Automated Text Messaging as an Adjunct to Cognitive Behavioral Therapy for Depression: A Clinical Trial

Abstract

BackgroundCognitive Behavioral Therapy (CBT) for depression is efficacious, but effectiveness is limited when implemented in low-income settings due to engagement difficulties including nonadherence with skill-building homework and early discontinuation of treatment. Automated messaging can be used in clinical settings to increase dosage of depression treatment and encourage sustained engagement with psychotherapy.ObjectivesThe aim of this study was to test whether a text messaging adjunct (mood monitoring text messages, treatment-related text messages, and a clinician dashboard to display patient data) increases engagement and improves clinical outcomes in a group CBT treatment for depression. Specifically, we aim to assess whether the text messaging adjunct led to an increase in group therapy sessions attended, an increase in duration of therapy attended, and reductions in Patient Health Questionnaire-9 item (PHQ-9) symptoms compared with the control condition of standard group CBT in a sample of low-income Spanish speaking Latino patients.MethodsPatients in an outpatient behavioral health clinic were assigned to standard group CBT for depression (control condition; n=40) or the same treatment with the addition of a text messaging adjunct (n=45). The adjunct consisted of a daily mood monitoring message, a daily message reiterating the theme of that week’s content, and medication and appointment reminders. Mood data and qualitative responses were sent to a Web-based platform (HealthySMS) for review by the therapist and displayed in session as a tool for teaching CBT skills.ResultsIntent-to-treat analyses on therapy attendance during 16 sessions of weekly therapy found that patients assigned to the text messaging adjunct stayed in therapy significantly longer (median of 13.5 weeks before dropping out) than patients assigned to the control condition (median of 3 weeks before dropping out; Wilcoxon-Mann-Whitney z=−2.21, P=.03). Patients assigned to the text messaging adjunct also generally attended more sessions (median=6 sessions) during this period than patients assigned to the control condition (median =2.5 sessions), but the effect was not significant (Wilcoxon-Mann-Whitney z=−1.65, P=.10). Both patients assigned to the text messaging adjunct (B=−.29, 95% CI −0.38 to −0.19, z=−5.80, P<.001) and patients assigned to the control conditions (B=−.20, 95% CI −0.32 to −0.07, z=−3.12, P=.002) experienced significant decreases in depressive symptom severity over the course of treatment; however, the conditions did not significantly differ in their degree of symptom reduction.ConclusionsThis study provides support for automated text messaging as a tool to sustain engagement in CBT for depression over time. There were no differences in depression outcomes between conditions, but this may be influenced by low follow-up rates of patients who dropped out of treatment.

Therapist-related feasibility of blended group therapy (bGT): Mixed methods study of a brief online- and mobile-supported group intervention for major depression (Preprint)

“…The feasibility of bGT has been investigated several times for anxiety disorders and depression [35][36][37][38][39][40][41][42].…”

“…Firstly, this article adds a first therapist-oriented perspective to previous findings on bGT [37][38][39][40][41][42]. Secondly, it applies a multimodal research strategy (e.g.…”

“…For example, a tablet-guided behavioural activation intervention was found to be feasible for the treatment of major depressive disorder [38]. In another study, Aguilera and colleagues found beneficial effects of group therapy augmented with monitoring and text messaging [39].…”

Design and acceptability of a psychosocial text messaging intervention for victims of gender-based violence

“…We also based our messaging on previous experience of research with Spanish speakers suffering from depression. 4 To build an environment of trust and to answer any questions or concerns from participants, we had direct telephone contact with each woman at the beginning of the investigation, after 14 days and at the end. We dedicated an average of 15 minutes of direct telephone contact with each woman (5 minutes for each contact).…”

“…Mobile phones can collect objective data for psychological and social studies but they need to be understood as a work tool for the therapist. 2,3 Several researchers have conducted experimental studies on cognitive-behavioural therapies (CBT) by sending text messages to mobile phones in various patient populations [4][5][6][7][8][9][10][11] but not specifically with female victims of gender violence. This group has a high need for mental health interventions and could benefit from these technologies.…”