The experience of Cognitive Behavioural Therapy (CBT) in depressed adolescents who are fatigued

Georgia Herring, Maria Loades, Nina Higson-Sweeney, Emily Hards, Shirley Reynolds, Nick Midgley

Research output: Contribution to journalArticlepeer-review



Fatigue is a common and debilitating symptom of major depressive disorder (MDD). Cognitive behavioural therapy (CBT) is a recommended psychological treatment for adolescents with moderate to severe depression. This study explored the experience of CBT in fatigued adolescents with MDD.

A qualitative study was conducted using existing data from the qualitative arm of a large randomized control trial, the IMPACT study.

Data were obtained from semi-structured interviews conducted after therapy. Participants were 18 adolescents (aged 13–18 years) who reached the clinical threshold for fatigue on diagnostic assessment before starting treatment. The data were analysed using thematic framework analysis.

Three themes and seven sub-themes were developed. Adolescents appeared to find taking part in initial sessions, engaging in ongoing sessions and completing homework challenging. Perceiving the therapist as genuine seemed to provide a sense of safety which enabled adolescents to open up in sessions. When the therapist was not perceived as genuine, adolescents appeared to find CBT less helpful. The structure of CBT appeared to enable treatment goals to be set, and facilitated an increase in meaningful activity. Ensuring that tasks were perceived as manageable and goals as achievable seemed important for participation. Cognitive restructuring appeared useful, although some adolescents tended to engage in distraction from thoughts as an alternative strategy.

This study provides an initial insight into how fatigued adolescents with MDD experience CBT. Further research is required to establish whether the themes are pervasive and relatedly, how best to treat depression in fatigued adolescents receiving CBT.
Original languageEnglish
JournalPsychology and Psychotherapy Theory, Research and Practice
Early online date21 Sep 2021
Publication statusE-pub ahead of print - 21 Sep 2021

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