None listed
Conditions
Brief summary
Anxiety and depressive disorders are highly prevalent among children and adolescents, are highly comorbid with each other, are chronic if left untreated, and lead to numerous problematic consequences. Digital mental health programs increase access to evidence-based interventions and have been shown to be highly effective for numerous mental health problems in youth. However, the online programs developed for child and adolescent mental health issues to date do not account for comorbidity, and instead focus on only one disorder (e.g., anxiety OR depression). Youth are therefore routinely provided with a digital mental health program targeting their primary presenting problem (i.e., the problem that is causing them the most distress or is most interfering with their functioning). This randomised controlled trial will target adolescents with both anxiety and depression, comparing an online program targeting BOTH anxiety and depression, with one that will target only the PRIMARY presenting problem (i.e., either anxiety OR depression). We expect that compared to the program targeting ONLY the primary presenting problem, the program directly targeting BOTH anxiety and depression will lead to better and longer-lasting mental health outcomes not only for the primary presenting problem, but also for the comorbid problem.
Interventions
The design involves a two-arm parallel-group RCT where adolescents aged 13-17 years with comorbid anxiety and depression will be randomly assigned to either the online comorbid (COM) program condition targeting comorbid anxiety and depression, or the online primary diagnosis (PRI) program condition targeting the primary presenting problem (anxiety or depression). Both arms (i.e. Intervention Arm 1 and Intervention Arm 2) will receive an online intervention program.
The online programs will be
The design involves a two-arm parallel-group RCT where adolescents aged 13-17 years with comorbid anxiety and depression will be randomly assigned to either the online comorbid (COM) program condition targeting comorbid anxiety and depression, or the online primary diagnosis (PRI) program condition targeting the primary presenting problem (anxiety or depression). Both arms (i.e. Intervention Arm 1 and Intervention Arm 2) will receive an online intervention program. The online programs will be accessed via the Momentum platform (https://momentumhub.org.au). The online interventions on the Momentum platform are self-directed and there is no contact with a therapist or a psychologist. The intervention program will be either 7 (PRI programs) or 10 (COM programs) sessions. The sessions will become available weekly. Each session does not have to be completed in one go, but each session will need to be completed before the participants move on to the next one. The users will receive automated reminders related to session availability. On the home page, the users will be able to monitor how far they are in their assigned program. The Momentum program sessions have been co-designed with young people to ensure they are engaging and interactive. Sessions include the use of images, interactive elements, pop-up messages, and quizzes that provide immediate feedback. Each session comprises approximately 30 slides and takes an estimated 45 minutes to complete. Number of sessions will change depending on the intervention arms. Homework assignments can be completed online or can be printed out. Each session follows a similar format: (1) Feelings check-in (where the young person completes brief anxiety and depression questionnaires); (2) A review of homework from the previous session; (3) A summary quiz of the previous session; (4) Presentation of the main content of the session (e.g., cognitive restructuring); (5) A quiz to see what they have learned from the session; and (6) Homework activities to be completed over the following week. Intervention Arm 1- Program targeting comorbidity of anxiety and depression (COM): There will be TWO versions of comorbid program: one for young people with primary anxiety and one for young people with primary depression. The content of these programs is identical, with only the order of session presentation differing between them. For young people with primary anxiety, the content specific to anxiety will be presented before the content specific to depression. For young people with primary depression, the content specific to depression will be presented before the content specific to anxiety. Program targeting comorbid anxiety and depression where anxiety is primary (COM-AD): This program will be provided to those participants with primary anxiety who have been allocated to the COM arm of the RCT. The COM-AD program involves 10 Cognitive Behavioural Therapy (CBT) sessions. Session 1 focuses on psychoeducation around anxiety AND depression. Sessions 2-4 focus on anxiety-specific skills (i.e., relaxation, avoidance and exposure). Sessions 5-7 focus on depression-specific skills (i.e., behavioural activation and appreciation/gratitude). Sessions 8-9 will focus on cognitive restructuring for anxiety AND depression. Session 10 will focus on relapse prevention for both anxiety AND depression. Program targeting comorbid anxiety and depression where depression is primary (COM-DA): This program will be provided to those participants with primary depression who have been allocated to the COM arm of the RCT. The COM-DA program involves 10 CBT sessions. Session 1 focuses on psychoeducation around depression AND anxiety. Sessions 2-4 focus on depression-specific skills (i.e., behavioural activation and appreciation/gratitude). Sessions 5-7 focus on anxiety-specific skills (i.e., relaxation, avoidance and exposure). Sessions 8-9 will focus on cognitive restructuring for depression AND anxiety. Session 10 will focus on relapse prevention for both anxiety AND depression.
Sponsors
Griffith University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator)
Eligibility
Sex/Gender
All
Age
13 Years to 17 Years
Healthy volunteers
No
Inclusion criteria
Following registration and the initial assessment process that is part of the open access Momentum Platform, adolescents aged 13-17 years who are found to demonstrate comorbid anxiety and depression symptoms will be invited to participate in the study. Participants must be willing to participate in either of the two conditions (COM or PRI).
Exclusion criteria
Potential participants will be excluded if the adolescent (i) has an intellectual or a developmental disorder (autism, developmental delay); (ii) is receiving other psychological/psychiatric treatment for their primary problem (anxiety or depression); (iii) is not stabilised on a medication prior to enrolment into this study or alters their medication dosage during the trial (if the participant is using medication for anxiety or depression); (iv) displays a high suicidal risk (i.e., a score >21 on the Suicidal Ideation Attributes Scale by Van Spijker et al. (2014)).
Outcome results
None listed