Improving Mood with Psychoanalytic and Cognitive Therapies (IMPACT)

Improving mood with psychoanalytic and cognitive therapies (IMPACT) is a randomised controlled, relapse prevention trial. The aims of IMPACT are to explore the effectiveness of three therapeutic interventions in the treatment and relapse prevention of depression in young people:

  • cognitive behavioural therapy
  • short-term psychoanalytic psychotherapy
  • and specialist clinical care.

A further two voluntary studies have been conducted in addition to the main impact trial:

  • IMPACT- My Experience (IMPACT-ME) is a qualitative study exploring young people's experience of overcoming depression and of treatments in the IMPACT trial
  • Magnetic Resonance-IMPACT (MR-IMPACT) used magnetic resonance imaging to explore brain function and intervention effects among young people with depression.

Project detail

Background

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. There is a need to identify psychological treatments that have long-term benefits in reducing the risk of relapse in later life.

The NICE guidelines recommend a range of psychological therapies (including Cognitive Behavioural Therapy and Short Term Psychoanalytic Psychotherapy) could be useful in the treatment of adolescent depression. In 2005, the NICE guidelines highlighted the need for a randomised controlled trial to assess the efficacy of CBT and psychodynamic psychotherapy in the treatment of adolescent depression.

The IMPACT trial was set up in response to NICE recommendations, and has been funded by the Health Technologies Assessment. The IMPACT study is the largest clinical trial of psychological therapies for adolescent depression ever to have taken place in Europe.

IMPACT has two sub-studies running alongside the main trial. Firstly, MR-IMPACT, which is using magnetic resonance imaging to explore brain function and intervention effects amongst depressed adolescents. Secondly, IMPACT-ME, which is a qualitative study exploring young people’s experiences of overcoming depression, as well as their expectations and experiences of treatment in the IMPACT trial.

The study aims to assess the effectiveness of three therapeutic interventions in the treatment and relapse prevention of adolescent depression. Furthermore, the study intends 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.

An additional aim of the trial is to explore whether, or how, cortisol levels and genes might influence individual responses to treatment.

Methods

The study is a pragmatic randomised controlled trial, which reflects how these services are provided, and used, in real NHS settings by the adolescent population. 470 participants aged 11-17 years with moderate/severe depression have been recruited from CAMHS within NHS Trusts across three regions in the UK: North London, East Anglia and the North West.

Participants are randomly allocated to one of the three interventions: Cognitive Behavioural Therapy (CBT), Short Term Psychoanalytic Psychotherapy (STPP) and Specialist Clinical Care (SCC). Outcome assessments take place with participants at 6, 12, 36, 52 and 86 weeks after starting treatment.

Key findings

We completed all follow-up assessments with IMPACT in January 2015, and aim to publish the results later in the year.

Publications

Goodyer, I. M., Tsancheva, S., Byford, S., Dubicka, B., Hill, J., Kelvin, R., et al. (2011). Improving mood with psychoanalytic and cognitive therapies (IMPACT): a pragmatic effectiveness superiority trial to investigate whether specialized psychological treatment reduces the risk for relapse in adolescents with moderate to severe unipolar depression: Study protocol for a randomized controlled trial. Trials, 12, 175. DOI: 10.1186/1745-6215-12-175

Project team

Dr Rob Senior

Professor Peter Fonagy

Dr Nick Midgley

Professor Mary Target

Professor Ian Goodyear

Tara McFarquhar