Skip to main content Accessibility help

Feasibility randomized controlled trial of a one-day CBT workshop (‘DISCOVER’) for 15- to 18-year-olds with anxiety and/or depression in clinic settings

  • Christina E. Loucas (a1), Irene Sclare (a2), Daniel Stahl (a3) and Daniel Michelson (a4)



‘DISCOVER’ one-day cognitive behavioural therapy (CBT) workshops have been developed to provide accessible, developmentally sensitive psychological support for older adolescents experiencing emotional difficulties. Previous school-based evaluations of the DISCOVER model have shown positive outcomes.


The current study aimed to test the model for clinically referred adolescents, in real-world settings.


A randomized controlled trial (RCT) assessed feasibility, acceptability and preliminary outcomes of the DISCOVER intervention, in comparison with usual care, for 15- to 18-year-olds with emotional difficulties. Participants were recruited from outpatient clinic waiting lists in UK child and adolescent mental health services (CAMHS). Research feasibility indicators included rates of recruitment, randomization, intervention participation (group workshops and individualized follow-up telephone calls), and data collection (at baseline and 8-week follow-up). Intervention acceptability was assessed using a structured service satisfaction questionnaire and semi-structured qualitative interviews with intervention participants. Preliminary clinical outcomes were explored using adolescent-reported validated measures of depression, anxiety and well-being.


n = 24 participants were randomized to intervention and usual care groups. Workshop attendance was good and high levels of treatment satisfaction were reported, although feasibility challenges emerged in recruitment and randomization. Trends were found towards potential improvements in anxiety and well-being for the intervention group, but the effect estimate for depression was imprecise; interpretability was also limited due to the small sample size.


DISCOVER appears to be a feasible and acceptable intervention model for clinically referred 15- to 18-year-olds with emotional difficulties. A full-scale RCT is warranted to evaluate effectiveness; protocol modifications may be necessary to ensure feasible recruitment and randomization procedures.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Feasibility randomized controlled trial of a one-day CBT workshop (‘DISCOVER’) for 15- to 18-year-olds with anxiety and/or depression in clinic settings
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Feasibility randomized controlled trial of a one-day CBT workshop (‘DISCOVER’) for 15- to 18-year-olds with anxiety and/or depression in clinic settings
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Feasibility randomized controlled trial of a one-day CBT workshop (‘DISCOVER’) for 15- to 18-year-olds with anxiety and/or depression in clinic settings
      Available formats


Corresponding author

*Corresponding author. Email:


Hide All
Abdinasir, K. (2017). Stick With Us: Tackling Missed Appointments in Children’s Mental Health Services. London: The Children’s Society. Retrieved from:
Abdinasir, K. and Pona, I. (2015). Access Denied: A Teenager’s Pathway through the Mental Health System. London: The Children’s Society. Retrieved from:
Ahmed, S. P., Bittencourt-Hewitt, A. and Sebastian, C. L. (2015). Neurocognitive bases of emotion regulation development in adolescence. Developmental Cognitive Neuroscience, 15, 1125. doi: 10.1016/j.dcn.2015.07.006
Balázs, J., Miklósi, M., Keresztény, A., Hoven, C. W., Carli, V., Wasserman, C., … Wasserman, D. (2013). Adolescent subthreshold-depression and anxiety: psychopathology, functional impairment and increased suicide risk. Journal of Child Psychology and Psychiatry, 54, 670677. doi: 10.1111/jcpp.12016.
Bearman, S. K. and Weisz, J. R. (2015). Review: Comprehensive treatments for youth comorbidity– evidence-guided approaches to a complicated problem. Child and Adolescent Mental Health, 20, 131141. doi: 10.1111/camh.12092
Beck, J. S. (2011). Cognitive Behavior Therapy: Basics and Beyond (2nd edn). New York: Guilford Press.
Bernard, H., Burlingame, G., Flores, P., Greene, L., Joyce, A., Kobos, J. C., … Feirman, D. (2008). Clinical practice guidelines for group psychotherapy. International Journal of Group Psychotherapy, 58, 455542. doi: 10.1521/ijgp.2008.58.4.455
Bradford, S. and Rickwood, D. (2012). Adolescent’s preferred modes of delivery for mental health services. Child and Adolescent Mental Health, 19, 3945. doi: 10.1111/camh.12002
Braun, V. and Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77101. doi: 10.1191/1478088706qp063oa
Brown, J. S. L., Cochrane, R. and Hancox, T. (2000). Large-scale health promotion stress workshops for the general public: a controlled evaluation. Behavioural and Cognitive Psychotherapy, 28, 139151.
Browne, R. H. (1995). On the use of a pilot sample for sample size determination. Statistics in Medicine, 14, 19331940. doi: 10.1002/sim.4780141709
Brown, J. S. L., Blackshaw, E., Stahl, D., Fennelly, L., McKeague, L., Sclare, I. and Michelson, D. (2019). School-based early intervention for anxiety and depression in older adolescents: a feasibility randomised controlled trial of a self-referral stress management workshop programme (‘DISCOVER’). Journal of Adolescence, 71, 150161. doi: 10.1016/j.adolescence.2018.11.009
Campinha-Bacote, D. and Dexter, D. (2012). Pre-group preparation in college counseling centers: through the use of an audio-visual aid (Electronic Thesis or Dissertation). Retrieved from:
Chapman, R., Loades, M., O’Reilly, G., Coyle, D., Patterson, M. and Salkovskis, P. (2016). ‘Pesky gNATs’: investigating the feasibility of a novel computerized CBT intervention for adolescents with anxiety and/or depression in a Tier 3 CAMHS setting. The Cognitive Behaviour Therapist, 9, e35. doi: 10.1017/S1754470X16000222
Children’s Commissioner for England (2016). Lightning Review: Access to Child and Adolescent Mental Health Services, May 2016. London: Children’s Commissioner for England. Retrieved from:
Chorpita, B. F. and Daleiden, E. L. (2009). Mapping evidence-based treatments for children and adolescents: application of the distillation and matching model to 615 treatments from 322 randomized trials. Journal of Consulting and Clinical Psychology, 77, 566579. doi: 10.1037/a0014565.
Chorpita, B. F., Taylor, A. A., Francis, S. E., Moffitt, C. and Austin, A. A. (2004). Efficacy of modular cognitive behavior therapy for childhood anxiety disorders. Behavior Therapy, 35, 263287. doi: 10.1016/S0005-7894(04)80039-X
Chorpita, B. F., Weisz, J. R., Daleiden, E. L., Schoenwald, S. K., Palinkas, L. A., Miranda, J., … Gibbons, R. D. (2013). Long-term outcomes for the Child STEPs randomized effectiveness trial: a comparison of modular and standard treatment designs with usual care. Journal of Consulting and Clinical Psychology, 81, 9991009. doi: 10.1037/a0034200.
Chorpita, B. F., Yim, L. M., Moffitt, C., Umemoto, L. A. and Francis, S. E. (2000). Assessment of symptoms of DSM-IV anxiety and depression in children: a revised child anxiety and depression scale. Behaviour Research and Therapy, 38, 835855. doi: 10.1016/S0005-7967(99)00130-8
Chu, B. C., Temkin, A. B. and Toffey, K. (2016). Transdiagnostic Mechanisms and Treatment for Children and Adolescents: An Emerging Field. Oxford: Oxford Handbooks Online.
Clark, D. M. (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: the IAPT experience. International Review of Psychiatry, 23, 318327. doi: 10.3109/09540261.2011.606803
Clarke, A., Friede, T., Putz, R., Ashdown, J., Martin, S., Blake, A., … Stewart-Brown, S. (2011). Warwick-Edinburgh mental well-being scale (WEMWBS): validated for teenage school students in England and Scotland. A mixed methods assessment. BMC Public Health, 11, 487. doi: 10.1186/1471-2458-11-487
Costello, E. J. and Angold, A. (1988) Scales to assess child and adolescent depression: checklists, screens, and nets. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 726737. doi: 10.1097/00004583-198811000-00011
Craske, M. G. (2012). Transdiagnostic treatment for anxiety and depression. Depression and Anxiety, 29, 749–743. doi: 10.1002/da.21992
Department of Health and NHS England (2015). Future in Mind: Promoting, Protecting and Improving our Children and Young People’s Mental Health and Wellbeing. London: Department of Health and NHS England. Retrieved from:
Dong, Y. and Peng, J. (2013). Principled missing data methods for researchers. Springerplus, 2, 222. doi: 10.1186/2193-1801-2-222
Edbrooke-Childs, J., Calderon, A., Wolpert, M. and Fonagy, P. (2015). Children and Young People’s Improving Access to Psychological Therapies: Rapid Internal Audit, National Report. London: CYP-IAPT. Retrieved from:
Fernandez, E., Salem, D., Swift, J. K. and Ramtahal, N. (2015). Meta-analysis of dropout from cognitive behavioral therapy: magnitude, timing, and moderators. Journal of Consulting and Clinical Psychology, 83, 1108–1022. doi: 10.1037/ccp0000044
Foot, C., Naylor, C. and Imison, C. (2010). The Quality of GP Diagnosis and Referral. London: The King’s Fund. Retrieved from:
Frith, E. (2016). CentreForum Commission on Children and Young People’s Mental Health: State of the Nation. London: CentreForum. Retrieved from:
Gandhi, T. J., Sittig, D.F., Franklin, M., Sussman, A. J., Fairchild, D. G. and Bates, D. W. (2000). Communication breakdown in the outpatient referral process. Journal of General Internal Medicine, 15, 626631. doi: 10.1046/j.1525-1497.2000.91119.x
Green, H., McGinnity, A., Meltzer, H., Ford, T. and Goodman, R. (2005). Mental Health of Children and Young People in Great Britain, 2004. A Survey Carried Out by the Office for National Statistics on Behalf of the Department of Health and the Scottish Executive. Basingstoke: Palgrave Macmillan. Retrieved from:
Goodyer, I. M., Reynolds, S., Barrett, B., Byford, S., Dubicka, B., Hill, J., … Fonagy, P. (2017). Cognitive behavioural therapy and short-term psychoanalytical psychotherapy versus a brief psychosocial intervention in adolescents with unipolar major depressive disorder (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled superiority trial. Lancet Psychiatry, 4, 109119. doi: 10.1016/S2215-0366(16)30378-9
Guest, G., Bunce, A. and Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18, 5982.
Hagermoser Sanetti, L. M., Collier-Meek, M. A. and Fallon, L. M. (2016). Fidelity with flexibility: treatment acceptability and individualised adaptations of evidence-supported treatments. In Maltzman, S. (ed), The Oxford Handbook of Treatment Processes and Outcomes in Psychology: A Multidisciplinary Biopsychosocial Approach (pp. 289308). New York: Oxford University Press.
Harper, B., Dickson, J. M. and Bramwell, R. (2014). Experiences of young people in a 16–18 Mental Health Service. Child and Adolescent Mental Health, 19, 9096. doi: 10.1111/camh.12024
Higa-McMillan, C. K., Francis, S. E., Rith-Najarian, L. and Chorpita, B. F. (2016). Evidence base update: 50 years of research on treatment for child and adolescent anxiety. Journal of Clinical Child and Adolescent Psychology, 45, 91113. doi: 10.1111/camh.12024
Hopkins, K., Crosland, P., Elliott, N. and Bewley, S. (2015). Diagnosis and management of depression in children and young people: summary of updated NICE guidance. BMJ, 350, h824. doi: 10.1136/bmj.h824
House of Commons Health Committee (2014). Children’s and Adolescents’ Mental Health and CAMHS: Third Report of Session 2014–15. House of Commons London: The Stationery Office Limited. Retrieved from:
Ioannidis, J. P. (2005). Why most published research findings are false. PLoS Medicine, 2, e124.
Khanna, M. S. and Kendall, P. C. (2010). Computer-assisted cognitive behavioral therapy for child anxiety: results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 78, 737745. doi: 10.1037/a0019739
Kim-Cohen, J., Caspi, A., Moffitt, T. E., Harrington, H., Milne, B. J. and Poulton, R. (2003). Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort. Archives of General Psychiatry, 60, 709717. doi: 10.1001/archpsyc.60.7.709
Larsen, D. L., Attkisson, C. C., Hargreaves, W. A. and Nguyen, T. D. (1979). Assessment of client/patient satisfaction: development of a general scale. Evaluation and Program Planning, 2, 197207. doi: 10.1016/0149-7189(79)90094-6
McGorry, P., Bates, T. and Birchwood, M. (2013). Designing youth mental health services for the 21st century: examples from Australia, Ireland and the UK. British Journal of Psychiatry, 202, s3035. doi: 10.1192/bjp.bp.112.119214
Memarzia, J., St Clair, M. C., Owens, M., Goodyer, I. M. and Dunn, V. J. (2015). Adolescents leaving mental health or social care services: predictors of mental health and psychosocial outcomes one year later. BMC Health Services Research, 15, 185. doi: 10.1186/s12913-015-0853-9
Michelson, D., Sclare, I., Stahl, D., Morant, N., Bonin, E. M. and Brown, J. S. (2016). Early intervention for depression and anxiety in 16-18-year-olds: protocol for a feasibility cluster randomised controlled trial of open-access psychological workshops in schools (DISCOVER). Contemporary Clinical Trials, 48, 5258. doi: 10.1016/j.cct.2016.02.003
Newby, J. M., McKinnon, A., Kuyken, W., Gilbody, S. and Dalgleish, T. (2015). Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clinical Psychology Review, 40, 91110. doi: 10.1016/j.cpr.2015.06.002
Ng, M. Y., Eckshtain, D. and Weisz, J. R. (2016). Assessing fit between evidence-based psychotherapies for youth depression and real-life coping in early adolescence. Journal of Clinical Child and Adolescent Psychology, 45, 732748. doi: 10.1080/15374416.2015.1041591
Persson, S., Hagquist, C. and Michelson, D. (2017). Young voices in mental health care: exploring children’s and adolescents’ service experiences and preferences. Clinical Child Psychology and Psychiatry, 22, 140151. doi: 10.1177/1359104516656722
Plaistow, J., Masson, K., Koch, D., Wilson, J., Stark, R. M., Jones, P. B. and Lennox, B. R. (2014). Young people’s views of UK mental health services. Early Intervention in Psychiatry, 8, 1223. doi: 10.1111/eip.12060
Pona, I., Royston, S., Bracey, C. and Gibbs, A. (2015). Seriously Awkward: How Vulnerable 16-17 Year Olds are Falling through the Cracks. London: The Children’s Society. Retrieved from:
Sclare, I. and Michelson, D. (2016). Innovations in CBT for young people: Improving access and outcomes for vulnerable youth. In Menzies, R. G., Kyrios, M., and Kazantzis, N. (eds), Innovations and Future Directions in the Behavioural and Cognitive Therapies (pp. 3438). Samford Valley, Queensland: Australian Academic Press.
Sclare, I., Michelson, D., Malpass, L., Coster, F. and Brown, J. (2015). Innovations in Practice: DISCOVER CBT workshops for 16-18-year-olds: development of an open-access intervention for anxiety and depression in inner-city youth. Child and Adolescent Mental Health, 20, 102106. doi: 10.1111/camh.12060
Shirk, S. R., DePrince, A. P., Crisostomo, P. S. and Labus, J. (2014). Cognitive behavioral therapy for depressed adolescents exposed to interpersonal trauma: an initial effectiveness trial. Psychotherapy, 51, 167179. doi: 10.1037/a0034845
Smith, D., Roche, E., O’Loughlin, K., Brennan, D., Madigan, K., Lyne, J., … O’Donoghue, B. (2014). Satisfaction with services following voluntary and involuntary admission. Journal of Mental Health, 23, 3845. doi: 10.3109/09638237.2013.841864
Southam-Gerow, M. A., Rodríguez, A., Chorpita, B. F. and Daleiden, E. (2012). Dissemination and implementation of evidence based treatments for youth: challenges and recommendations. Professional Psychology: Research and Practice, 43, 527534. doi: 10.1037/a0029101
Stallard, P., Udwin, O., Goddard, M. and Hibbert, S. (2007). The availability of cognitive behaviour therapy within specialist child and adolescent mental health services (CAMHS): a national survey. Behavioural and Cognitive Psychotherapy, 35, 501505. doi: 10.1017/S1352465807003724
Steinberg, L. (2005). Cognitive and affective development in adolescence. Trends in Cognitive Science, 9, 6974. doi: 10.1016/j.tics.2004.12.005
Stewart, R., Soremekun, M., Perera, G., Broadbent, M., Callard, F., Denis, M., … Lovestone, S. (2009). The South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) case register: development and descriptive data. BMC Psychiatry, 9, 51. doi: 10.1186/1471-244X-9-51
Van Breukelen, G. J. (2006). ANCOVA versus change from baseline: more power in randomized studies, more bias in nonrandomized studies [corrected]. Journal of Clinical Epidemiology, 59, 920925. doi: 10.1016/j.jclinepi.2006.02.007
Weersing, V. R., Jeffreys, M., Do, M.-C. T., Schwartz, K. T. G. and Bolano, C. (2017). Evidence base update of psychosocial treatments for child and adolescent depression. Journal of Clinical Child and Adolescent Psychology, 46, 1143. doi: 10.1080/15374416.2016.1220310
Weersing, V. R., Rozenman, M. and Gonzalez, A. (2009). Core components of therapy in youth: do we know what to disseminate? Behavior Modification, 33, 2447. doi: 10.1177/0145445508322629
Weisz, J. R., Kuppens, S., Ng, M. Y., Eckshtain, D., Ugueto, A. M., Vaughn-Coaxum, R., … Fordwood, S. R. (2017). What five decades of research tells us about the effects of youth psychological therapy: a multilevel meta-analysis and implications for science and practice. American Psychologist, 72, 79117. doi: 10.1037/a0040360
Wolpert, M., Jacob, J., Napoleone, E., Whale, A., Calderon, A. and Edbrooke-Childs, J. (2017). Child- and Parent-Reported Outcomes and Experience from Child and Young People’s Mental Health Services 2011–2015. London: Child Outcomes Research Consortium (CORC). Retrieved from:


Type Description Title
Supplementary materials

Loucas et al. supplementary material
Loucas et al. supplementary material 1

 Word (75 KB)
75 KB


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Feasibility randomized controlled trial of a one-day CBT workshop (‘DISCOVER’) for 15- to 18-year-olds with anxiety and/or depression in clinic settings

  • Christina E. Loucas (a1), Irene Sclare (a2), Daniel Stahl (a3) and Daniel Michelson (a4)
Submit a response


No Comments have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *