Frank Flynn: Innovative Therapy for Teen Depression

What inspires people to act selflessly, help others, and make personal sacrifices? Each quarter, this column features one piece of scholarly research that provides insight on what motivates people to engage in what psychologists call “prosocial behavior” — things like making charitable contributions, buying gifts, volunteering one’s time, and so forth. In short, it looks at the work of some of our finest researchers on what spurs people to do something on behalf of someone else.

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In this column I look at an innovative therapy for one of our society’s most serious problems: teen depression. Up to a quarter of young people experience a depressive disorder by the age of 19. Cognitive behavioral therapy is the preferred treatment for depression, but less than a fifth of young people with depressive disorder receive it. This is partly because of shortages in the mental healthcare workforce, and partly because young people may be reluctant to seek help.

A research team led by Sally Merry at the University of Auckland has designed a computerized cognitive behavioral therapy intervention for adolescents seeking help for depression called SPARX (Smart, Positive, Active, Realistic, X-factor thoughts), and tested it on nearly 200 New Zealand adolescents aged 12 to 19. The researchers developed a computer-based intervention because the medium is so attractive to most young people.

The results of the intervention suggest that SPARX may be an effective alternative to traditional care for depressed adolescents. In particular, it may be useful in addressing some of the unmet demand for treatment.

What is SPARX? Simply put, SPARX is a video game that provides therapy for the user, although the user may be receiving the therapy unwittingly. More specifically, SPARX is an interactive fantasy game that uses both first person instruction and a three dimensional interactive game in which the young person undertakes a series of challenges to restore the balance in a fantasy world dominated by GNATs (Gloomy Negative Automatic Thoughts). The program, delivered on CD-ROM, consists of seven modules focusing on getting participants to find hope, deal with emotions, overcome problems, and recognize and shift negative thoughts. It also guides participants to set and monitor real-life challenges, equivalent to homework. The game is supplemented by a paper notebook with summaries of each module and spaces to add comments about the challenges completed.

Researchers recruited young people with symptoms of depression, from youth clinics, general practices, and school-based counseling services in seven provincial and urban locations in New Zealand. Participants completed the modules either in clinics or at home.

Participating in the SPARX program resulted in a clinically significant reduction in depression, anxiety, and hopelessness among adolescents, and an improved quality of life.

The intervention was at least as good as conventional therapeutic treatment in primary healthcare sites in New Zealand, and proved even more effective for those who were most depressed at the start. Adolescents enjoyed SPARX and had a high rate of adherence to it. The treatment effects persisted up to three months after the completion of the program.

The results are fairly impressive given that SPARX was entirely a self-help resource. The only contact participants had with a clinician was at recruitment, and the only input they had from health professionals during the course of treatment was a brief phone call that took place one month after the program began. SPARX thus promises to be an effective, low-cost therapy that can reach many more young people who don’t have access to or inclination to pursue psychological help. It could also be used as the first component in a stepped-care approach to managing depression in this age group.

The success of SPARX suggests new avenues for incorporating emotional health resources into educational systems worldwide. Happier teenagers are more productive and outward-reaching individuals. Could computer games be used as a medium for other forms of prosocial behavior as well? Merry’s team has certainly opened the door to this promising possibility.

More groundbreaking research about prosocial behavior will come in the summer quarter.

Research selected by Professor Frank Flynn, Professor of Organizational Behavior and The Hank McKinnell-Pfizer Inc. Director of the Center for Leadership Development and Research at the Stanford Graduate School of Business.