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Published on: November 21, 2025
Consensus on components of psychological treatment for depression to reduce symptoms and target relapse risk factors
Gabrielle Grey1, Roz Shafran2, Cecily Brem1
1Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
Background:
Depression is increasingly prevalent in young adults and relapse is common. This study aimed to obtain consensus on Cognitive Behavioural Therapy (CBT)-based treatment components considered important by experts for reducing symptoms and targeting relapse risk factors in young adults (18-25 years).
Methods:
We conducted a modified-Delphi study of three survey rounds, two panels and a consensus meeting. Academics/clinicians (n = 46) and young adult experts-by-experience (n = 24) rated treatment components, therapist competencies, relapse risk factors and interventions, content of relapse-prevention sessions, and post-treatment relapse-prevention strategies. Items were rated on 1-9 Likert scales. "Consensus-important" was defined as ≥70% of either panel rating the item 7-9 and ≤15% rating 1-3.
Results:
Behavioural experiments were the highest-rated CBT component in both panels, though the target differed. The Academic/Clinician panel rated experiments targeting negative automatic thoughts highest (97%, n = 30) while the Young Adult panel rated those targeting rumination highest (71%, n = 24). Social isolation/loneliness, stress in relationships and cognitive biases were the top-rated relapse risk factors pooled across both panels. Identifying and challenging negative automatic thoughts, problem solving and behavioural activation often reached consensus as important to target relapse risk factors. Consensus was reached on the content of relapse prevention session(s) with identifying triggers rated most highly by both panels.
Conclusions:
The findings identify stakeholder-endorsed candidate treatment components for co-design and prospective evaluation of feasibility, effectiveness and relapse risk reduction. A modular approach may be beneficial, including core CBT components and modules targeting relapse risk factors such as social isolation/loneliness, interpersonal stress, cognitive biases, sleep and rumination.
Registration:
Open Science Framework (https://osf.io/gu7tm; DOI 10.17605/OSF.IO/GU7TM).
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