The initial design and programme theory for a new work-focused psychotherapeutic intervention to treat moderate-severe recurrent depression and enhance job retention

Purpose: Here we report a case study of the initial design and programme theory of an interdisciplinary Work-focused Relational Group CBT Treatment Programme for moderate-severe depression using realist methods.

Design/methodology: Our case study shows how we (i) designed the intervention using component analysis of existing literature and focus groups of frontline practitioners and former service users and mind-mapping analysis to establish its operational logic; and (ii) evaluated the theory underpinning the intervention using realist synthesis and evaluation to establish its conceptual logic.

Findings: An iterative hybrid approach of literature review, component analysis, focus group discussion, and realist methods established the initial design and programme theory for the new intervention. The intervention focused on three areas of therapy, three inter-dependent outcomes, in a group format, with opportunities created for peer interaction. The main theoretical principles most likely to promote efficacy were to accelerate and optimise activation of one or more of six hypothesised mechanisms: realise, reflect, regulate, resolve, relate, and retain/resume in the context of skilfully facilitated group psychotherapy.

Social Implications: This study outlines a methodological approach based on the layered ontology of critical realist philosophy, applied to a successful example, which will be useful during the early stages of design and development of new group-based psychotherapeutic interventions.

Originality: By adopting the critical realist approach, we identified underlying mechanisms of change in relational group CBT. The theoretically integrated approach involving service-users and practitioners from different professional backgrounds was unique and meant that the treatment programme was multi-modal rather than informed by a single therapeutic or theoretical approach.