CBT for depression: a pilot RCT comparing mobile phone vs. computer

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Abstract

Background

This paper reports the results of a pilot randomized controlled trial comparing the delivery modality (mobile phone/tablet or fixed computer) of a cognitive behavioural therapy intervention for the treatment of depression. The aim was to establish whether a previously validated computerized program (The Sadness Program) remained efficacious when delivered via a mobile application.

Method

35 participants were recruited with Major Depression (80% female) and randomly allocated to access the program using a mobile app (on either a mobile phone or iPad) or a computer. Participants completed 6 lessons, weekly homework assignments, and received weekly email contact from a clinical psychologist or psychiatrist until completion of lesson 2. After lesson 2 email contact was only provided in response to participant request, or in response to a deterioration in psychological distress scores. The primary outcome measure was the Patient Health Questionnaire 9 (PHQ-9). Of the 35 participants recruited, 68.6% completed 6 lessons and 65.7% completed the 3-months follow up. Attrition was handled using mixed-model repeated-measures ANOVA.

Results

Both the Mobile and Computer Groups were associated with statistically significantly benefits in the PHQ-9 at post-test. At 3 months follow up, the reduction seen for both groups remained significant.

Conclusions

These results provide evidence to indicate that delivering a CBT program using a mobile application, can result in clinically significant improvements in outcomes for patients with depression.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN 12611001257954

Related collections

Most cited references 9

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Major depressive disorder: new clinical, neurobiological, and treatment perspectives.

David Kupfer, Ellen Frank, Mary Phillips (2012)

In this Seminar we discuss developments from the past 5 years in the diagnosis, neurobiology, and treatment of major depressive disorder. For diagnosis, psychiatric and medical comorbidity have been emphasised as important factors in improving the appropriate assessment and management of depression. Advances in neurobiology have also increased, and we aim to indicate genetic, molecular, and neuroimaging studies that are relevant for assessment and treatment selection of this disorder. Further studies of depression-specific psychotherapies, the continued application of antidepressants, the development of new treatment compounds, and the status of new somatic treatments are also discussed. We address two treatment-related issues: suicide risk with selective serotonin reuptake inhibitors, and the safety of antidepressants in pregnancy. Although clear advances have been made, no fully satisfactory treatments for major depression are available. Copyright Â© 2012 Elsevier Ltd. All rights reserved.

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The costs of depression.

Ronald C Kessler (2012)

The data reported herein show clearly that major depression is a commonly occurring and burdensome disorder. The high prevalence, early age of onset, and high persistence of MDD in the many different countries where epidemiologic surveys have been administered confirm the high worldwide importance of depression. Although evidence is not definitive that MDD plays a causal role in its associations with the many adverse outcomes reviewed here, there is clear evidence that depression has causal effects on a number of important mediators, making it difficult to assume anything other than that depression has strong causal effects on many dimensions of burden. These results have been used to argue for the likely cost -effectiveness of expanded depression treatment from a societal perspective. Two separate, large-scale, randomized, workplace depression treatment effectiveness trials have been carried out in the United States to evaluate the cost effectiveness of expanded treatment from an employer perspective. Both trials had positive returns on investment to employers. A substantial expansion of worksite depression care management programs has occurred in the United States subsequent to the publication of these trials. However, the proportion of people with depression who receive treatment remains low in the United States and even lower in other parts of the world. A recent US study found that only about half of workers with MDD received treatment in the year of interview and that fewer than half of treated workers received treatment consistent with published treatment guidelines. Although the treatment rate was higher for more severe cases, even some with severe MDD often failed to receive treatment. The WMH surveys show that treatment rates are even lower in many other developed countries and consistently much lower in developing countries. Less information is available on rates of depression treatment among patients with chronic physical disorders, but available evidence suggests that expanded treatment could be of considerable value. Randomized, controlled trials are needed to expand our understanding of the effects of detection and treatment of depression among people in treatment for chronic physical disorders. In addition, controlled effectiveness trials with long-term follow-ups are needed to increase our understanding of the effects of early MDD treatment interventions on changes in life course role trajectories, role performance, and onset of secondary physical disorders.

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Excess mortality in depression: a meta-analysis of community studies.

Pim Cuijpers, Filip Smit (2002)

Although most studies examining the relationship between depression and mortality indicate that there is excess mortality in depressed subjects, this is not confirmed in all studies. Furthermore, it has been hypothesized that mortality rates in depressed men are higher than in depressed women. Finally, it is not clear if the increased mortality rates exist only in major depression or also in subclinical depression. A meta-analysis was conducted to examine these questions. A total of 25 studies with 106,628 subjects, of whom 6416 were depressed, were examined. Both univariate and multivariate analyses were conducted. The overall relative risk (RR) of dying in depressed subjects was 1.81 (95% CI: 1.58-2.07) compared to non-depressed subjects. No major differences were found between men and women, although the RR was somewhat larger in men. The RR in subclinical depression was no smaller than the RR in clinical depression. Only RRs of mortality were examined, which were not corrected for important confounding variables, such as chronic illnesses, or life-style. In the selected studies important differences existed between study characteristics and populations. The number of comparisons was relatively small. There is an increased risk of mortality in depression. An important finding of this study is that the increased risk not only exists in major depression, but also in subclinical forms of depression. In many cases, depression should be considered as a life-threatening disorder.

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Author and article information

Journal

Journal ID (nlm-ta): BMC Psychiatry

Journal ID (iso-abbrev): BMC Psychiatry

Title: BMC Psychiatry

Publisher: BioMed Central

ISSN (Electronic): 1471-244X

Publication date Collection: 2013

Publication date (Electronic): 7 February 2013

Volume: 13

Page: 49

Affiliations

[1 ]Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent’s Hospital, 394-404 Victoria Street, Darlinghurst, NSW, Australia

Article

Publisher ID: 1471-244X-13-49

DOI: 10.1186/1471-244X-13-49

PMC ID: 3571935

PubMed ID: 23391304

SO-VID: 8d39efb5-64b2-409b-b076-bed7258f00b7

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

CBT for depression: a pilot RCT comparing mobile phone vs. computer

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Abstract

Background

Method

Results

Conclusions

Trial registration

Related collections

Measurement of Glucocorticoid Receptor Signaling in Major Depression

Most cited references 9

Major depressive disorder: new clinical, neurobiological, and treatment perspectives.

The costs of depression.

Excess mortality in depression: a meta-analysis of community studies.

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