TreadWill: Development and pragmatic randomized controlled trial of an unguided, computerized cognitive behavioral therapy intervention in a lower middle-income country

Abstract

Most individuals vulnerable to depression do not receive adequate or timely treatment globally. Unguided computerized cognitive behavioral therapy (cCBT) has the potential to bridge this treatment gap. However, the real-world effectiveness of unguided cCBT interventions, particularly in low- and middle-income countries (LMICs), remains inconclusive. In this study, we report the design and development of a new unguided cCBT intervention, TreadWill, and its pragmatic evaluation. TreadWill was designed to be fully automated, engaging, easy to use, and accessible in LMICs. To evaluate its effectiveness and engagement level, we performed a double-blind, fully-remote, randomized controlled trial with 598 participants in India. The use of TreadWill significantly reduced depression-related and anxiety-related symptoms. Compared with a plain-text version with the same therapeutic content, the full-featured version of TreadWill showed significantly higher engagement. Overall, our study provides a new resource and evidence for the use of unguided cCBT as a scalable intervention in LMICs.

Design of serious games based on cognitive bias modification and learned helplessness paradigms for treatment of depression.

“…Considering the higher penetration of smartphones than computers or tablets, we presented images in 2x1, 2x2, or 3x2 grids to ensure that the images and emotions can be seen easily. A primitive version of this game was present in an earlier version of TreadWill (Ghosh et al, 2021); the updated game described here has a more polished design (e.g., better layout, in-game progress indicator), improved gameplay (e.g., music, adaptive difficulty level), and more sophisticated game elements (e.g., badges, ability to buy extra time).…”

“…The serious games we have developed have been included in a software-based intervention, TreadWill (Ghosh et al, 2021), to make it a multimodal intervention for the treatment of depressive symptoms. The designs we have provided can also be adapted into other interventions for many other disorders where cognitive biases are involved (MacLeod, 2012).…”