Activation Therapy for the Treatment of Inpatient Depression

8 x 30-40 minute therapist sessions of Activation Therapy on-site at the psychiatric unit (4/week) and 10 x online practise sessions over 2 weeks (5/week) in addition to Treatment as Usual (see comparator treatment). Activation Therapy consists of two components. Cognitive Activation and Behavioural Activation. Cognitive Activation is the use of therapist guided computerised cognitive exercises from a programme called Scientific Brain Training Pro (https://www.scientificbraintrainingpro.com/ - provided free of charge for this study). These exercises are designed to activate parts of the brain that are under-active with depression. This system has been selected based on its use of tasks with flexibility to alter level of difficulty to meet the individual’s current functioning, ease of use and delivery in an attractive interactive format. Therapists will select cognitive tasks suitable for the patient’s current level of functioning from a menu of tasks, and in later sessions, review progress. Collaborative practice, encouragement and coaching will take place. Therapists will be experienced registered nurses, social workers, or psychologists familiar with the requirements of ward environments and working within multi-disciplinary teams. Patients will be encouraged to practise the exercises in-between therapy sessions to reinforce and build on learning occurring during therapy. Patients will focus on the exercises used in therapy when doing the on-line practise sessions. Behavioural Activation occurs alongside the Cognitive Activation in the therapy led sessions. Behavioural Activation involves identification of both positive and negative reinforcers maintaining depressive symptoms and behaviours, and of reinforcers that promote more adaptive behaviours (i.e. those that re-engage the depressed person with previously rewarding or potentially rewarding aspects across the important domains of life). Personal values are identified and activities focussed on those values are considered. A graded hierarchy of pleasurable activities and activities that give the patient a sense of competency is then chosen and worked through collaboratively with the patient. Collaborative problem-solving of difficulties in undertaking the tasks occurs. Training/adherence Activation Therapy will be delivered according to our Activation Therapy manual by mental health professionals trained and closely supervised with a focus on adherence and competence. Fidelity checklists of core strategies delivered during each sesson will be completed by therapists after each session to ensure all elements are delivered. A random selection of 10% of audiotaped sessions will be listened to by a supervisor and scored according to the Quality of Behavioral Activation Scale. Participant adherence will be measured by the 9-item Short Form Behavioral Activation Scale (BADS-SF) completed by participants at baseline, session 4 and session 8. A single question self-rating the extent of practice of Behavioural Activation activities within the past 24 hours will be completed by participants at each session. The frequency and duration of on-line cognitive activation exercises will also be monitored through the Scientific Brain Training Pro programme.