A mindfulness-based approach for adolescent non-responders to first-line treatments of depression and their carers: establishing feasibility of implementation and delivery  (MH30)


Mindfulness-Based Cognitive Therapy (MBCT) is an evidence-based intervention for relapse prevention among adults who have suffered repeated depressive episodes. It adds mindfulness (or the intentional focus of attention on the present moment without judgement) to established cognitive therapy strategies. Adolescence marks the peak incidence of depression. Many young people fail to fully respond to current initial treatment options. MBCT might help them, particularly if we could identify young people who were most likely to suffer repeated episodes before these occurred. We have developed a MBCT manual for young people and their carers, for, and with the input of young people, called Mindfulness for Adolescents and Carers or MAC. Previous work shows that MAC is feasible and acceptable, but we need to address important knowledge gaps prior to a future programme of research to test MAC s effectiveness, cost-effectiveness, mechanisms of action, and implementation.

Aims and objectives:

This proposal addresses four important uncertainties and will: (1) develop the training programme for therapists, which may need to differ in emphasis depending on whether they come from child mental health or mindfulness backgrounds; (2) describe current care pathways (to aid recruitment) and develop an understanding of what Treatment As Usual (TAU; probable comparator) comprises for the young people we want to recruit; (3) test the process for identifying young people and their carers and see how many start and finish MAC, so we better understand how many clinics we need to work with to test MAC in a definitive trial; and (4) test the acceptability of asking for blood and saliva samples for the future study of how MAC works. Methods: We will train therapists who will deliver one MAC group at each site (London and Exeter). The competency of the new therapists will be assessed to help refine training and supervision processes. We would randomise participants to one of two arms (10 adolescents and carers to MAC intervention and 10 to TAU at each site) to understand the proportion of young people identified by clinicians who would be eligible, consent to participate and attend MAC groups. Similarly, we would record how many were willing to provide biological samples. A case note audit supplemented by interviews with therapists and families would describe pathways to referral and TAU. Workshop and group supervision will be developed as an integrated programme of training and quality assurance.

Timelines for delivery:

The project will run for 12 months from July 2020. Months 1-3 will be used to develop the training programme, months 3-4 for delivery of the training, months 3-6 will be utilised for recruitment to groups and months 6-9 will be used to deliver MAC with both sites running concurrently. Scoping of care pathways and analysis will take place throughout. Anticipated impact and dissemination: In addition to a programme grant to be submitted in August 2021, this proposal would provide useful knowledge about current care pathways for young people with emotional disorders that would be of use to researchers, practitioners, service providers and commissioners.