Evaluating the Feasibility of Limbix Spark: a Cognitive Behavioral Therapy Based Mobile and Virtual Reality Intervention for Adolescent Depression

Depression, the most common mental health disorder among adolescents, is a major public health concern with significant personal, societal, and economic burdens, particularly as incidence rates are increasing. Effective care for adolescent depression is limited due to lack of access to care, increasingly long waitlists, stigma surrounding mental health, and ineffectiveness of pharmaceutical options. There is an urgent need for accessible, cost-effective, and evidence-based treatment options for adolescents with depression.

The development of effective digital health programs for adolescents is a key strategy to reduce the personal, familiar and societal burden of depression. Such programs provide an innovative way to deliver resources in a cost-effective, accessible fashion. Cognitive-behavioral therapy (CBT) is effective in the prevention and treatment of depression in children and adolescents. Digital forms of CBT have also been shown to be efficacious in the treatment of anxiety and depressive symptoms in youth, however. adherence to such programs in clinical trials and particularly in real world evidence evaluations is low. Virtual reality (VR) holds promise as a way to enhance adherence to and the efficacy of digital CBT for depression.

To address the need for effective, accessible, and engaging treatments for adolescent depression, the objective of this project is to evaluate the feasibility, acceptability, and preliminary evidence of efficacy of Limbix Spark: a 5 week CBT-based mobile + VR self-guided program. Limbix Spark is specifically designed to implement behavioral activation, a CBT skill, which involves completing self-monitored activities that provide a sense of pleasure or mastery in order to reduce depressive symptoms and improve functional outcomes. VR allows adolescents to complete such activities in virtual environments as a potential stepping stone to engaging in similar experiences in the real world.

30 participants aged 12-21 years old with mild to severe depressive symptoms and with smart phone access will be enrolled. During a baseline visit, participants or participants' legal guardians, will be asked to provide written informed consent and potential participants under 18 will be asked to provide written assent after study procedures are explained and any questions are answered by study staff in accordance with good clinical practice (GCP) and human subjects research guidelines.

After consent, all eligible participants will be assigned to complete the 5-week Limbix Spark program. Participants and their legal guardian if under 18 will first complete baseline assessments, including the Patient Health Questionnaire (PHQ-8) Generalized Anxiety Disorder scale (GAD-7), the Positive and Negative Affective Schedule (PANAS-C), the Behavioral Activation for Depression Scale-Short Form (BADS-SF), 20-item Short Form Survey (SF-20), Mood and Feelings Questionnaire Short Parent version (MFQ-PS). Participants will then receive VR equipment, and receive an initial orientation to the Limbix Spark program. Program orientation will include training on how to set up and use the VR headset and how to download and use the mobile app.