Use of a Fully Automated Internet-Based Cognitive Behavior Therapy Intervention in a Community Population of Adults With Depression Symptoms: Randomized Controlled Trial.

Mark B Schure,William L Bryan,Paul A Nakonezny,Matthew J Byerly,John H Greist,Janet C Lindow,Sandra J Bailey

doi:10.2196/14754

Abstract

BackgroundAlthough internet-based cognitive behavior therapy (iCBT) interventions can reduce depression symptoms, large differences in their effectiveness exist.ObjectiveThe aim of this study was to evaluate the effectiveness of an iCBT intervention called Thrive, which was designed to enhance engagement when delivered as a fully automated, stand-alone intervention to a rural community population of adults with depression symptoms.MethodsUsing no diagnostic or treatment exclusions, 343 adults with depression symptoms were recruited from communities using an open-access website and randomized 1:1 to the Thrive intervention group or the control group. Using self-reports, participants were evaluated at baseline and 4 and 8 weeks for the primary outcome of depression symptom severity and secondary outcome measures of anxiety symptoms, work and social adjustment, psychological resilience, and suicidal ideation.ResultsOver the 8-week follow-up period, the intervention group (n=181) had significantly lower depression symptom severity than the control group (n=162; P<.001), with a moderate treatment effect size (d=0.63). Moderate to near-moderate effect sizes favoring the intervention group were observed for anxiety symptoms (P<.001; d=0.47), work/social functioning (P<.001; d=0.39), and resilience (P<.001; d=0.55). Although not significant, the intervention group was 45% less likely than the control group to experience increased suicidal ideation (odds ratio 0.55).ConclusionsThese findings suggest that the Thrive intervention was effective in reducing depression and anxiety symptom severity and improving functioning and resilience among a mostly rural community population of US adults. The effect sizes associated with Thrive were generally larger than those of other iCBT interventions delivered as a fully automated, stand-alone intervention.Trial RegistrationClinicalTrials.gov NCT03244878; https://clinicaltrials.gov/ct2/show/NCT03244878

Highlights

Depression is the leading cause of disability globally [1] and is associated with impaired function [2], higher morbidity and mortality [3,4], greater health care use [5], and higher risk of suicide [6]
These findings suggest that the Thrive intervention was effective in reducing depression and anxiety symptom severity and improving functioning and resilience among a mostly rural community population of US adults
The effect sizes associated with Thrive were generally larger than those of other internet-based cognitive behavior therapy (iCBT) interventions delivered as a fully automated, stand-alone intervention

Summary

Introduction

Depression is the leading cause of disability globally [1] and is associated with impaired function [2], higher morbidity and mortality [3,4], greater health care use [5], and higher risk of suicide [6]. Cognitive behavior therapy (CBT), when delivered by clinicians, is an evidence-based psychotherapy for treating acute depression symptoms that reduces relapse risk [7,8,9]. For the approximately 46 million Americans living in rural regions [11], access to adequate mental health care is often limited or nonexistent [12]. In Montana (the focus of this study), 65.0% of residents live in rural regions [13]; the state has a higher prevalence of depression than the national average and has had one of the highest suicide rates in the United States over the past four decades [14,15]. Internet-based cognitive behavior therapy (iCBT) interventions can reduce depression symptoms, large differences in their effectiveness exist

Methods

Results

Discussion

Conclusion