. Finally, personalised goals for sleep, wake, exercise, and light exposure will be set for the following two weeks. At the end of the session, participants will be asked to wear the watch for a further two weeks of monitoring. At Week 7, participants will attend a final 2 hour individual behavioural regulation session with the research investigator. In the final session, a personalised analysis of their full six-week “Recharge” app and actigraphy watch results will be conducted. Behavioural regulation strategies used throughout the program will be discussed and refined, and completed and non-completed goals for sleep, wake, exercise, and light exposure will be identified. During the last half of the session, a brief workshop on relapse prevention and management will be given. This will involve a brief education on lapses and relapses and how they occur, and training on specific skills needed to manage a lapse or relapse should one occur after the conclusion of the program. Finally, participants will be asked to fill out a series of questionnaires and tests on mental and physical health. At the end of the session, participants will be asked to wear the watch for a further two weeks of monitoring. Two weeks after the end of the program, participants will be asked to complete a final follow-up assessment, including wearing the actigraphy watch for two weeks and completing a final series of questionnaires on mental and physical health to examine any changes post-study.