Search

Objective: Mental health disorders affect many children in South Africa, where vulnerability is high, and treatment is limited. We sought to determine the feasibility and acceptability of a universally delivered classroom‐based programme for the promotion of mental health in young adolescents. Method: We pilot tested an 8 session, cognitive‐behavioural therapy‐based programme, 4 Steps To My Future (4STMF) in two schools. Participants were grade 5 learners (n = 222; Meanage = 10.62 (Standard deviation = 0.69)). 4STMF was delivered in class time by trained psychology postgraduates. Feasibility (rates of parental opt‐out, child assent, assessment completion at baseline and follow‐up, programme completion, session attendance and programme fidelity), acceptability (teacher feedback and focus groups with learners), as well as demographic data and data on a battery of a psychological measures were collected at baseline, postintervention and at one‐month follow‐up. Results: Most eligible learners at both schools agreed to participate (85% – school 1; 91% – school 2) with more than 80% completing postintervention measures. Learner session attendance and programme fidelity were high. Teachers rated facilitators highly on confidence, preparedness, enthusiasm and classroom management and observed children to be enjoying the programme. Focus group data suggest that learners liked the programme, could recall the content and had shared some of the content with their family. An exploratory analysis of outcomes showed significant pre–post differences on self‐esteem at school 1 and on emotion regulation at school 1 and school 2, maintained at follow‐up. Conclusions: This pilot study has shown that 4STMF can acceptably and feasibly be delivered, at classroom level, as a universal school‐based prevention programme to young adolescent learners in South African primary schools. The programme could fit in with school context, could be delivered by nonspecialists, showed significant improvements on self‐esteem and emotion regulation and was liked by the learners. [ABSTRACT FROM AUTHOR]

Cognitive behavior therapy for insomnia (CBTi), delivered face-to-face or digitally, can improve the mental health of adults. Although insomnia is common in adolescents, the effects of digital CBTi on adolescent mental health have seldom been investigated. The aims of this study were to explore: (i) the acceptability of a digital CBTi intervention, Sleepio, as a first-step intervention for adolescents referred to specialist mental health services (CAMHS), (ii) the impact on sleep and mental health and (iii) subsequent CAMHS interventions. Sleepio is a computerized CBTi intervention comprised of six sequentially delivered sessions. Digital Sleepio was offered to new referrals to CAMHS with poor sleep and mental health problems. Results. Of the 75 eligible adolescents, 70 (93%; 95% CI: 85% to 98%) accepted Sleepio with 59 starting the programme and consenting to participate in the study. Of these, 37 (63%; 95% CI: 49% to 75%) completed at least half of the programme. There were post-intervention improvements in sleep, mood, and anxiety; the improvement in sleep was greater for those who completed at least half the programme compared to those who did not. Of those who completed all the programme, 55% (15/29) did not need any subsequent specialist CAMHS input. Of the 11 adolescents who accepted but never started Sleepio, none engaged with other CAMHS interventions and were subsequently discharged. Our study has a number of limitations, in particular the absence of a control group and the loss of follow-up data for programme drop-outs. Nonetheless, these results suggest that digital CBTi may offer a novel and acceptable way of improving the sleep and mental health of adolescents with insomnia. A fully powered randomized controlled trial is required to obtain definitive estimates of the effects of the intervention. [ABSTRACT FROM AUTHOR]

Background: Anxiety problems are extremely common and have an early age of onset. We previously found, in a study in England, that fewer than 3% of children with an anxiety disorder identified in the community had accessed an evidence‐based treatment (Cognitive Behavioural Therapy; CBT). Key ways to increase access to CBT for primary school‐aged children with anxiety problems include (a) proactive identification through screening in schools, (b) supporting parents and (c) the provision of brief, accessible interventions (and capitalising on technology to do this). Method: We provided a brief, therapist guided treatment called Online Support and Intervention (OSI) to parents/carers of children identified, through school‐based screening, as likely to have anxiety problems. Fifty out of 131 children from 17 Year 4 classes in schools in England screened positive for 'possible anxiety problems' and 42 (84%) of these (and 7 who did not) took up the offer of OSI. We applied quantitative and qualitative approaches to assess children's outcomes and families' experiences of this approach. Results: Inbuilt outcome monitoring indicated session on session improvements throughout the course of treatment, with substantial changes across measures by the final module (e.g. Child Outcome Rating Scale d = 0.84; Goal Based Outcomes d = 1.52). Parent engagement and satisfaction was high as indicated by quantitative and qualitative assessments, and intervention usage. Conclusions: We provide promising preliminary evidence for the use of OSI as an early intervention for children identified as having anxiety problems through school‐based screening. [ABSTRACT FROM AUTHOR]

Background: Cognitive behavioural therapy (CBT) training is highly demanded by clinicians; however, a standardized competence assessment for professionals working with children and young people (CYP) can be problematic. Psychometric tools used for this purpose are typically adult oriented measures. Aim: The present study provides psychometric properties of the Cognitive Behaviour Therapy Scale for Children and Young People (CBTS-CYP) derived from a comparative analysis with the Cognitive Therapy Scale (CTS). Method: The CBTS-CYP was used alongside CTS in a CBT supervision training course, consisting of a cohort of 51 therapists. A total of 36 audio/video recorded full CBT sessions were assessed for the purpose of determining CBT competence and adherence to the theory and model. The training involved a total of 80 hours of supervision in 10 meetings via an online videoconferencing platform between July 2020 and February 2021. Results: Face validity and inter-rater reliability of CBTS-CYP were high, with the intraclass correlation values being good (0.60–0.74) or excellent (0.74 and above); the correlations of each CBTS-CYP and CTS items were significant; internal consistency of the scale showed that Cronbach alpha values for total-scale and its two subdimensions were above.93. For a cut-off score of 55 out of 90, sensitivity reached 90.73% and specificity 90.73%. A score of 2 points or above from any single item could be considered as the second minimum criterion for competence. Conclusions: CBTS-CYP offers a valid and reliable scale to evaluate the competence and adherence quality of CBT sessions with children and adolescents. [ABSTRACT FROM AUTHOR]

Background: Social anxiety disorder (SAD) is common. It usually starts in adolescence, and without treatment can disrupt key developmental milestones. Existing generic treatments are less effective for young people with SAD than with other anxiety disorders, but an adaptation of an effective adult therapy (CT-SAD-A) has shown promising results for adolescents. Aims: The aim of this study was to conduct a qualitative exploration to contribute towards the evaluation of CT-SAD-A for adoption into Child and Adolescent Mental Health Services (CAMHS). Method: We used interpretative phenomenological analysis (IPA) to analyse the transcripts of interviews with a sample of six young people, six parents and seven clinicians who were learning the treatment. Results: Three cross-cutting themes were identified: (i) endorsing the treatment; (ii) finding therapy to be collaborative and active; challenging but helpful; and (iii) navigating change in a complex setting. Young people and parents found the treatment to be useful and acceptable, although simultaneously challenging. This was echoed by the clinicians, with particular reference to integrating CT-SAD-A within community CAMHS settings. Conclusions: The acceptability of the treatment with young people, their parents and clinicians suggests further work is warranted in order to support its development and implementation within CAMHS settings. [ABSTRACT FROM AUTHOR]

Background: Cognitive therapy, based on the Clark and Wells (1995) model, is a first-line treatment for adults with social anxiety disorder (SAD), and findings from research settings suggest it has promise for use with adolescents (Cognitive Therapy for Social Anxiety Disorder in Adolescents; CT-SAD-A). However, for the treatment to be suitable for delivery in routine clinical care, two questions need to be addressed. Aims: Can therapists be trained to achieve good outcomes in routine Child and Adolescent Mental Health Services (CAMHS), and what are the costs associated with training and treatment? Method: CAMHS therapists working in two NHS trusts received training in CT-SAD-A. They delivered the treatment to adolescents with SAD during a period of supervised practice. We examined the clinical outcomes for the 12 patients treated during this period, and estimated costs associated with treatment and training. Results: Treatment produced significant improvements in social anxiety symptoms, general anxiety and depression symptoms, and reductions in putative process measures. Seventy-five per cent (9 out of 12) patients showed a reliable and clinically significant improvement in social anxiety symptoms, and 64% (7/11) lost their primary diagnosis of SAD. The total cost to the NHS of the CT-SAD-A treatment was £4047 (SD = £1003) per adolescent treated, of which £1861 (SD = £358) referred to the specific estimated cost of face-to-face delivery; the remaining cost was for training and supervising therapists who were not previously familiar with the treatment. Conclusions: This study provides preliminary evidence that clinicians can deliver good patient outcomes for adolescents with SAD in routine CAMHS during a period of supervised practice after receiving a 2-day training workshop. Furthermore, the cost of delivering CT-SAD-A with adolescents appeared to be no more than the cost of delivering CT-SAD with adults. [ABSTRACT FROM AUTHOR]

Background: Anxiety is the most common psychological difficulty reported by youth worldwide and may also be a significant problem for children with visual impairments. Cognitive behaviour therapy (CBT) interventions have proven to be successful in treating childhood anxiety; however, mostly these are not suitable for children with visual impairments, as the materials used are not sufficiently accessible to this population. Objectives: The present study was motivated by the dearth of research on this topic and aimed to examine the effects of a specifically tailored, group-based, universally delivered, CBT intervention for anxiety in children with visual impairments and to examine the influence of three predictor variables (i.e. age, gender and level of visual impairment) on prevention effects. Method: A randomised wait-list control group design with pre-, post- and follow-up intervention measures was employed. The final sample of 52 children (aged 9–14) with varying degrees of visual impairment received the anxiety intervention. Participants were followed over a course of 10 months during which their anxiety symptoms were assessed quantitatively at four time points (T1–T4). Results: The results indicated that the anxiety intervention did not significantly decrease symptoms of anxiety within the intervention groups. However, the intervention appeared beneficial for girls, younger children and legally blind participants. Conclusion: This study demonstrated how CBT interventions can be adapted for use in children with visual impairments. Results obtained provide a foundation upon which future updated anxiety intervention programmes can be built, meeting the need for further research in this area. [ABSTRACT FROM AUTHOR]

The majority of psychological treatment research is dedicated to investigating the effectiveness of cognitive behavioural therapy (CBT) across different conditions, population and contexts. We aimed to summarise the current systematic review evidence and evaluate the consistency of CBT's effect across different conditions. We included reviews of CBT randomised controlled trials in any: population, condition, format, context, with any type of comparator and published in English. We searched DARE, Cochrane, MEDLINE, EMBASE, PsycINFO, CINAHL, CDAS, and OpenGrey between 1992 and January 2019. Reviews were quality assessed, their data extracted and summarised. The effects upon health-related quality of life (HRQoL) were pooled, within-condition groups. If the across-condition heterogeneity was I2 < 75%, we pooled effects using a random-effect panoramic meta-analysis. We summarised 494 reviews (221 128 participants), representing 14/20 physical and 13/20 mental conditions (World Health Organisation's International Classification of Diseases). Most reviews were lower-quality (351/494), investigated face-to-face CBT (397/494), and in adults (378/494). Few reviews included trials conducted in Asia, South America or Africa (45/494). CBT produced a modest benefit across-conditions on HRQoL (standardised mean difference 0.23; 95% confidence intervals 0.14–0.33, I2 = 32%). The effect's associated prediction interval −0.05 to 0.50 suggested CBT will remain effective in conditions for which we do not currently have available evidence. While there remain some gaps in the completeness of the evidence base, we need to recognise the consistent evidence for the general benefit which CBT offers. [ABSTRACT FROM AUTHOR]

Depression and anxiety are common during adolescence. Whilst effective interventions are available treatment services are limited resulting in many adolescents being unable to access effective help. Delivering mental health interventions via technology, such as computers or the internet, offers one potential way to increase access to psychological treatment. The aim of this systematic review and meta-analysis was to update previous work and investigate the current evidence for the effect of technology delivered interventions for children and adolescents (aged up to 18 years) with depression and anxiety. A systematic search of eight electronic databases identified 34 randomized controlled trials involving 3113 children and young people aged 6-18. The trials evaluated computerized and internet cognitive behavior therapy programs (CBT: n = 17), computer-delivered attention bias modification programs (ABM: n = 8) cognitive bias modification programs (CBM: n = 3) and other interventions (n = 6). Our results demonstrated a small effect in favor of technology delivered interventions compared to a waiting list control group: g = 0.45 [95% CI 0.29, 0.60] p < 0.001. CBT interventions yielded a medium effect size (n = 17, g = 0.66 [95% CI 0.42-0.90] p < 0.001). ABM interventions yielded a small effect size (n = 8, g = 0.41 [95%CI 0.08-0.73] p < 0.01). CBM and 'other' interventions failed to demonstrate a significant benefit over control groups. Type of control condition, problem severity, therapeutic support, parental support, and continuation of other ongoing treatment significantly influenced effect sizes. Our findings suggest there is a benefit in using CBT based technology delivered interventions where access to traditional psychotherapies is limited or delayed. [ABSTRACT FROM AUTHOR]

Background: Paediatric chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a relatively common and disabling condition. The National Institute for Health and Clinical Excellence (NICE) recommends Cognitive Behavioural Therapy (CBT) as a treatment option for paediatric CFS/ME because there is good evidence that it is effective. Despite this, most young people in the UK are unable to access local specialist CBT for CFS/ME. A randomised controlled trial (RCT) showed FITNET was effective in the Netherlands but we do not know if it is effective in the National Health Service (NHS) or if it is cost-effective. This trial will investigate whether FITNET-NHS is clinically effective and cost-effective in the NHS.Methods: Seven hundred and thirty-four paediatric patients (aged 11-17 years) with CFS/ ME will be randomised (1:1) to receive either FITNET-NHS (online CBT) or Activity Management (delivered via video call). The internal pilot study will use integrated qualitative methods to examine the feasibility of recruitment and the acceptability of treatment. The full trial will assess whether FITNET-NHS is clinically effective and cost-effective. The primary outcome is disability at 6 months, measured using the SF-36-PFS (Physical Function Scale) questionnaire. Cost-effectiveness is measured via cost-utility analysis from an NHS perspective. Secondary subgroup analysis will investigate the effectiveness of FITNET-NHS in those with co-morbid mood disorders.Discussion: If FITNET-NHS is found to be feasible and acceptable (internal pilot) and effective and cost-effective (full trial), its provision by the NHS has the potential to deliver substantial health gains for the large number of young people suffering from CFS/ME but unable to access treatment because there is no local specialist service. This trial will provide further evidence evaluating the delivery of online CBT to young people with chronic conditions.Trial Registration: ISRCTN registry, registration number: ISRCTN18020851 . Registered on 4 August 2016. [ABSTRACT FROM AUTHOR]

Introduction: Anxiety is the most common psychological problem reported among children with visual impairments. Although cognitive behavior therapy interventions have proven successful in treating childhood anxiety, it is unclear whether they are suitable and accessible for children who have visual impairments. This study aimed to determine if and how traditional cognitive behavior therapy-based interventions could be adapted for use with this specific population by interviewing children with visual impairments themselves. Methods: A qualitative research design was used. Sixteen children with visual impairments (aged 9 to 13 years) participated in two focus group interviews. Participants attended two special schools in the Western Cape, South Africa. Interviews were audio-recorded and transcribed verbatim, and content analysis was undertaken. Results: Three primary themes emerged from the focus group data: (1) difficulties encountered by children with visual impairments; (2) existing coping strategies; and (3) insight into the concepts of feelings, thoughts and behaviors (central to cognitive behavior therapy). Discussion: The emergent themes and their implications for the adaptation of a cognitive behavior therapy-based anxiety intervention are discussed. Implications for practitioners: Results provide practitioners with guidelines to consider when using or adapting therapeutic techniques such as cognitive behavior therapy for children with visual impairments. [ABSTRACT FROM AUTHOR]

Background: Evaluations of school-based anxiety prevention programmes have reported improvements in psychological functioning although little is known about their effect upon educational outcomes. Methods: One thousand three hundred and sixty-two children from 40 primary schools in England took part in the randomised controlled trial, Preventing Anxiety in Children through Education in Schools. The trial investigated the effectiveness of a universal school-based cognitive behaviour therapy prevention programme, FRIENDS, delivered by health care staff or school staff compared with usual personal, social, health and education (PSHE) lessons. Self-report psychological outcomes and educational attainment on national standardised attainment tests in reading, writing and maths were collected 12 months postintervention. Analysis was performed at individual level using multivariable mixed effect models controlling for gender, type of intervention and school effect. Registered trial: ISRCTN: 23563048. Results: At 12 months, anxiety reduced in the health-led FRIENDS group compared to school-led FRIENDS and PSHE. There were no between-group differences in academic performance regardless of gender, deprivation, ethnicity and additional educational needs. Conclusions: School-based mental health interventions should assess psychological and educational outcomes. Further research should directly compare the effects of interventions led by health and school staff. [ABSTRACT FROM AUTHOR]

Background A substantial minority of adolescents suffer from depression and it is associated with increased risk of suicide, social and educational impairment, and mental health problems in adulthood. A recently conducted randomized controlled trial in England evaluated the effectiveness of a manualized universally delivered age-appropriate CBT programme in school classrooms. The cost-effectiveness of the programme for preventing low mood and depression for all participants from a health and social care sector perspective needs to be determined. Methods A trial-based cost-effectiveness analysis based on a cluster-randomized controlled trial (trial registration - ISRCTN 19083628) comparing classroom-based CBT with usual school provision of Personal Social and Health Education. Per-student cost of intervention was estimated from programme records. The study was undertaken in eight mixed-sex UK secondary schools, and included 3,357 school children aged 12 to 16 years (in the two trial arms evaluated in the cost-effectiveness analysis). The main outcome measures were individual self-reported data on care costs, Quality-Adjusted Life-Years ( QALYs, based on the EQ-5D health-related quality-of-life instrument) and symptoms of depression (Short Mood and Feelings Questionnaire) at baseline, 6 and 12 months. Results Although there was lower quality-adjusted life-years over 12 months (−.05 QALYs per person, 95% confidence interval −.09 to −.005, p = .03) with CBT, this is a 'clinically' negligible difference, which was not found in the complete case analyses. There was little evidence of any between-arm differences in SMFQ scores (0.19, 95% CI −0.57 to 0.95, p = .62), or costs (£142, 95% CI −£132 to £415, p = .31) per person for CBT versus usual school provision. Conclusions Our analysis suggests that the universal provision of classroom-based CBT is unlikely to be either more effective or less costly than usual school provision. [ABSTRACT FROM AUTHOR]

Background: There is increased interest in developing training in cognitive behaviour therapy (CBT) with children and young people. However, the assessment of clinical competence has relied upon the use of measures such as the Cognitive Therapy Scale-Revised (CTS-R: Blackburn et al., 2001) which has been validated to assess competence with adults. The appropriateness of this measure to assess competence when working with children and young people has been questioned. Aim: This paper describes the development and initial evaluation of the Cognitive Behaviour Therapy Scale for Children and Young People (CBTS-CYP) developed specifically to assess competence in CBT with children and young people. Method: A cross section of child CBT practitioners (n = 61) were consulted to establish face validity. Internal reliability, convergent validity and discriminative ability were assessed in two studies. In the first, 12 assessors independently rated a single video using both the Cognitive Behaviour Therapy Scale for Children and Young People (CBTS-CYP) and Cognitive Therapy Scale-Revised (CTS-Revised: Blackburn et al., 2001). In the second, 48 different recordings of CBT undertaken with children and young people were rated on both the CBTS-CYP and CTS-R. Results: Face validity and internal reliability of the CBTS-CYP were high, and convergent validity with the CTS-R was good. The CBTS-CYP compared well with the CTS-R in discriminative ability. Conclusion: The CBTS-CYP provides an appropriate way of assessing competence in using CBT with children and young people. Further work is required to assess robustness with younger children and the impact of group training in reducing inter-rater variations. [ABSTRACT FROM AUTHOR]

Background: Computerised Cognitive Behaviour Therapy (cCBT) offers the potential to make evidence based interventions more available and accessible for children and young people. Research is currently limited and proof of concept studies are required to explore the viability and possible therapeutic benefits of cCBT as a universal or targeted intervention in schools. Method: In Study 1, cCBT was provided as a universal intervention to 13 participants who were assigned to either group cCBT or a matched computer gaming condition. In Study 2, cCBT was provided as a targeted intervention by trained school nurses to 12 participants with mild or moderate emotional problems. Results: Both studies found cCBT to result in immediate post intervention benefits and feedback about the programme was very positive. Conclusion: This study provides proof of concept that cCBT provided as a universal or targeted emotional health intervention in schools is viable and may result in immediate therapeutic benefits. These findings are limited by the small sample size and absence of follow-up but suggest that more methodologically robust evaluations should be pursued. [ABSTRACT FROM AUTHOR]

Background: Research has demonstrated the effectiveness of computerized cognitive behaviour therapy (cCBT) for depression and anxiety in adults, but there has been little work with children and adolescents. Aims: To describe the development of a cCBT intervention (Think, Feel, Do) for young people, and preliminary outcomes and feedback from a pilot randomized controlled trial. Method: Twenty participants aged 11 to 16 with depression or anxiety were randomized to receive cCBT immediately or after a delay. Standardized measures were used to assess self-reported anxiety, depression, self-esteem and cognitions, as well as parent rated strengths and difficulties. A feedback form was also completed to assess young people's views of the programme. Results: A total of 15 participants completed the pre and post assessments in the trial, and 17 provided feedback on the intervention. Paired samples t-tests demonstrated significant improvements on 3 subscales in the control condition, compared to 7 subscales in the cCBT condition. Feedback showed moderate to high satisfaction for participants. Conclusions: This study provides encouraging preliminary results for the effectiveness and acceptability of cCBT with this age group. [ABSTRACT FROM AUTHOR]

Children and young people diagnosed with Asperger’s Syndrome (AS) have significant social-communication difficulties and impaired empathy and theory of mind skills. These difficulties place them at risk of developing mental health problems, particularly anxiety, depression and obsessive compulsive disorder. Although Cognitive Behavioural Therapy (CBT) is recognised as an effective intervention for these problems in both child and adult populations, little research has specifically looked at the use of CBT with children and young people with an AS diagnosis. However, limited evidence suggests that CBT, if suitably adapted, is a feasible and potentially helpful treatment option. This paper focuses on the clinical practice of CBT and explores how the underpinning therapeutic relationship can be modified to meet the cognitive needs of this particular group of young clients. [ABSTRACT FROM PUBLISHER]

Background: Research has begun to examine the effectiveness of computerized cognitive behaviour therapy (cCBT) with children and adolescents. Although cCBT appears promising, the attitudes of clinicians towards this type of intervention with children and young people have not been assessed, yet these are important in determining when and if cCBT will be offered. Aims: To survey clinicians' attitudes towards cCBT with children and adolescents. Method: A self-report questionnaire was completed by 43 mental health professionals attending a conference. Results: Clinicians were cautious but generally positive about the use of cCBT with children and adolescents, particularly for the delivery of prevention programmes and in the treatment of mild/moderate problems. Few felt that cCBT should be available freely online without any professional support. Indeed, the lack of a therapeutic relationship and professional support were identified as the biggest problems, whilst the potential to use cCBT at home was the greatest advantage identified. Conclusions: This survey suggests that clinicians are generally positive about the use of cCBT with children and adolescents for the prevention and treatment of mild/moderate problems. Further research is required to address clinicians' concerns about the effectiveness of cCBT for more substantial problems and the level of therapeutic support required. [ABSTRACT FROM AUTHOR]

Emotional disorders in children are common and although effective interventions are available comparatively few receive specialist help. School nurses were trained to deliver an evidence-based emotional health cognitive behaviour therapy programme, FRIENDS, to 106 non-referred children aged 9–10 attending three schools. Levels of anxiety and self-esteem were stable in the 6-month period before FRIENDS. Three months after completing FRIENDS, anxiety had significantly decreased and self-esteem increased. Children with the most severe emotional problems benefited from the programme. The value of delivering standardised evidence based programmes in schools by school nurses is discussed and the need for further research highlighted. [ABSTRACT FROM AUTHOR]

Background: Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) in adolescents is common and disabling. Teenagers in the United Kingdom are more likely to recover if they access specialist care, but most do not have access to a local specialist CFS/ME service. Delivering treatment remotely via the internet could improve access to treatment.Objective: This study aims to assess (1) the feasibility of recruitment and retention into a trial of internet-delivered specialist treatment for adolescents with CFS/ME and (2) the acceptability of trial processes and 2 web-based treatments (to inform continuation to full trial).Methods: This study is an internal pilot for the initial 12 months of a full randomized controlled trial (RCT), with integrated qualitative methods (analysis of recruitment consultations and participant and clinician interviews). Recruitment and treatment were delivered remotely from a specialist pediatric CFS/ME treatment service within a hospital in South West United Kingdom. Adolescents (aged 11-17 years) from across the United Kingdom with a diagnosis of CFS/ME and no access to local specialist treatment were referred by their general practitioner to the treatment center. Eligibility assessment and recruitment were conducted via remote methods (telephone and on the web), and participants were randomized (via a computer-automated system) to 1 of 2 web-based treatments. The trial intervention was Fatigue in Teenagers on the InterNET in the National Health Service, a web-based modular CFS/ME-specific cognitive behavioral therapy program (designed to be used by young people and their parents or caregivers) supported by individualized clinical psychologist electronic consultations (regular, scheduled therapeutic message exchanges between participants and therapist within the platform). The comparator was Skype-delivered activity management with a CFS/ME clinician (mainly a physiotherapist or occupational therapist). Both treatments were intended to last for up to 6 months. The primary outcomes were (1) the number of participants recruited (per out-of-area referrals received between November 1, 2016, to October 31, 2017) and the proportion providing 6-month outcome data (web-based self-report questionnaire assessing functioning) and (2) the qualitative outcomes indicating the acceptability of trial processes and treatments.Results: A total of 89 out of 150 (59.3% of potentially eligible referrals) young people and their parents or caregivers were recruited, with 75 out of 89 (84.2%) providing 6-month outcome data. Overall, web-based treatment was acceptable; however, participants and clinicians described both the advantages and disadvantages of remote methods. No serious adverse events were reported.Conclusions: Recruiting young people (and their parents or caregivers) into an RCT of web-based treatment via remote methods is feasible and acceptable. Delivering specialist treatment at home via the internet is feasible and acceptable, although some families prefer to travel across the United Kingdom for face-to-face treatment.Trial Registration: ISRCTN 18020851; http://www.isrctn.com/ISRCTN18020851.International Registered Report Identifier (irrid): RR2-10.1186/s13063-018-2500-3. [ABSTRACT FROM AUTHOR]

Objectives Design Methods Results Conclusions Rates of PTSD are up to 12 times higher in care‐experienced young people (CEYP) compared to their peers. Trauma‐focused CBTs (tf‐CBT) are the best‐evidenced treatment for youth with PTSD, yet, in practice, CEYP often struggle to access this treatment. We worked alongside services to understand barriers and facilitators of the implementation of cognitive therapy for PTSD (a type of tf‐CBT) to CEYP.This was an active, open implementation trial.We recruited 28 mental health teams across England, including general CAMHS, targeted CAMHS for CEYP and social care‐based teams. From these teams, participants were 243 mental health professionals, from a wide variety of professional backgrounds. Following recruitment/intervention training, teams participated in rolling three monthly focus groups and individual interviews, to understand what helped and hindered implementation. Data were analysed using a framework analysis conducted using CFIR 2.0.Almost half of the teams were able to implement, but only approximately one quarter with CEYP, specifically. Universal barriers that were discussed by almost all teams particularly highlighted service structures and poor resourcing as major barriers to delivery to CEYP, as well as the complexities of the young person and their network. Unique factors that differentiated teams who did and did not implement included commissioning practices, the culture of the team, leadership engagement and style, and the development of supervision structures.Findings offer key considerations for mental health teams, service leads, commissioners and policy‐makers to enhance delivery of best‐evidenced mental health treatments like CT‐PTSD, for CEYP. [ABSTRACT FROM AUTHOR]

The article focuses on research based on long-term benefits of cognitive-behavioural prevention (CBP) for adolescents at risk of depression. Topics discussed include long-term benefits of cognitive-behavioural prevention is parents are not depressed at the onset of the programme; increased developmental competence in those who received CBP versus usual care; and strongest effects of CBP on new onsets of depression that occurred during the first 9 months after study enrolment.

Abstract: Anxiety affects 10% of all children and disrupts educational, socio-emotional development and overall functioning of the child and family. Research has shown that parenting factors (i.e. intrusiveness, negativity, distorted cognitions) contribute to the development and maintenance of childhood anxiety. Recent studies have therefore investigated if the treatment effect of traditional cognitive behavioural therapy may be enhanced by adding a parental component. However, randomised controlled trials have not shown unequivocal support for this assumption. The results are inconsistent and ambiguous. This article investigates possible reasons for this inconsistency and in particular differences in methodology and the theoretical relevance of the applied parental components are highlighted as possible contributory factors. Another factor is that treatment effect is mainly measured by change in the child''s diagnostic status rather than changes in parental or family functioning. [Copyright &y& Elsevier]