Treating Young Adult Depression With Text-Delivered Cognitive Behavioral Therapy: A Pilot Randomized Clinical Trial

Mason, Michael; Coatsworth, J. Douglas; Zaharakis, Nikola; Russell, Michael A.; Wallis, Dorothy; Brown, Aaron; Hale, Christopher

doi:10.1016/j.beth.2022.09.005

Cited by 2 publications

(13 citation statements)

References 31 publications

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“…We expanded our initial 4-week CBT-txt treatment [ 9 ] into an 8-week intervention. CBT-txt intervention content is guided by CBT core mechanisms [ 13 ] and is sequenced using the in-person treatment manual of Muñoz et al [ 20 ].…”

Section: Methodsmentioning

confidence: 99%

“…We followed previous successful research in developing text-delivered interventions derived from in-person treatments [ 9 , 27 - 29 ]. The following four steps were used to ensure that the core mechanisms of CBT were incorporated into CBT-txt: (1) selected an evidence-based treatment manual as an adaptation source [ 20 ] as well as primary CBT source materials [ 26 ], (2) developed texts to match the treatment manual content and structure [ 20 ], (3) cross-checked the texts against the core mechanisms of CBT for depression [ 13 ], and (4) applied a CBT fidelity scale [ 30 ] to rate the texts with an outside expert, Dr John Curry, who provided independent quality assurance scoring.…”

Section: Methodsmentioning

confidence: 99%

“…This study was conducted to better understand the mechanisms of SMS text message–delivered cognitive behavioral therapy (CBT-txt) as well as the acceptability of the treatment length. Our recent randomized clinical trial treating 102 young adults in the United States with at least moderate depressive symptomatology found that CBT-txt was acceptable, feasible, and efficacious compared with a waitlist control condition [ 9 ]. This 2-month trial had 4 weeks of treatment and tested a single mediator, behavioral activation, with assessments at baseline and at 1- and 2-month follow-ups.…”

Section: Introductionmentioning

confidence: 99%

“…The initial CBT-txt trial found that the strongest treatment effect appeared at the 1-month follow-up (immediately after the treatment ended), particularly for participants who began with severe depressive symptoms. Mediation analysis revealed significant indirect treatment effects of increases in behavioral activation on reducing depressive symptoms, suggesting a mechanism of change [ 9 , 11 ]. Based upon these promising findings, we examined the treatment satisfaction data from this study, which revealed participants’ interest in receiving more treatment content and an increase in the duration of the intervention.…”

Section: Introductionmentioning

confidence: 99%

“…The first hypothesis was that participants allocated to the treatment condition would show greater reductions in their depressive symptoms immediately following treatment (2 months after enrollment) and at the 3-month follow-up than participants in the waitlist control condition. Because treatment response has been linked to baseline symptom severity [ 9 , 16 ], we also tested whether treatment effects were moderated by the participants’ baseline severity level. The second hypothesis was that treatment effects would be mediated by behavioral activation, such that increases in behavioral activation would reduce depressive symptoms in the treatment condition relative to the controls.…”

Section: Introductionmentioning

confidence: 99%

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Testing Mechanisms of Change for Text Message–Delivered Cognitive Behavioral Therapy: Randomized Clinical Trial for Young Adult Depression

Mason¹,

Coatsworth²,

Zaharakis³

et al. 2023

JMIR Mhealth Uhealth

Self Cite

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Background Current psychiatric epidemiological evidence estimates that 17% of young adults (aged 18-25 years) experienced a major depressive episode in 2020, relative to 8.4% of all adults aged ≥26 years. Young adults with a major depressive episode in the past year are the least likely to receive treatment for depression compared with other age groups. Objective We conducted a randomized clinical trial following our initial 4-week SMS text message–delivered cognitive behavioral therapy (CBT-txt) for depression in young adults. We sought to test mechanisms of change for CBT-txt. Methods Based on participant feedback, outcome data, and the empirical literature, we increased the treatment dosage from 4-8 weeks and tested 3 mechanisms of change with 103 young adults in the United States. Participants were from 34 states, recruited from Facebook and Instagram and presenting with at least moderate depressive symptomatology. Web-based assessments occurred at baseline prior to randomization and at 1, 2, and 3 months after enrollment. The primary outcome, the severity of depressive symptoms, was assessed using the Beck Depression Inventory II. Behavioral activation, perseverative thinking, and cognitive distortions were measured as mechanisms of change. Participants were randomized to CBT-txt or a waitlist control condition. Those assigned to the CBT-txt intervention condition received 474 fully automated SMS text messages, delivered every other day over a 64-day period and averaging 14.8 (SD 2.4) SMS text messages per treatment day. Intervention texts are delivered via TextIt, a web-based automated SMS text messaging platform. Results Across all 3 months of the study, participants in the CBT-txt group showed significantly larger decreases in depressive symptoms than those in the control group (P<.001 at each follow-up), producing a medium-to-large effect size (Cohen d=0.76). Over half (25/47, 53%) of the treatment group moved into the “high-end functioning” category, representing no or minimal clinically significant depressive symptoms, compared with 15% (8/53) of the control condition. Mediation analysis showed that CBT-txt appeared to lead to greater increases in behavioral activation and greater decreases in cognitive distortions and perseverative thinking across the 3-month follow-up period, which were then associated with larger baseline to 3-month decreases in depression. The size of the indirect effects was substantial: 57%, 41%, and 50% of the CBT-txt effect on changes in depression were mediated by changes in behavioral activation, cognitive distortions, and perseverative thinking, respectively. Models including all 3 mediators simultaneously showed that 63% of the CBT-txt effect was mediated by the combined indirect effects. Conclusions Results provide evidence for the efficacy of CBT-txt to reduce young adult depressive symptoms through hypothesized mechanisms. To the best of our knowledge, CBT-txt is unique in its SMS text message–delivered modality, the strong clinical evidence supporting efficacy and mechanisms of change. Trial Registration ClinicalTrials.gov NCT05551702; https://clinicaltrials.gov/study/NCT05551702

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Testing Mechanisms of Change for Text Message–Delivered Cognitive Behavioral Therapy: Randomized Clinical Trial for Young Adult Depression

Mason¹,

Coatsworth²,

Zaharakis³

et al. 2023

JMIR Mhealth Uhealth

Self Cite

View full text Add to dashboard Cite

show abstract

Testing Mechanisms of Change for Text Message–Delivered Cognitive Behavioral Therapy: Randomized Clinical Trial for Young Adult Depression (Preprint)

Mason¹,

Coatsworth²,

Zaharakis³

et al. 2023

Preprint

View full text Add to dashboard Cite

BACKGROUND Current psychiatric epidemiological evidence estimates 17% of young adults (ages 18-25) experienced a Major Depressive Episode (MDE) in 2020, relative to 8.4% of all adults 26 and older. Young adults with past year MDE are the least likely to receive any treatment for depression compared to other age groups OBJECTIVE In an effort to address this need, we conducted a follow-up randomized clinical trial to our initial 4-week text-delivered cognitive behavioral therapy for young adult depression (CBT-txt). We sought to specify the appropriate treatment dosage and identify mechanisms of change for CBT-txt. METHODS Based on participant feedback, outcome data, and the empirical literature, we increased the treatment dosage from 4 to 8 weeks and tested 3 mechanisms of change with 103 U.S. young adults. Participants were from 33 states recruited from Facebook and Instagram, presenting with at least moderate depressive symptomatology. Assessments occurred at baseline prior to randomization and at 1, 2, and 3 months post-enrollment. The primary outcome, severity of depressive symptoms, was assessed using the Beck Depression Inventory II. Behavioral activation, perseverative thinking, and cognitive distortions were measured as mechanisms of change. RESULTS At each of the three follow-ups, participants in the CBT-txt group showed significantly larger decreases in depressive symptoms than those in the control group and produced a medium/large effect size (Cohen’s d = .76). CBT-txt reduced BDI-II scores by 18 points and 53% of the treatment group moved from ‘moderate or severe depressive symptoms’ to ‘none to minimal depressive symptoms.’ Mediation analysis showed that CBT-txt appeared to lead to greater increases in behavioral activation and greater decreases in cognitive distortions and perseverative thinking across the three-month follow-up period, which were then associated with larger baseline-to-three-month decreases in depression. The size of indirect effects was substantial: 57%, 41%, and 50% of the CBT-txt effects on change in depression were mediated by change in behavioral activation, cognitive distortions, and perseverative thinking, respectively. CONCLUSIONS These results provide further evidence for the efficacy of CBT-txt to reduce young adult depressive symptoms through hypothesized mechanisms. To our knowledge, CBT-txt is unique in its text-delivered modality and in its strong clinical evidence supporting efficacy and in identifying mechanisms of change. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT05551702

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Treating Young Adult Depression With Text-Delivered Cognitive Behavioral Therapy: A Pilot Randomized Clinical Trial

Cited by 2 publications

References 31 publications

Testing Mechanisms of Change for Text Message–Delivered Cognitive Behavioral Therapy: Randomized Clinical Trial for Young Adult Depression

Testing Mechanisms of Change for Text Message–Delivered Cognitive Behavioral Therapy: Randomized Clinical Trial for Young Adult Depression

Testing Mechanisms of Change for Text Message–Delivered Cognitive Behavioral Therapy: Randomized Clinical Trial for Young Adult Depression (Preprint)

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