title: Comparing counselling alone versus counselling supplemented with guided use of a well-being app for university students experiencing anxiety or depression (CASELOAD): protocol for a feasibility trial.
abstract: BACKGROUND
  University counselling services face a unique challenge to offer short-term therapeutic support to students presenting with complex mental health needs and in a setting which suits the academic timetable. The recent availability of mobile phone applications (apps) offers an opportunity to supplement face-to-face therapy and has the potential to reach a wider audience, maintain engagement between therapy sessions, and enhance therapeutic outcomes. The present study, entitled Counselling plus Apps for Students Experiencing Levels of Anxiety or Depression (CASELOAD), aims to explore the feasibility of supplementing counselling with guided use of a well-being app.
  
  
  METHODS
  Forty help-seeking university students (aged 18 years and over) with symptoms of moderate anxiety or depression will be recruited from a University Counselling Service (UCS) in the United Kingdom (UK). Participants will be recruited via counsellors who provide the initial clinical assessment and who determine treatment allocation to one of two treatments on the basis of client-treatment fit. The two conditions comprise (1) counselling alone (treatment as usual/TAU) or (2) counselling supplemented with guided use of a well-being app (enhanced intervention). Trained counsellors will deliver up to six counselling sessions in each treatment arm across a 6-month period, and the session frequency will be decided by client-counsellor discussion. Assessments will occur at baseline, every counselling session, post-intervention (3 months after consent) and follow-up (6 months after consent). Assessments will include clinical measures of anxiety, depression, psychological functioning, specific mental health concerns (e.g. academic distress and substance misuse), resilience and therapeutic alliance. The usage, acceptability, feasibility and potential implications of combining counselling with guided use of the well-being app will be assessed through audio recordings of counselling sessions, telephone interviews with participants, focus groups with counsellors and counsellor notes.
  
  
  CONCLUSIONS
  This study will inform the design of a randomised pilot trial a﻿nd﻿ a definitive trial which aim to improve therapy engagement, reduce dropout and enhance clinical outcomes of student counselling.
  
  
  BACKGROUND
  ISRCTN55102899.
authors.affiliation: Department of Psychology, University of Sheffield, Sheffield, S10 2TN UK.
authors.forename: Emma
authors.identifier: 0000-0003-2137-8187
authors.initials: E
authors.lastname: Broglia
authors.affiliation: Department of Psychology, University of Sheffield, Sheffield, S10 2TN UK.
authors.forename: Abigail
authors.initials: A
authors.lastname: Millings
authors.affiliation: Department of Psychology, University of Sheffield, Sheffield, S10 2TN UK.|Centre for Psychological Services Research, Department of Psychology, University of Sheffield, Sheffield, S10 2TN UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Barkham
keywords: Acceptability; Anxiety; Augmented therapy; Behaviour monitoring; Counselling; Depression; Feasibility; Student mental health; Well-being app