Improving Mood with Psychoanalytic and Cognitive Therapies - My Experience (IMPACT-ME)

  • Research Project Team

    • Dr Nick Midgley,
    • Professor Mary Target,
    • Dr Sally O'Keeffe,
    • Dr Emily Stapley,
    • Danny Isaacs


  • Background

    The IMPACT study is a large clinical trial of psychological treatment for adolescent depression.

    IMPACT-My Experience (IMPACT-ME) is drawing on this unique opportunity to explore the experience of young people and families taking part in the trial.

    IMPACT-ME is a qualitative, longitudinal study following up a sub-sample of families involved in IMPACT.

  • Aims

    IMPACT-ME aims to explore the process of overcoming severe depression as experienced by adolescents and their families receiving psychological therapies.

    We are including the perspectives of adolescents, families and therapists in order to gain a better understanding of the process of overcoming depression and what factors help or hinder recovery.

  • Methodology

    All families taking part in the IMPACT trial in North London were invited to take part in the IMPACT-ME study.

    Qualitative, semi-structured interviews were carried out with young people and parents at three time points (for full details of the design of the study, see Midgley, Ansaldo & Target, 2014).

    77 young people and 43 parents were interviewed pre-therapy, 81 young people and 53 parents were interviewed post-therapy, and 91 young people and 57 parents one year later.

    Therapists were also invited to take part in IMPACT-ME, and 76 therapist interviews have been conducted. We also have an active service users group, IMPACT-US, who have been advisors in various aspects of the project, including dissemination of our findings.

  • Results

    Prior to starting therapy, 77 adolescents took part in a qualitative interview, and drawing on this data, the team have published papers on the following topics:

    • Adolescents’ expectations of therapy. Five main themes were found: “The difficulty of imagining what will happen in therapy”, “the talking cure”, “the therapist as doctor”, “therapy as a relationship”, and “regaining the old self, or developing new capacities”.
    • Adolescents’ experiences of depression. Five main aspects of the experience of depression were identified: “misery, despair and tears”, “anger and violence towards self and others”, “a bleak view of everything”, “isolation and cutting off from the world”, and “the impact on education”.
    • Adolescents’ causal beliefs about their depression. Some of the young people had specific ideas about the causes of their depression, which closely matched identified risk factors for depression, including bullying, relationship problems, bereavement and rejection. However, for many young people, they struggled to make sense of what had caused their depression. A minority of young people saw their depression as part of their personality or character, or felt that they were to blame for their problems. For others, they believed that depression was linked with a biological cause or they saw it as a genetic condition, having seen their family members go through similar struggles.

    Drawing on qualitative interviews with the adolescents after they completed therapy, the team also carried out a study investigating adolescents’ experiences of taking part in a randomised controlled trial. The team found that the vast majority of adolescents found it acceptable to participate in the clinical trial, and many agreed to participate for reasons of ‘conditional altruism’. However consent was often given without great understanding of the key elements of the trial, including the difference between treatment arms and the randomisation process.

    The IMPACT-ME team worked with a group of young people and parents who had taken part in the IMPACT-ME study, to create short films about their experiences of depression. Facing Shadows is a short, animated film about adolescents’ experiences of depression and getting help. Journey Through the Shadows is a short film about living with a child who suffers from depression, and three parents’ journeys towards getting help. We also created a Behind the Scenes film, which shows how the films were made. These films are available to watch on YouTube (see links below). 

    For details about the work carried out about adolescents who stopped going to therapy, please see Sally O’Keeffe’s PhD project.

    For details about the work carried out on the parents’ perspectives, please see Emily Stapley's PhD project.

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