In recent years, there has been tension between young people's need for specialty mental
health care (sGGZ) and the lack of sufficient available resources and staff. As a result,
waiting lists have increased. To increase the accessibility and efficiency of care,
online treatment through video calling is a promising method. Online treatment can help
reduce waiting lists, as there are no limitations in terms of physical space and
geographical proximity to clients and health care professionals, and it allows mental
health professionals to work more efficiently and reach more young people, as they have
no travel time and can plan flexibly from any location. An additional advantage of online
treatment is its low threshold. Young people with mental health problems often face
stigma and shame for physically going to a mental health facility. Online treatment via
video call can remove this barrier and allow young people to access the care they need
from their familiar surroundings.
It is plausible that fully online treatment with youth is at least as effective as
treatment in a physical location, regardless of cultural origin, gender, or social
environment, because youth are familiar with digital communication, the technical
application has now been sufficiently developed, and blended treatment has been assessed
as effective in research. However, it has not yet been sufficiently scientifically
studied whether fully online treatment via video calling in youth is actually a worthy
alternative to physical treatment in reducing mental health problems among youth.
This research project of GGZ Noord-Holland-Noord (GGZ-NHN), on which Drs. E. te Brake
will receive her doctorate, therefore focuses on the effectiveness of fully online
treatment within the youth sGGZ compared to regular treatment at a physical location.
This study explicitly includes a role for experts by experience who, from the perspective
of clients and relatives, contribute to the design and execution of the study and the
implementation of the results into treatment practice.
The proposed research includes a Randomized Controlled Trial (RCT), specifically focused
on two common therapies with adolescents in the sGGZ: Acceptance and Commitment Therapy
(ACT) and Eye Movement Desensitization and Reprocessing (EMDR). Cognitive behavior
therapy (CBT) could be an obvious choice because of its extensive knowledge and
experience, as well as available scientific evidence. But the investigators prefer the
more generalist ACT because CBT uses a separate protocol for each target group. As a
third-generation form of therapy, ACT is a suitable intervention because its universal
protocol is applicable to a broad target group. Moreover, ACT has been shown to be not
inferior to cognitive behavioral therapy in terms of effectiveness. The methodology shows
significant improvements in depressive symptoms, quality of life, and perception of
competence.
Treatment will be protocolized according to the guidelines prescribed by the manual for
this purpose. The protocol used is specifically intended for the target group aged 15-25.
However, it is known that adolescents between 12 and 15 can also benefit well from ACT.
Age-appropriate adjustments in language use will be applied here. In addition, EMDR will
be investigated for trauma-specific symptoms, as digital tools are available with EMDR
that allow for a good comparison with EMDR in a physical location.
Because an RCT generates reliable and generalizable information, and the investigators
examine two commonly used interventions in the mental health system, the study fits well
with policymakers' effectiveness-evidence criteria. If it turns out that fully online
treatment is a worthy alternative to treatment at a physical location, then this lays a
foundation for online work. It thus contributes to the low threshold, accessibility, and
affordability of youth mental health care.