Behavioural activation versus mindfulness-based guided self-help treatment administered through a smartphone application: a randomised controlled trial

Abstract

ObjectivesEvaluating and comparing the effectiveness of two smartphone-delivered treatments: one based on behavioural activation (BA) and other on mindfulness.DesignParallel randomised controlled, open, trial. Participants were allocated using an online randomisation tool, handled by an independent person who was separate from the staff conducting the study.SettingGeneral community, with recruitment nationally through mass media and advertisements.Participants40 participants diagnosed with major depressive disorder received a BA treatment, and 41 participants received a mindfulness treatment. 9 participants were lost at the post-treatment.InterventionBA: An 8-week long behaviour programme administered via a smartphone application. Mindfulness: An 8-week long mindfulness programme, administered via a smartphone application.Main outcome measuresThe Beck Depression Inventory-II (BDI-II) and the nine-item Patient Health Questionnaire Depression Scale (PHQ-9).Results81 participants were randomised (mean age 36.0 years (SD=10.8)) and analysed. Results showed no significant interaction effects of group and time on any of the outcome measures either from pretreatment to post-treatment or from pretreatment to the 6-month follow-up. Subgroup analyses showed that the BA treatment was more effective than the mindfulness treatment among participants with higher initial severity of depression from pretreatment to the 6-month follow-up (PHQ-9: F (1, 362.1)=5.2, p<0.05). In contrast, the mindfulness treatment worked better than the BA treatment among participants with lower initial severity from pretreatment to the 6-month follow-up (PHQ-9: F (1, 69.3)=7.7, p<0.01); BDI-II: (F(1, 53.60)=6.25, p<0.05).ConclusionsThe two interventions did not differ significantly from one another. For participants with higher severity of depression, the treatment based on BA was superior to the treatment based on mindfulness. For participants with lower initial severity, the treatment based on mindfulness worked significantly better than the treatment based on BA.Trial registrationClinical Trials NCT01463020.

The Efficacy and Acceptability of Third-Wave Behavioral and Cognitive eHealth Treatments: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Carlbring et al (2013) and Kivi et al (2014) tested an 8-week guided Internet-delivered intervention combining components of behavioral activation and ACT. One study evaluated an 8-week guided MBCT program administered via smartphone application (Ly et al, 2014), while another examined an unguided Internetdelivered MBCT intervention (Dowd et al, 2015). An off-line computer-based CBASP treatment was tested by Braithwaite and Fincham (2007) and Cukrowicz and Joiner (2007).…”

“…Participants rated the treatments as satisfactory (Trompetter et al, 2015;Lappalainen et al, 2014Lappalainen et al, , 2015, enjoyable (Glick & Orsillo, 2015), useful (Kristjánsdóttir et al, 2013), and helpful (Cukrowicz & Joiner, 2007), as measured by the Client Satisfaction Questionnaire (Attkisson & Zwick, 1982), visual analogue scales, and brief questionnaires, respectively. Four studies administered the Credibility/Expectancy Questionnaire (Borkovec & Nau, 1972;Devilly & Borkovec, 2000) and ratings indicated that participants perceived the third-wave eHealth treatments as credible (Kelly & Carter, 2015;Ljótsson et al, 2010;Ly et al, 2014). Participants rated the Internet-delivered intervention administered by Levin, Pistorello, Seeley, and Hayes (2014) within the top 10% of scores on the System Usability Scale (Tullis & Albert, 2008).…”

Ecological momentary interventions for depression and anxiety

“…In this section, we review evidence on the efficacy of such treatments and key findings that highlight open questions in their use. EMIs intended to reduce depression do so through interventions aimed at various proximal outcomes such as engagement in pleasurable activities (Ly et al, 2014), increasing positive emotions (Tugade & du Pont, 2014), or other pathways. EMIs for depression have also made use of diverse conceptual treatment strategies including acceptance and commitment therapy (Ahtinen et al, 2013;Lappalainen et al, 2013;Ly, Dahl, Carlbring, & Andersson, 2012) and interpersonal therapy (Dagoo et al, 2014), but the majority have been cognitive-behavioral in focus including cognitive-behavioral therapy (CBT), behavioral activation (Burns et al, 2011), relaxation (Grassi, Preziosa, Villani, & Riva, 2007), and self-monitoring (Agyapong, Ahern, McLoughlin, & Farren, 2012).…”

Digital Characteristics and Dissemination Indicators to Optimize Delivery of Internet-Supported Mindfulness-Based Interventions for People With a Chronic Condition: Systematic Review (Preprint)

“…The overall mean age of participants was 45 years (mean age range: 36 -57.6 years). Three studies comprised active comparison groups, including the same MBI delivered in person [41], a web-based behavioural activation condition [44], and a progressive muscle relaxation program [48]. Control conditions were attention control (n=1) [42], online discussion forum (n=2) [43,49], psychoeducational (n=1) [47], wait-list (n=2) [41,45] or usual care (n=2) [36,46].…”

“…a primary outcome was feasibility, but sample size was calculated with adequate power to reducing mood disturbance (secondary outcome) OCD = Obsessive compulsive disorder; QE = Quasi-Experimental, QoL = Quality of Life; FU = follow up Studies were published from 2008 and conducted in Sweden (n=3); [43,44,49], Canada (n=2); [41,45], the United States (n=2) [42,46], the Netherlands (n=1); [36], Ireland (n=1); [47] and Germany (n=1); [48]. Eight studies were RCTs [36,[42][43][44][45][47][48][49], and two were quasi experimental design [41,46]. Most studies involved female participants with an overall mean of 74.8%, ranging between 46.3% [36] and 98% [42].…”