Symptom Severity at Week 4 of Cognitive-Behavior Therapy Predicts Depression Remission

2019 ◽  
Vol 50 (4) ◽  
pp. 791-802 ◽  
Author(s):  
Jacqueline B. Persons ◽  
Cannon Thomas
Keyword(s):  
Behavior Therapy ◽  
Cognitive Behavior Therapy ◽  
Symptom Severity ◽  
Cognitive Behavior

Randomized controlled trial of digital cognitive behavior therapy for prenatal insomnia symptoms: Effects on postpartum insomnia and mental health

SLEEP ◽  
2021 ◽  
Author(s):  
Jennifer N Felder ◽  
Elissa S Epel ◽  
John Neuhaus ◽  
Andrew D Krystal ◽  
Aric A Prather
Keyword(s):  
Mental Health ◽  
Depressive Symptoms ◽  
Behavior Therapy ◽  
Cognitive Behavior Therapy ◽  
Symptom Severity ◽  
Standard Care ◽  
Anxiety Symptom ◽  
Controlled Trial ◽  
Cognitive Behavior ◽  
Insomnia Symptom

Abstract Study objectives To evaluate the effects of digital cognitive behavior therapy for insomnia (dCBT-I) delivered during pregnancy on subjective sleep outcomes, depressive symptoms, and anxiety symptoms through six months postpartum. Methods People up to 28 weeks gestation (N=208) with insomnia were randomized to six weekly sessions of dCBT-I or standard care. We report follow-up data at three and six months postpartum. The primary outcome was insomnia symptom severity. Secondary sleep outcomes included global sleep quality and insomnia caseness. Mental health outcomes included depressive and anxiety symptom severity. We evaluated between-condition differences in change from baseline for each postpartum timepoint and categorical outcomes. Results dCBT-I participants did not experience significantly greater improvements in insomnia symptom severity relative to standard care participants, but they did experience higher rates of insomnia remission and lower rates of insomnia caseness at six months postpartum. dCBT-I participants experienced greater improvements in depressive symptom severity from baseline to both postpartum timepoints, and in anxiety symptom severity from baseline to three months postpartum. The proportion of participants with probable major depression at three months postpartum was significantly higher among standard care (18%) than dCBT-I (4%, p=.006) participants; this between-condition difference was pronounced among the subset (n=143) with minimal depressive symptoms at baseline (18% vs 0%). Conclusion dCBT-I use during pregnancy leads to enduring benefits for postpartum insomnia remission. Findings provide strong preliminary evidence that dCBT-I use during pregnancy may prevent postpartum depression and anxiety, which is notable when considering the high frequency and importance of these problems.

scholarly journals Twelve-Month Follow-Up to a Fully Automated Internet-Based Cognitive Behavior Therapy Intervention for Rural Adults With Depression Symptoms: Single-Arm Longitudinal Study

10.2196/21336 ◽  
2020 ◽  
Vol 22 (10) ◽  
pp. e21336 ◽  
Author(s):  
Mark Schure ◽  
Bernadette McCrory ◽  
Kathryn Tuchscherer Franklin ◽  
John Greist ◽  
Ruth Striegel Weissman
Keyword(s):  
Suicidal Ideation ◽  
Outcome Measures ◽  
Behavior Therapy ◽  
Cognitive Behavior Therapy ◽  
Symptom Severity ◽  
The United States ◽  
Secondary Outcome ◽  
Depression Symptoms ◽  
Cognitive Behavior ◽  
Program Adherence

Background Internet-based cognitive behavior therapy (iCBT) interventions have the potential to help individuals with depression, regardless of time and location. Yet, limited information exists on the longer-term (>6 months) effects of iCBT and adherence to these interventions. Objective The primary aim of this study was to evaluate the longitudinal (12 months) effectiveness of a fully automated, self-guided iCBT intervention called Thrive, designed to enhance engagement with a rural population of adults with depression symptoms. The secondary aim was to determine whether the program adherence enhanced the effectiveness of the Thrive intervention. Methods We analyzed data from 181 adults who used the Thrive intervention. Using self-reports, participants were evaluated at baseline, 8 weeks, 6 months, and 12 months for the primary outcome of depression symptom severity using the Patient Health Questionnaire-9 (PHQ-9) scale and secondary outcome measures, namely, the Generalized Anxiety Disorder Scale-7 (GAD-7) scores, Work and Social Adjustment Scale (WSAS) scores, Conner-Davidson Resilience Scale-10 (CD-RISC-10) scores, and suicidal ideation (ninth item of the PHQ-9 scale) scores. The Thrive program adherence was measured using the numbers of program logins, page views, and lessons completed. Results The assessment response rates for 8-week, 6-month, and 12-month outcomes were 58.6% (106/181), 50.3% (91/181), and 51.4% (93/181), respectively. By 8 weeks, significant improvements were observed for all outcome measures. These improvements were maintained at 12 months with mean reductions in severities of depression (mean –6.5; P<.001) and anxiety symptoms (mean –4.3; P<.001). Improvements were also observed in work and social functioning (mean –6.9; P<.001) and resilience (mean 4.3; P<.001). Marked decreases were observed in suicidal ideation (PHQ-9 ninth item score >1) at 6 months (16.5%) and 12 months (17.2%) compared to baseline (39.8%) (P<.001). In regard to the program adherence, cumulative counts of page views and lessons completed were significantly related to lower PHQ-9, GAD-7, and WSAS scores and higher CD-RISC-10 scores (all P values <.001 with an exception of page views with WSAS for which P value was .02). Conclusions The Thrive intervention was effective at reducing depression and anxiety symptom severity and improving functioning and resilience among a population of adults from mostly rural communities in the United States. These gains were maintained at 1 year. Program adherence, measured by the number of logins and lessons completed, indicates that users who engage more with the program benefit more from the intervention. Trial Registration ClinicalTrials.gov NCT03244878; https://clinicaltrials.gov/ct2/show/NCT03244878

scholarly journals Twelve-Month Follow-Up to a Fully Automated Internet-Based Cognitive Behavior Therapy Intervention for Rural Adults With Depression Symptoms: Single-Arm Longitudinal Study (Preprint)

2020 ◽  
Author(s):  
Mark Schure ◽  
Bernadette McCrory ◽  
Kathryn Tuchscherer Franklin ◽  
John Greist ◽  
Ruth Striegel Weissman
Keyword(s):  
Suicidal Ideation ◽  
Outcome Measures ◽  
Behavior Therapy ◽  
Cognitive Behavior Therapy ◽  
Symptom Severity ◽  
The United States ◽  
Secondary Outcome ◽  
Depression Symptoms ◽  
Cognitive Behavior ◽  
Program Adherence

BACKGROUND Internet-based cognitive behavior therapy (iCBT) interventions have the potential to help individuals with depression, regardless of time and location. Yet, limited information exists on the longer-term (&gt;6 months) effects of iCBT and adherence to these interventions. OBJECTIVE The primary aim of this study was to evaluate the longitudinal (12 months) effectiveness of a fully automated, self-guided iCBT intervention called Thrive, designed to enhance engagement with a rural population of adults with depression symptoms. The secondary aim was to determine whether the program adherence enhanced the effectiveness of the Thrive intervention. METHODS We analyzed data from 181 adults who used the Thrive intervention. Using self-reports, participants were evaluated at baseline, 8 weeks, 6 months, and 12 months for the primary outcome of depression symptom severity using the Patient Health Questionnaire-9 (PHQ-9) scale and secondary outcome measures, namely, the Generalized Anxiety Disorder Scale-7 (GAD-7) scores, Work and Social Adjustment Scale (WSAS) scores, Conner-Davidson Resilience Scale-10 (CD-RISC-10) scores, and suicidal ideation (ninth item of the PHQ-9 scale) scores. The Thrive program adherence was measured using the numbers of program logins, page views, and lessons completed. RESULTS The assessment response rates for 8-week, 6-month, and 12-month outcomes were 58.6% (106/181), 50.3% (91/181), and 51.4% (93/181), respectively. By 8 weeks, significant improvements were observed for all outcome measures. These improvements were maintained at 12 months with mean reductions in severities of depression (mean –6.5; <i>P</i>&lt;.001) and anxiety symptoms (mean –4.3; <i>P</i>&lt;.001). Improvements were also observed in work and social functioning (mean –6.9; <i>P</i>&lt;.001) and resilience (mean 4.3; <i>P</i>&lt;.001). Marked decreases were observed in suicidal ideation (PHQ-9 ninth item score &gt;1) at 6 months (16.5%) and 12 months (17.2%) compared to baseline (39.8%) (<i>P</i>&lt;.001). In regard to the program adherence, cumulative counts of page views and lessons completed were significantly related to lower PHQ-9, GAD-7, and WSAS scores and higher CD-RISC-10 scores (all <i>P</i> values &lt;.001 with an exception of page views with WSAS for which <i>P</i> value was .02). CONCLUSIONS The Thrive intervention was effective at reducing depression and anxiety symptom severity and improving functioning and resilience among a population of adults from mostly rural communities in the United States. These gains were maintained at 1 year. Program adherence, measured by the number of logins and lessons completed, indicates that users who engage more with the program benefit more from the intervention. CLINICALTRIAL ClinicalTrials.gov NCT03244878; https://clinicaltrials.gov/ct2/show/NCT03244878

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