Depression is a costlyproblem in the UK, accounting for nearly 12 billion pounds annually and 17% ofUK disability services. Regular cognitive behavioural therapy (CBT) iseffective in reducing symptoms by 50% in two-thirds of the population and whilegood at reducing negative affective symptoms (e.g. rumination), it is not asfocused on positive affective symptoms (anhedonia; Dunn & Widnall, 2017). ADepT (Augmented Depression Therapy) is a proposedtreatment for depression focusing on improving positive affective symptoms andproviding increased teamwork between the client and clinician (Dunn &Widnall, 2017). This treatment combines behavioural activation and cognitivetherapy, in the hopes of boosting positivity and wellbeing. While CBT contains20 weekly sessions, ADepT will contain 15 weekly acute sessions followed by 5booster sessions that span over the year.
The booster sessions are aimed tolessen instances of relapse following the end of therapy (Dunn & Widnall,2017). The pilot study recruited 14 patients, 1 of which waslost in follow-up. Several measures of depression, anxiety, anhedonia andwellbeing were looked at as well as qualitative interviews. Between half andtwo-thirds of clients showed clinically significant improvement of depressionand half showed clinical improvement on anhedonia (Dunn & Widnall, 2017).Overall, the treatment was rated very positively and feasible. Theproposed next step is a randomized control trial that includes many measurescovering a wide variety of modalities.
There are several questionnaires pre-,during and post-treatment, a sub-set of clients and clinicians will alsoreceive qualitative interviews, and clients will undertake a series ofexperimental cognitive measures. Clients will also use a phone application inwhich they will be asked to rate their mood 8 times a day for one week, pre-and post-treatment (Dunn & Widnall, 2017). The ADepT pilot study showed significant improvements onsymptoms of depression for most of its sample and was rated quite positively byclients. The proposed randomized control trial however, includes many stagesand measures that were not looked at in the pilot study for feasibility andclient satisfaction. Clients will be asked to fill out 25 questionnaires overthe course of 18 months, the majority must be filled out 4 or more times.
Forqualitative analysis clients will be asked to fill out a feedback booklet abouttheir experiences during the trial which will be used to inform interviews witha sub-set of the sample within a 6-month period. Finally, the 3 cognitivecomputerized tasks and phone app will be given before and after treatment.Overall this is an astounding amount of work for the clients to undergo duringtreatment. The recommendation is to eliminate unnecessary orredundant analysis to lessen the burden on clients. Looking first at theelectronic measures, the phone app is a unique and exciting measure looking atmood and could provide rich, real-time information about participants symptoms.Research shows that while telehealth and smartphones show promising data, theyare not well validated in use of trials (Bush et al., 2013; Ozgdalga, Ozdalga,& Ahuja, 2012).
The use in this study seems quite intrusive to a client’sday-to-day life and for clients with more severe depression, recording theirmood 8 times a day for a week could prove nearly impossible. It is recommendedthat recordings be limited to 5 times a day at pre-determined times decidedupon by the clinician and client together. The computer tasks are quite timeconsuming and demanding on clients but could provide informative data. It issuggested that they be as short as possible to minimize strain on participants (Dozois,2009; Gotlib et al.
, 2004). The number of questionnaires is staggering andshould be limited. The weekly questionnaires could be changed to alternateweeks to lessen the burden. There are 5 health economic outcomes that will be deliveredat intake, 6, 12, 18 months could be lessened.
The EuroQol Five DimensionsQuestionnaire for example has many dimensions that are covered by otherquestionnaires and might not be necessary. Additionally, the Work and SocialAdjustments Scale and the Adult Use Service Schedule have similar questionssurrounding work and functionality. The intensity of this proposal could belessened somewhat by eliminating redundant or time-consuming aspects of thevarious measures.
