Improving Mood with Psychoanalytic And Cognitive Therapies (IMPACT)

In the UK, 1 in 10 young people referred to child and adolescent mental health services (CAMHS) receives a diagnosis of depression. There are strong links between adolescent depression and recurrent depressive episodes and suicidality in later life. This highlights the need to identify psychological treatments that have long-term benefits in reducing the risk of relapse in later life. In 2005, the National Institute for Health and Care Excellence (NICE) guidelines highlighted the need for a randomised controlled trial (RCT) to assess the efficacy of cognitive behavioural therapy (CBT) and short-term psychoanalytic psychotherapy (STPP) in the treatment of adolescent depression. The IMPACT trial was set up in response to NICE recommendations and is the largest clinical trial of psychological therapies for adolescent depression ever to have taken place in Europe.

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- To assess the effectiveness of three therapeutic interventions in the treatment and relapse prevention of adolescent depression.
- To estimate the overall health, social and educational costs of the interventions based on research findings and build ground for future adolescent depression treatment recommendations.
- To explore whether, or how, cortisol levels and genes might influence individual responses to treatment.
The study was a pragmatic RCT, which reflects how these services are provided in real NHS settings and used by young people. In total, 470 participants aged 11-17 years with moderate/severe depression were recruited from CAMHS within NHS trusts across three regions in the UK: North London, East Anglia and the North West. Participants were randomly allocated to one of the three interventions: CBT, STPP and a brief psychosocial intervention. Outcome assessments took place with participants at 6, 12, 36, 52 and 86 weeks after starting treatment.
Young people in all three arms of the study were found to have sustained reduced depressive symptoms at 86- week follow-up. The three treatments were found to be equally effective in maintaining reduced depressive symptoms, with an average of a 49%-52% reduction in depressive symptoms one year after the end of treatment. There were no significant differences in the total costs of the three treatment groups by the end of the study.
Goodyer, I. M., Tsancheva, S., Byford, S., Dubicka, B., Hill, J., Kelvin, R., Reynolds, S., Roberts, C., Senior, R., Suckling, J., Wilkinson, P., Target, M., & Fonagy, P. (2011). Improving mood with psychoanalytic and cognitive therapies (IMPACT): A pragmatic effectiveness superiority trial to investigate whether specialised psychological treatment reduces the risk for relapse in adolescents with moderate to severe unipolar depression: study protocol for a randomised controlled trial. Trials, 12, 175. https://doi.org/10.1186/1745-6215-12-175
O'Keeffe, S., Martin, P., Target, M., & Midgley, N. (2019). “I just stopped going”: A mixed methods investigation into types of therapy dropout in adolescents with depression. Frontiers in Psychology, 10, 75. https://doi.org/10.3389/fpsyg.2019.00075
O'Keeffe, S., Martin, P., & Midgley, N. (2020). When adolescents stop psychological therapy: Rupture-repair in the therapeutic alliance and association with therapy ending. Psychotherapy (Chicago, Ill.), 57(4), 471–490. https://doi.org/10.1037/pst0000279
Wilmots, E., Midgley, N., Thackeray, L., Reynolds, S., & Loades, M. (2020). The therapeutic relationship in cognitive behaviour therapy with depressed adolescents: A qualitative study of good-outcome cases. Psychology and Psychotherapy, 93(2), 276–291. https://doi.org/10.1111/papt.12232
Cirasola, A., Midgley, N., Fonagy, P., Impact Consortium, & Martin, P. (2021). The alliance-outcome association in the treatment of adolescent depression. Psychotherapy (Chicago, Ill.), 58(1), 95–108. https://doi.org/10.1037/pst0000366
Aitken, M., Haltigan, J. D., Szatmari, P., Dubicka, B., Fonagy, P., Kelvin, R., Midgley, N., Reynolds, S., Wilkinson, P. O., & Goodyer, I. M. (2020). Toward precision therapeutics: general and specific factors differentiate symptom change in depressed adolescents. Journal of child psychology and psychiatry, and allied disciplines, 61(9), 998–1008. https://doi.org/10.1111/jcpp.13194
Fiorini, G., Saunders, R., & Fonagy, P. The Impact Consortium & Midgley, N. (2022). Trajectories of change in general psychopathology levels among depressed adolescents in short-term psychotherapies. Psychotherapy Research. https://doi.org/10.1080/10503307.2022.2040751
Davies, S. E., Neufeld, S. A. S., van Sprang, E., Schweren, L., Keivit, R., Fonagy, P., Dubicka, B., Kelvin, R., Midgley, N., Reynolds, S., Target, M., Wilkinson, P., van Harmelen, A. L., & Goodyer, I. M. (2020). Trajectories of depression symptom change during and following treatment in adolescents with unipolar major depression. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 61(5), 565–574. https://doi.org/10.1111/jcpp.13145
Krause, K., Midgley, N., Edbrooke-Childs, J., & Wolpert, M. (2021). A comprehensive mapping of outcomes following psychotherapy for adolescent depression: The perspectives of young people, their parents and therapists. European Child and Adolescent Psychiatry, 30(11), 1779–1791. https://doi.org/10.1007/s00787-020-01648-8
Midgley, N., Cregeen, S., Hughes, C., & Rustin, M. (2013). Psychodynamic psychotherapy as treatment for depression in adolescence. Child and Adolescent Psychiatric Clinics of North America, 22(1), 67–82. https://doi.org/10.1016/j.chc.2012.08.004
Calderon, A., Schneider, C., Target, M., Midgley, N., & IMPACT Consortium (2019). 'Interaction structures' between depressed adolescents and their therapists in short-term psychoanalytic psychotherapy and cognitive behavioural therapy. Clinical Child Psychology and Psychiatry, 24(3), 446–461. https://doi.org/10.1177/1359104518807734
Midgley, N., Reynolds, S., Kelvin, R., Loades, M., Calderon, A., Martin, P., IMPACT Consortium, & O'Keeffe, S. (2018). Therapists' techniques in the treatment of adolescent depression. Journal of Psychotherapy Integration, 28(4), 413–428. https://doi.org/10.1037/int0000119

Improving Mood with Psychoanalytic And Cognitive Therapies (IMPACT)

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