A Cognitive-Behavioral Multimedia Internet Program to Prevent Youth Depression

描述(申请人提供)：抑郁症是困扰青少年的最普遍的精神障碍之一。它严重影响角色功能，通常需要反复或慢性病程。由于大多数抑郁青年从未接受过治疗，因此迫切需要制定易于实施和广泛传播的有效预防方案。拟议的项目将完成交互式多媒体(IMM)认知行为治疗(CBT)计划的开发，以预防12至15岁青少年的临床抑郁和改善抑郁症状。该程序将可通过互联网或CD-ROM访问。该计划改编自一项经过经验验证的干预措施，将包括六次CBT每周会议、与青少年抑郁症相关的额外浏览器模块，以及一个在线支持系统。六个CBT课程将包括：关于情绪和抑郁的教育；情绪和活动监测；增加积极思维；安排和参与愉快的活动；将情绪、活动和想法联系起来；以及规划未来。基于能力的教学设计将使用自定进度的教程、支持性同行表彰和行为建模小插曲为重复课程构建结构。其他浏览器模块包括抑郁自我筛选、学习放松、增强社交技能以及改善沟通和解决问题。在线支持系统将包括一个电子公告栏，与干预教练举行的个人每周会议，以及一个询问专家论坛。该方案将包括四个目标人群：学校/社区环境和少年司法环境中的青少年男孩和女孩。该计划的基本结构将为每个目标人群相同，但具体内容将为每个用户群体定制。第一阶段的原型提供了关于理解抑郁、跟踪情绪和活动水平以及参与愉快活动的培训。第一阶段方案针对的是少年司法环境中的男女青年。与仅提供信息的控制组相比，结果显示，岗位前员工的知识、自我效能感和使用所教授技能的意图发生了显著变化，具有较大的多变量效应量。在为期一周的随访中，年轻人报告说，在过去的一周里，参与愉快活动的人数显著增加。在第二阶段，该方案的范围将扩大到包括额外的技能培训，为四个用户群体中的每一个用户提供目标版本。第二阶段的产品将设计为在互联网/光盘上使用。全面开发的计划将在互联网上进行大型随机试验(n=300)进行评估，并进行为期6个月的随访期，以比较干预和控制条件下抑郁症状和抑郁发生率的变化。

DESCRIPTION (provided by applicant): Depression is one of the most prevalent mental disorders to afflict adolescents. It seriously impacts role functioning and typically takes a recurrent or chronic course. Because most depressed youth never receive treatment, there is a critical need to develop effective prevention programs that can be easily implemented and widely disseminated. The proposed project will complete development of an interactive multimedia (IMM) cognitive-behavioral therapy (CBT) program for preventing clinical depression and ameliorating depressive symptomatology in young adolescents aged 12 to 15 years old. The program will be accessible via the Internet or CD-ROM. Adapted from an empirically validated intervention, the program will include six CBT weekly sessions, additional browser modules related to youth depression, and an online support system. The six CBT sessions will include: education about moods and depression; mood and activity monitoring; increasing positive thinking; scheduling and engaging pleasant activities; relating mood, activities, and thoughts; and planning for the future. The competency-based instructional design will be structured for repeat sessions using self-paced tutorials, supportive peer testimonials, and behavior modeling vignettes. Additional browser modules include depression self-screening, learning to relax, enhancing social skills, and improving communication and problem solving. The online support system will include an electronic bulletin board, personal weekly conferences with an intervention coach, and an ask-an-expert forum. The program will include four target populations: adolescent boys and girls in school/community settings and in juvenile justice settings. The basic structure of the program will be the same for each target population, but specific content will be customized to each user group. The Phase I prototype provided training on understanding depression, tracking mood and activity levels, and engaging in pleasant activities. The Phase I program was targeted to female and male youth in juvenile justice settings. Compared to an information-only control group, the results showed significant pre-post changes in knowledge, self-efficacy, and intentions to use the skills taught, with a large multivariate effect size. At one-week follow-up, youth reported significant increases for the engagement in pleasant activities over the past week. In Phase II, the scope of the program will be expanded to included additional skills training, with targeted versions for each of the four user groups. The Phase II product will be designed for use on the Internet/CD-ROM. The fully developed program will be evaluated in large a randomized trial (n = 300) on the Internet with a six-month follow-up period to compare change in depressive symptoms and incidence rates of depression between intervention and control conditions.