The research aims to investigate the effectiveness of playback theatre program on improving mental health for adolescents and youth. This study adopts a multicentre randomized control trial two arms research design. A randomised controlled trial will compare a typical 7-session therapeutic song-writing program with a waitlist-control group to determine whether the 7-session playback theatre program can produce better outcomes for young people with depressive symptoms, including improvement in depressive symptoms, self-stigma, self-esteem, sense of hope and social support at post-intervention. The 7-session playback theatre program will be delivered by trained and experienced social workers and helping professionals who are familiar with music therapy. A research staff, who does not involve in the group allocation and delivery of group intervention, conduct the intervention outcomes assessment of the participants before and after the intervention. Standardized assessment tools are used to assess the intervention outcomes. The ethical considerations of this study were reviewed and approved by the Human and Artefacts Ethics Sub-Committee of the City University of Hong Kong in 2026.
Psychosocial interventions have been shown to be effective in improving the mental health of adolescents and youth. Among the different types of psychosocial interventions, playback theatre program has been shown to be effective in improving depression, anxiety and self-esteem. In a typical playback theatre, participants play the roles of a teller, the conductor, the actors and the audience. After a short introduction, the conductor asks the members of the audience to tell a moment or feeling from their lives. After the teller sharing the story, the actors immediately improvise a piece of theatre, in which they reflect back the story with empathy. Playback improvisation can have a powerful effect on the storyteller, the actors and the audience. Method Aim. The research aims to investigate the effectiveness of playback theatre program on improving mental health for adolescents and youth. Design. This research study adopts mixed methods research design, involving both quantitative and qualitative study. The quantitative study aims to investigate the effectiveness of the playback theatre program for adolescent and youth people with depressive symptoms. The qualitative study aims to examine the benefits, advantages and limitations of the playback theatre program from the users' perspective. The ethical considerations of this study were reviewed and approved by the Human and Artefacts Ethics Sub-Committee of the City University of Hong Kong in 2026. Quantitative Research Method Objective. This quantitative study aims to investigate the effectiveness of the playback theatre program for adolescents and youth with mental health issues. Hypotheses: After completing the playback theatre program, participants will show significantly greater improvement in depressive symptoms, anxiety symptoms, self-stigma, self-esteem and sense of hope at post-intervention. Research Design. This study is a multicentre randomised waiting list control study. Eligible participants will be recruited from local secondary schools and Salvation Army social service centres in different districts, through open recruitment via promotional activities and referrals from these centres. A total of 120 participants will be recruited over a study period of approximately 15 months. Using block randomisation, 120 eligible participants will be randomly allocated in a 1:1 ratio to an intervention group or a waitlist control group. 60 participants in the intervention group will receive a playback theatre program. 60 participants on the waiting list will not receive an intervention in the initial phase, but will receive the same playback theatre program at a later stage. 5 intervention groups and 5 waitlist control groups will be conducted, with each intervention group consisting of 12 participants. A research assistant, blinded to randomised allocation, will conduct pre- and post-intervention outcome assessment using standardised assessment tools. See Figure 1 for the flow of participants through each stage of the study. Intervention group. The playback theatre program consists 7 session. One session will be conducted per week, with each session lasting for about 90 minutes. A social worker and a helping professional who is familiar with music therapy will be recruited to run the playback theatre program at a collaborative social service centre and school. A standardized program manual is designed by the research team. The social worker and a counsellor who run the playback theatre program will receive training and supervision on conducting the playback theatre program by the research team. Data analysis. An analysis will be performed in accordance with the intent-to-treat principle using multiple imputation method analysis for any missing data. For all analyses, two-tailed p values of \< 0.05 is considered statistically significant. Data analyses will be performed using SPSS 29.0. Within group intervention effects are investigated using pair-sample t-test. Between group intervention effects are investigated using 2 (group) x 2 (time) repeated measures of one-way analysis of variance (ANOVA). Within and between group effect sizes are computed using Cohen's d, with values of 0.2, 0.5, and 0.8 considered as small, medium, and large respectively. Qualitative Research Method Objective. This qualitative study aims to explore the benefits, advantages and limitations of the playback theatre program from the users' perspective. Research Design. The qualitative study uses an interpretative interview method with purposive sampling. 5 focus groups will be conducted, with each focus group consisting of 2-4 participants selected from each intervention group. Data collection. Each focus groups will be facilitated by a research staff with an interview protocol developed for this study. Participants will be asked questions such as the following: "In what ways, if any, did the intervention group help you to improve your mental health such as depression and anxiety"; "In what ways, if any, did the intervention group help you to improve self-esteem and build up a sense of hope?"; "What are the advantages and limitations, if any, of the intervention group?"; "and "Any suggestions, if any, for improving the intervention group?". The results of the qualitative analysis will provide insights for further development and modifications of the playback theatre program. Data analysis. The content of focus groups will be audio-recorded and transcribed into verbatim by the research team. All transcripts of the focus groups will be coded. These codes will then be reviewed and grouped into broader categories and subcategories, resulting in themes and subthemes. Reflective thematic analysis will be used to identify, analyse and report themes so that themes can be developed both inductively (i.e. data-driven) and deductively (i.e. theory-driven). The research team will systematically read and re-read the transcripts, following the six stages of analysis, including: (1) becoming familiar with the data, (2) generating codes, (3) constructing themes, (4) reviewing potential themes, (5) defining and naming themes, and (6) producing the report.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
120
The playback theatre program consists of 7 sessions. One session will be conducted per week, with each session lasting for about 90 minutes. A social worker and a helping professional who is familiar with music therapy will be recruited to run the playback theatre program at a collaborative social service centre and school. A standardized program manual is designed by the research team. The social worker and a counsellor who run the playback theatre program will receive training and supervision on conducting the playback theatre program by the research team
Waitlist control group will receive will receive treatment as usual provided by the collaborative centres and schools, including recreational activities and interest classes, at the initial stage and will receive the same playback theatre program at a later stage
City University of Hong Kong
Kowloon Tong, Hong Kong, Hong Kong
RECRUITINGThe Chinese Depression Anxiety Stress Scale (DASS-Y)
The Chinese Depression Anxiety Stress Scale (DASS) DASS is a 21-item scale to assesses participants' self-reported depression, anxiety, and stress with good validity and reliability (Cronbach's α = 0.80 for the DASS Anxiety subscale, 0.83 for the DASS Depression subscale, 0.82 for the DASS Stress subscale, and 0.92 for the DASS total scale). Each item (e.g. I felt down-hearted and blue) is scored from 0 (did not apply to me at all) to 3 (applied to me very much or most of the time). The scores are summed over the items with higher scores indicating a higher severity of symptoms
Time frame: It will be used before and after the intervention (over 7-weeks)
The Chinese Internalised Stigma of Mental Illness (ISMI)
The Chinese Internalised Stigma of Mental Illness (ISMI) is a 10 -item self-reported scale to measure changes in self-stigma in four dimensions, i.e. shame/alienation (ISMI-SH), stereotype endorsement (ISMI-SE), perceived discrimination (ISMI-PD) and social withdrawal (IMIS-SW), with good validity and reliability (Cronbach's α = 0.93; 0.85; 0.75; 0.84 and for ISMI total scale, ISMI-SH, ISMI-SE, ISMI-PD, ISMI-SW). Each item (e.g. People discriminate against me because I have a mental illness) is rated with a score on a 4-point scale which ranges from "1" (strongly agree) to "4" (strongly disagree). Scores are averaged over the items with higher scores indicating greater self-stigma
Time frame: It will be used before and after the intervention (over 7-weeks)
The Chinese Rosenberg Self-Esteem Scale (RSES)
The Chinese Rosenberg Self-Esteem Scale (RSES) is a 10-item scale to assess participants' self-reported self-esteem in two dimensions, i.e. self-worth (RSES-SW) and self-depreciation (RSES-SD) with good validity and reliability (Cronbach's α = 0.63; 0.74, and 0.81 for RSES, RESE-SW, and RSES-SD). Each item (e.g. I feel that I have a number of good qualities) is rated on a 4-point scale with scores ranging from "1" (strongly agree) to "4" (strongly disagree). The scores are summed over the items with higher scores indicating better self-esteem.
Time frame: It will be used before and after the intervention (over 7-weeks)
The Chinese Hope Scale (HOPE)
The Chinese Hope Scale (HOPE) is a 12-item scale to assess participants' self-reported hope in two dimensions, i.e., agency (i.e., goal-directed energy) and pathways (i.e., planning to accomplish goals) with good validity and reliability (Cronbach's α = 0.81; 0.70 and 0.76 for the Hope total scale, agency subscale and pathway subscale). Each item (e.g. I can think of many ways to get out of a jam) is answered using an 8-point scale ranging from "1" (definitely false) to "4" (definitely true). The scores are summed over the items, so that higher scores indicate a higher level of hope.
Time frame: It will be used before and after the intervention (over 7-weeks)
The Chinese Multidimensional Scale of Perceived Social Support (MSPSS)
The Chinese Multidimensional Scale of Perceived Social Support (MSPSS) is a 12-item scale to assess participants' self-reported hope in three dimensions, i.e., family, friends, and significant others with good validity and reliability (Cronbach's α = 0.91, 0.77, 0.88, and 0.88 for the MSPSS total scale, family, friends, and significant others subscale). Each item (e.g. There is a special person with whom I can share joys and sorrows) is answered using an 7-point scale ranging from "1" (strongly disagree) to "7" (strongly agree). The scores are summed over the items, so that higher scores indicate greater social support
Time frame: It will be used before and after the intervention (over 7-weeks)
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