Use of a Fully Automated Internet-Based Cognitive Behavior Therapy Intervention in a Community Population of Adults With Depression Symptoms: Randomized Controlled Trial
Background: Although internet-based cognitive behavior therapy (iCBT) interventions can reduce depression symptoms, large differences in their effectiveness exist.
Objective: The aim of this study was to evaluate the effectiveness of an iCBT intervention called Thrive, which was designed to enhance engagement when delivered as a fully automated, stand-alone intervention to a rural community population of adults with depression symptoms.
Methods: Using no diagnostic or treatment exclusions, 343 adults with depression symptoms were recruited from communities using an open-access website and randomized 1:1 to the Thrive intervention group or the control group. Using self-reports, participants were evaluated at baseline and 4 and 8 weeks for the primary outcome of depression symptom severity and secondary outcome measures of anxiety symptoms, work and social adjustment, psychological resilience, and suicidal ideation.
Results: Over the 8-week follow-up period, the intervention group (n=181) had significantly lower depression symptom severity than the control group (n=162; P<.001), with a moderate treatment effect size (d=0.63). Moderate to near-moderate effect sizes favoring the intervention group were observed for anxiety symptoms (P<.001; d=0.47), work/social functioning (P<.001; d=0.39), and resilience (P<.001; d=0.55). Although not significant, the intervention group was 45% less likely than the control group to experience increased suicidal ideation (odds ratio 0.55).
Conclusions: These findings suggest that the Thrive intervention was effective in reducing depression and anxiety symptom severity and improving functioning and resilience among a mostly rural community population of US adults. The effect sizes associated with Thrive were generally larger than those of other iCBT interventions delivered as a fully automated, stand-alone intervention.
Schure MB, Lindow JC, Greist JH, Nakonezny PA, Bailey SJ, Bryan WL, Byerly MJ. Use of a Fully Automated Internet-Based Cognitive Behavior Therapy Intervention in a Community Population of Adults With Depression Symptoms: Randomized Controlled Trial. J Med Internet Res 2019;21(11):e14754 DOI: 10.2196/14754
Twelve-month follow-up to a fully automated internet-based cognitive behavior therapy intervention for community-dwelling adults with depression symptoms
Background: Internet-based cognitive behavior therapy (iCBT) interventions have the potential to help individuals suffering from depression, regardless of time and location. Yet, limited information exists on the longer-term effects of iCBT and adherence to these interventions.
Objective: The primary aim of this study was to evaluate the longitudinal (one year) effectiveness of a fully automated, self-guided iCBT intervention called Thrive, designed to enhance engagement for a rural community population of adults with depression symptoms. The secondary aim was to determine whether program adherence enhanced effectiveness of the Thrive intervention.
Methods: We analyzed data from 181 adults who were randomized to the Thrive intervention group. Using self-reports, intervention group participants were evaluated at baseline, 8 weeks, 6 months, and 12 months for the primary outcome of depression symptom severity (Patient Health Questionnaire [PHQ-9]) and secondary outcome measures including the Generalized Anxiety Disorder Scale (GADS-7), Work and Social Adjustment Scale (WSAS), Connor-Davidson Resilience Scale (CD-RISC-10), and suicidal ideation (PHQ-9 ninth item). Thrive program adherence was measured using number of program logins, pages views and lessons completed.
Results: By 8 weeks, significant improvements were observed for all outcome measures. These improvements were maintained at 12 months with mean reductions in depression and anxiety symptom severity (M = -6.5, P<.001 and M = -4.3, P<.001, respectively). Improvements were also observed in work and social functioning (M = -6.9, P<.001) and resilience (M = 4.3, P<.001). Twenty-two percent fewer participants endorsed suicidal ideation (PHQ-9 ninth item score >1) at 12 months (17.2%) compared to baseline (39.8%; P<.001) In regard to program adherence, the cumulative count of page views and lessons completed were significantly related to lower PHQ-9, GAD-7, WSAS scores, and higher CD-RISC-10 scores.
Conclusions: The Thrive intervention was effective at reducing depression and anxiety symptom severity and improving functioning and resilience among a mostly rural community population of US adults. These gains were maintained at one year. Program adherence measured by number of logins and lessons completed indicate that users who engage more with the program benefit more.
Schure M, McCrory B, Tuchscherer Franklin K, Greist J, Weissman RS. Twelve-Month Follow-Up to a Fully Automated Internet-Based Cognitive Behavior Therapy Intervention for Rural Adults With Depression Symptoms: Single-Arm Longitudinal Study. J Med Internet Res. 2020 Oct 2;22(10):e21336. doi: 10.2196/21336. Erratum in: J Med Internet Res. 2020 Oct 23;22(10):e25146.