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An Early Intervention for Adolescent Depression Targeting Emotional Mental Images and Memory Specificity: A Process Evaluation

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
JournalEuropean Child and Adolescent Psychiatry
Early online date16 Nov 2021
Accepted/In press24 Oct 2021
E-pub ahead of print16 Nov 2021
Published16 Nov 2021

Bibliographical note

Funding Information: The analysis was conducted in several stages. First, researchers immersed themselves in the young people’s experiences of the intervention by familiarising themselves with the data through reading the transcripts and data analysis meetings. Second, to organise the data, the coding framework was developed by three researchers (VP, who has a background in clinical psychology, LS who has a background in psychology as well as being a service-user consultant on the trial, and ML who has a background in psychology and extensive experience in qualitative analysis). We then piloted this initial framework on two interviewees to further refine our framework and categories, discussing the development of the coding framework as a team. This provided the opportunity to understand any challenges within our coding process and to ensure that our understanding of the categories was consistent across researchers. It also helped us to refine our framework, so that it was a good fit for the issues within the data. The interviews were each coded using the framework by VP and LS. Throughout, the framework developed in a responsive manner to any emergent data-driven issues from each interview and was systematically refined to ensure that concepts were appropriately identified, agreed, and described. VP and LS met regularly, and ML provided consultation on the continual development of the coding framework. Finally, we began to interpret and summarise the data to identify patterns within it. There were no notable disagreements between researchers regarding the identification and description of concepts within the analysis. Analysis was supported by qualitative analysis computer software NVivo 12 []. Publisher Copyright: © 2021, Crown.

King's Authors


We have evaluated a novel early intervention for adolescent depression (age 16–18) in a feasibility randomised controlled trial. This nested process evaluation aimed to understand how this complex intervention worked. We sought to understand participants’ views and experiences of receiving and interacting with the intervention to evaluate whether the underpinning theoretical basis of the intervention is justified and whether it contributes to valued outcomes for participants. Twelve participants were invited to take part in semi-structured interviews. Framework analysis was employed to identify important aspects of adolescents’ experiences. The active ingredients identified by participants were consistent with and extended our understanding of the theoretical basis of the intervention. Four principle themes were identified: understanding how memory works and being able to remember memories in more detail; processing negative experiences and letting go; imagining positive future events; and understanding and being kinder to myself. The outcomes of the intervention were valued by participants. Six principle themes were identified: improving mood and well-being; reducing impact of negative memories; motivation and goal-directed behaviour; overcoming avoidance and rumination; relationships, communication and being open; and self-understanding and acceptance. A simplified logic model is also proposed to connect the intervention components, active ingredients, and valued outcomes. The findings provide an in-depth understanding of how participants interacted with the intervention and what they derived from it. For example, the findings establish processing negative experiences as a core intervention component, extend it to include letting go of these memories, and highlight that reducing the impact of negative memories is valued by participants. This richer understanding guides further intervention development and future implementation.

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