Development and feasibility of augmented depression therapy for complex depression (ADepT+): a randomised, controlled feasibility trial
Depression
ADepT+ therapy consists of up to 20 acute 60-minute individual therapy sessions over 8 months, followed by up to 5 optional 60-minute booster sessions offered flexibly in the subsequent 12 months. Therapy will be delivered face-to-face, online or by phone according to patient preference and what is practically possible. The primary goal of ADepT+ is to build wellbeing, viewing depression, anxiety, interpersonal, emotional and identity symptoms as barriers that get in the way of wellbeing. The key adaptations (+) for complex depression from standard ‘ADepT’ therapy include an extended assessment phase, to support the therapeutic relationship and understand how additional difficulties and possible trauma exposure link to current depression, and additional 'change' sessions to integrate additional skills to regulate emotions and manage relationships. Clients are supported to identify values, consistent goals, and to behaviourally activate themselves towards achieving these goals. Patterns of thinking and behaving that get in the way of individuals dealing with challenges (being resilient) and taking opportunities (thriving) as they work towards these goals are mapped out and then the client is encouraged to learn new adaptive patterns of thinking and behaving. Therapy will be delivered by at least three therapists with an existing training in cognitive behavioural, behavioural or dialectical behavioural therapy and experience of working with people with mood disorders. Therapists will undergo additional ADepT+ specific training as required. Ongoing supervision will be provided for 90 minutes per week in a small group format facilitated by an experienced ADepT+ supervisor/trainer.
1. Aged 18 years or older 2. Score in the clinical range on the PHQ-9 depression scale (scores >=10) 3. Meet diagnostic criteria for a current major depressive episode using the Structured Clinical Interview for Diagnosis 4. Describe depression as the primary presenting problem they prefer therapy to focus on 5. Report difficulties in emotional, interpersonal, identity or impulsivity regulation, consistent with personality difficulties or personality disorder (assessed by scoring >=9 on the PDS-ICD-11 ) 6. Willing and able to give informed consent for participation within the trial 7. Have sufficient written and spoken English to be able to make use of therapy and to be able to complete research assessments without the need of a translator 8. Have completed the intake measures 9. Be registered with a General Practice within the study site catchment area (Devon) who they are willing to be notified of their participation within the trial Therapist participant inclusion: 1. Served as a therapist on the ADepT+ feasibility trial 2. Delivered at least one ADepT+ therapy session to a participant
1. Currently receiving psychosocial therapy 2. Current substance dependence according to ICD-11 criteria (as this may interfere with the ability to engage in and use therapy; current substance abuse is not an exclusion criterion) 3. Current/past history of schizophrenia or Bipolar-I diagnosis (Bipolar-II diagnosis not an exclusion criterion) 4. Presents with co-occurring difficulties that cannot be safely managed in a primary care outpatient setting; or that would significantly interfere with engagement in therapy; or are indicated to be the most appropriate primary focus of current treatment (for example, PTSD, complex PTSD, problematic eating, cognitive impairment, learning disability) 5. Current moderate to severe personality disorder and/or antisocial personality traits that require secondary/tertiary care management 6. Displaying marked risk to self (self-harm or suicide) or others, that cannot be safely managed in a primary care outpatient setting 7. Participant anticipates they will be unable to regularly attend therapy sessions within the site area (e.g. planning to move out of the study area, work commitments prevent regular attendance, lengthy period of travel not mitigated by access to online therapy sessions) 8. Currently receiving inpatient mental healthcare No specific therapist participant exclusion criteria.