Depression week, pre- and post-treatment (Dunn & Widnall,

Depression is a costly
problem in the UK, accounting for nearly 12 billion pounds annually and 17% of
UK disability services. Regular cognitive behavioural therapy (CBT) is
effective in reducing symptoms by 50% in two-thirds of the population and while
good at reducing negative affective symptoms (e.g. rumination), it is not as
focused on positive affective symptoms (anhedonia; Dunn & Widnall, 2017).

            ADepT (Augmented Depression Therapy) is a proposed
treatment for depression focusing on improving positive affective symptoms and
providing increased teamwork between the client and clinician (Dunn &
Widnall, 2017). This treatment combines behavioural activation and cognitive
therapy, in the hopes of boosting positivity and wellbeing. While CBT contains
20 weekly sessions, ADepT will contain 15 weekly acute sessions followed by 5
booster sessions that span over the year. The booster sessions are aimed to
lessen instances of relapse following the end of therapy (Dunn & Widnall,
2017).

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            The pilot study recruited 14 patients, 1 of which was
lost in follow-up. Several measures of depression, anxiety, anhedonia and
wellbeing were looked at as well as qualitative interviews. Between half and
two-thirds of clients showed clinically significant improvement of depression
and half showed clinical improvement on anhedonia (Dunn & Widnall, 2017).
Overall, the treatment was rated very positively and feasible.

The
proposed next step is a randomized control trial that includes many measures
covering a wide variety of modalities. There are several questionnaires pre-,
during and post-treatment, a sub-set of clients and clinicians will also
receive qualitative interviews, and clients will undertake a series of
experimental cognitive measures. Clients will also use a phone application in
which 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 on
symptoms of depression for most of its sample and was rated quite positively by
clients. The proposed randomized control trial however, includes many stages
and measures that were not looked at in the pilot study for feasibility and
client satisfaction. Clients will be asked to fill out 25 questionnaires over
the course of 18 months, the majority must be filled out 4 or more times. For
qualitative analysis clients will be asked to fill out a feedback booklet about
their experiences during the trial which will be used to inform interviews with
a sub-set of the sample within a 6-month period. Finally, the 3 cognitive
computerized tasks and phone app will be given before and after treatment.
Overall this is an astounding amount of work for the clients to undergo during
treatment.

            The recommendation is to eliminate unnecessary or
redundant analysis to lessen the burden on clients. Looking first at the
electronic measures, the phone app is a unique and exciting measure looking at
mood and could provide rich, real-time information about participants symptoms.
Research shows that while telehealth and smartphones show promising data, they
are 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’s
day-to-day life and for clients with more severe depression, recording their
mood 8 times a day for a week could prove nearly impossible. It is recommended
that recordings be limited to 5 times a day at pre-determined times decided
upon by the clinician and client together. The computer tasks are quite time
consuming and demanding on clients but could provide informative data. It is
suggested that they be as short as possible to minimize strain on participants (Dozois,
2009; Gotlib et al., 2004). The number of questionnaires is staggering and
should be limited. The weekly questionnaires could be changed to alternate
weeks to lessen the burden. There are 5 health economic outcomes that will be delivered
at intake, 6, 12, 18 months could be lessened. The EuroQol Five Dimensions
Questionnaire for example has many dimensions that are covered by other
questionnaires and might not be necessary. Additionally, the Work and Social
Adjustments Scale and the Adult Use Service Schedule have similar questions
surrounding work and functionality. The intensity of this proposal could be
lessened somewhat by eliminating redundant or time-consuming aspects of the
various measures.

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