The development and evaluation of an online Behavioural Activation programme for the treatment of low mood and depression in adolescents

Background: Depression is a major health concern, with an estimated prevalence of 2% in UK adolescents. Behavioural Activation (BA), a psychological therapy that is simple and can be delivered by a wide variety of clinicians has demonstrated effectiveness in the treatment of adults. However less research has examined its application with young people. Receiving timely and effective treatments is essential for recovery and prevention of recurrence but can be impeded by both individual and service-related barriers. Evidence from systematic reviews and meta-analyses suggests that delivering interventions in an online format may circumvent these barriers. This research aimed to develop and evaluate an online BA programme for adolescents with low mood and/or depression.

Methods: Aligning to important phases of co-design in intervention development, this work encompasses stages of assessment, development, and evaluation. The findings from a systematic review and meta-analysis and qualitative work with young people and healthcare professionals informed the development of a new online BA intervention (BALM). The intervention’s acceptability was examined in a non-randomised feasibility study.

Results: Through consolidating and synthesising the findings from the assessment stages of this thesis whilst considering the biopsychosocial development of adolescents, a ten-session online BA programme (BALM) was developed. An initial
evaluation of BALM with 12 adolescents experiencing low mood and/or depression demonstrated it is feasible to recruit to a treatment of this type. However, whilst several therapy components were deemed acceptable, low adherence and high
dropout highlighted the modifications required both to BALM and the delivery of future, similar research.

Conclusions: This thesis has provided additional support to considering BA as an alternative treatment option for adolescents experiencing low mood and/or depression notwithstanding the need to carefully consider measures to support engagement and
adherence. Online delivery may help to address the multifaceted barriers faced by adolescents when accessing timely support.