Randomized Controlled Trial of Computerized Cognitive Behavioral Therapy Program for Adolescent Offenders with Depression

Main Article Content

Saranya Wannachaiyakul
Darawan Thapinta
Hunsa Sethabouppha
Petsunee Thungjaroenkul
Surinporn Likhitsathian


                  Depression affects the lives of young offenders and requires treatment. However, too few therapists, high service costs, and stigma are barriers preventing them from accessing mental health services in many countries. Although, computer-assisted psychotherapy has been proven a revolutionary intervention for reducing depression and enhancing accessibility, it has not been used for depressed youths with delinquency problems both in Thailand and abroad.  This randomized control trial investigated the effectiveness of the Computerized Cognitive Behavioral Therapy program for reducing depression among youths with delinquency problems. The youths in a juvenile vocational training center in northern Thailand who met the inclusion criteria were randomly assigned into an experimental group receiving the program in addition to usual activities, while the control group received only the usual activities (n=42 per group). Depression was measured using the Thai Patient Health Questionnaire before the program started, then 1 and 2 months after the intervention. Repeated measure ANOVA, and independent t-test were used to test the program efficacy. Results revealed that participants in the experimental group after entering the program, and 1 and 2 months after the intervention had significantly lower mean scores of depression than before receiving the program. Additionally, they had a significantly lower mean score of depression than that of the control group immediately after completing the program. The findings indicated that the CCBT program can reduce depression among youths with delinquency problems. Nurses should integrate this program as a depression intervention for youths in this group. However, further study is needed for examining the sustainability of the long term impacts of the program in reducing depression.

Article Details

How to Cite
Wannachaiyakul S, Thapinta D, Sethabouppha H, Thungjaroenkul P, Likhitsathian S. Randomized Controlled Trial of Computerized Cognitive Behavioral Therapy Program for Adolescent Offenders with Depression. PRIJNR [Internet]. 2017 Feb. 28 [cited 2022 May 19];21(1):32-43. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/62508
Original paper


1.Vincent GM. Screening and assessment in juvenile justice systems: identifying mental health needs and risk of reoffending. Washington, DC: Technical Assistance Partnership for Child and Family Mental Health, Department of Psychiatry University of Massachusetts Medical School; 2012.

2. Chiang Mai Observation and Protection Center. The report of depressive assessment among juvenile offenders in Chiang Mai Observation and Protection Center. Chiang Mai Observation and Protection Center: Chiang Mai; 2012.

3. Underwood LA, Washington A. Mental Illness and Juvenile Offenders. International Journal of Environmental Research and Public Health. 2016; 13(2): 1-14.

4. Nasir R, Zainah AZ, Khairudin R, Wan Shahrazad WS, Nen S, Subhi N. Cognitive Distortion as a predictor towards depression among delinquent adolescents. Pertanika Journal of Social Sciences & Humanities. 2011; 19(5):75-82.

5. Nasir R, Zamani ZA, YusooffF, Khairudin R. Cognitive distortion and depression among juvenile delinquents in Malaysia. Procedia Social and Behavioral Sciences. 2010; 5: 272-276.

6. Ngamsri M, Takviriyanun N, Chaopricha S. The effect of a cognitive behavior therapy program on depression among adolescents in one juvenile training center in the North East of Thailand. Nursing Journal. 2014; 41(4): 36-47.

7. Beck JS. Cognitive behavior therapy: basics and beyond 2 nd ed. New York: Guilford Press; 2011.

8. Spielvogle HN. Understanding and addressing barriers: engaging adolescents in mental health services [Ph.D Thesis]. Toronto, Ontario: University of Toronto; 2011.

9. Kayrouz R, Dear BF, Johnston L, Gandy M, Fogliati VJ, Sheehan J, et al. A feasibility open trial of guided Internetdelivered cognitive behavioural therapy for anxiety and depression amongst Arab Australians. Internet Interventions. 2015; 2(1): 32-38.

10. Simon G, EliZabeth L, Catherine H, Gwen B, Puvan T, Ricardo A, et al. Computerised cognitive behaviour therapy (cCBT) as treatment for depression in primary care (REEACT trial): large scale pragmatic randomised controlled trial. British Medical Journal . 2015; 351:1-13.

11. Kaltenthaler E, Cavanagh K. Computerized cognitive behavioral therapy and its uses. Progress in Neurology and Psychiatry. 2010; 14(3): 22-29.

12. Foroushani PS, Schneider J, & Assareh N. Meta-review of the effectiveness of computerized CBT in treating depression. BMC Psychiatry. 2011; 11(131): 1-6.

13. Richardson T, Stallard P, Velleman S. Computerised cognitive behavioural therapy for the prevention and treatment of depression and anxiety in children and adolescents: a systematic review. Clinical Child and Family Psychology Review. 2010; 13(3): 275-290.

14. Ebert DD, Zarski A-C, Christensen H, Stikkelbroek Y, Cuijpers P, Berking M., et al. Internet and computer-based cognitive behavioral therapy for anxiety and depression in youth: a meta-analysis of randomized controlled outcome trials. PLoS ONE. 2015; 10(3): e0119895.

15. Cuijpers P, Hollon SD, van Straten A, et al. Does cognitive behaviour therapy have an enduring effect that is superior to keeping patients on continuation pharmacotherapy?: a meta-analysis. BMJ Open 2013; 3:e002542.

16. Foroushani PS, Schneider J, Assareh N. Meta-review of the effectiveness of computerized CBT in treating depression. BMC Psychiatry. 2011; 11(131): 1-6.

17. Burns N, Grove SK. The practice of nursing research: conduct, critique and utilization. 4th ed. Philadelphia: W. B. Saunders Company; 2001. 840p.

18. Polit DF, Hungler BP. Nursing research: principles and methods. 6th ed. New York: Lippincott Williams & Wilkins; 1999.757p.

19. Kaltenthaler E, Parry G, Beverley C, Ferriter M. Computerized cognitive behavioral therapy for depression: systematic review. British Journal of Psychiatry. 2008; 193(3): 181-184.

20. Lotrakul M, Sumrithe S, Saipanish R. Reliability and validity of the Thai version of the PHQ-9. BMC Psychiatry. 2008; 8(46): 1-7.

21. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine. 2001; 16(9): 606-613.

22. Seels B, Glasgow Z. Making instructional design decisions. 2nd ed. Upper Saddle River, NJ: Merrill; 1998. 180p.

23. Beck AT. Depression: clinical, experimental and theoretical aspects. New York: Harper Row; 1967. 370p.

24. Rhodes H. Grant S. A review of computerised cognitive behavioural therapy (cCBT) for depression. Cumbria Partnership Journalof Research Practice and Learning. 2012; 2(1): 2-9.

25. Vallury KD, Jones M, Oosterbroek C. Computerized Cognitive Behavior Therapy for Anxiety and Depression in Rural Areas: a systematic review. Journal of Medical Internet Research. 2015;17(6):e139.

26. Stallard P, Richardson T, Velleman S, Attwood M. Computerized CBT (Think, Feel, Do) for depression and anxiety in children and adolescents: outcomes and feedback from a pilot randomized controlled trial. Behavioural and Cognitive Psychotherapy. 2011; 39: 273-284.

27. Gega L, Swift L, Barton G, Todd G, Reeve N, Bird K, et al. Computerised therapy for depression with clinician vs. assistant and brief vs. extended phone support: study protocol for a randomised controlled trial. Trials. 2012;13(151): 1-11.

28. Australian Bureau of Statistics. In fact - statistical information on the act and region, No.1308.8. 2010. [cited April 2013]. Available from https://www.abs.gov.au/ ausstats/ abs@.nsf/0/E148C4EFA043D699CA2577EE000C8 884?opendocument

29. Driessen E, Hollon SD. Cognitive behavioral therapy for mood disorders: efficacy, moderators and mediators. The Psychiatric Clinics of North America. 2010; 33(3): 537-555.

30. Gearing RE, Schwalbe CSJ, Lee H, Hoagwood KE. The effectiveness of booster sessions in CBT treatment for child and adolescent mood and anxiety disorders. Depression and Anxiety. 2013; 30(9):800-808.

31. Lyubomirsky S, Layous K. How do simple positive activities increase well-being?. Psychological Science. 2013; 22(1): 57–62.

32. Layous K, Chancellor J, Lyubomirsky S, Wang L, Doraiswamy PM. Delivering happiness: translating positive psychology intervention research for treating major and minor depressive disorders. The Journal of Alternative and Complementary Medicine. 2011; 17(8): 1-9.

Most read articles by the same author(s)

1 2 > >>