Cognitive Behavioural Therapy for Youths With Depressive and Anxiety Symptoms in Hong Kong

• Cognitive Behavioural Therapy (Behavioral): CBT is a well-established, evidence-based intervention frequently used for easing depressive and anxiety symptoms. The intervention will be delivered for 6-7 sessions, each session lasts for 1.5 hours, in the format of a group for a period of 6-7 weeks by frontline social or youth workers trained by professional CBT clinicians. Core treatment components include mood monitoring, emotion education, behavioural activation, emotion cycle/ ABC model, identification of automatic thoughts, and cognitive restructuring. It is designed to improve youths' abilities/ skills in handling their moods to have better emotional management.

Primary outcomes

• Change in depressive and anxiety levels [Baseline, after 7 weeks of intervention/wait, and 1 month after post-intervention]: Depression Anxiety Stress Scales (DASS), scores ranging from 0-42 for each subscale, with higher scores representing worse outcome
• Change in social anxiety levels [Baseline, after 7 weeks of intervention/wait, and 1 month after post-intervention]: Social Interaction Anxiety Scale (SIAS), scores ranging from 0-80 with higher scores representing higher levels of social anxiety hence worse outcome
• Change in depressive levels [Baseline, after 7 weeks of intervention/wait, and 1 month after post-intervention]: Patient Health Questionnaire-9 (PHQ-9), scores ranging from 0-27 with higher scores representing higher depressive levels hence worse outcome
• Change in distress levels [Baseline, after 7 weeks of intervention/wait, and 1 month after post-intervention]: Kessler Psychological Distress Scale (K6), scores ranging from 0-25 with higher scores representing higher distress hence worse outcome
• Change in depressive symptoms [Baseline, after 7 weeks of intervention/wait, and 1 month after post-intervention]: Beck Depression Inventory II (BDI-II), scores ranging from 0-63 with higher scores representing severe depressive symptoms hence worse outcome
• Change in anxiety symptoms [Baseline, after 7 weeks of intervention/wait, and 1 month after post-intervention]: Beck Anxiety Inventory (BAI), scores ranging from 0-36 with higher scores representing severe anxiety symptoms hence worse outcome
• Change in anxiety levels [Baseline, after 7 weeks of intervention/wait, and 1 month after post-intervention]: Generalized Anxiety Stress Scale-7 (GAD-7), scores ranging from 0-21 with higher scores representing higher anxiety levels hence worse outcome

Secondary outcomes

• Change in functioning [Baseline, after 7 weeks of intervention/wait, and 1 month after post-intervention]: Role Functioning Scale (RFS), scores ranging from 1-28 with higher scores representing better functioning
• Change in social and occupational functioning [Baseline, after 7 weeks of intervention/wait, and 1 month after post-intervention]: Social and Occupational Functioning Assessment Scale (SOFAS), scores ranging from 0-100 with higher scores representing better functioning
• Change in quality of life [Baseline, after 7 weeks of intervention/wait, and 1 month after post-intervention]: 12-item Short Form Survey (SF-12), scores ranging from 0-100 with higher scores representing better quality of life
• Change in self-harm [Baseline, after 7 weeks of intervention/wait, and 1 month after post-intervention]: Self-harming behaviour, plans and thoughts, recording as binary response (0=No, 1=Yes)
• Change in resilience [Baseline, after 7 weeks of intervention/wait, and 1 month after post-intervention]: Connor-Davidson Resilience Scale (CD-RISC), scores ranging from 0-100 with higher scores indicating higher resilience
• Change in future outlook [Baseline, after 7 weeks of intervention/wait, and 1 month after post-intervention]: Future Outlook Inventory (FOI), scores ranging from 1-70 with higher scores indicating greater degree of future consideration
• Change in self-esteem [Baseline, after 7 weeks of intervention/wait, and 1 month after post-intervention]: Rosenberg Self Esteem Scale (RSE), scores ranging from 0-30 with higher scores indicating higher self-esteem
• Change in mindfulness [Baseline, after 7 weeks of intervention/wait, and 1 month after post-intervention]: Mindful Attention Awareness Scale (MAAS), scores ranging from 1-6 with higher scores indicating higher mindful awareness

Sex: All, ages: 12 Years to 24 Years, accepts healthy volunteers

Inclusion Criteria:

* LevelMind@JC users with mild to moderate distress level (n=120);
* have sufficient proficiency in Chinese to understand verbal instructions and give informed consent;

Exclusion Criteria:

* known diagnosis of intellectual disability
* organic brain disorder
* photosensitive epilepsy
* significant visual, auditory or balance impairment
* current or previous use of illicit drugs
* known psychiatric diagnosis (stabilized diagnosis and treatment)
* receiving any psychosocial treatment for social withdrawal such as CBT or;
* current or active suicidal ideation or attempts.