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

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 Use of a Fully Automated Internet-Based Cognitive Behavior Therapy Intervention in a Community Population of Adults With Depression Symptoms: Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Mark B Schure ◽  
Janet C Lindow ◽  
John H Greist ◽  
Paul A Nakonezny ◽  
Sandra J Bailey ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Rural Community ◽  
Symptom Severity ◽  
Intervention Group ◽  
Effect Sizes ◽  
Control Group ◽  
Depression Symptoms ◽  
Depression Symptom ◽  
Cognitive Behavior ◽  
Community Population

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; <italic>P</italic>&lt;.001), with a moderate treatment effect size (<italic>d</italic>=0.63). Moderate to near-moderate effect sizes favoring the intervention group were observed for anxiety symptoms (<italic>P</italic>&lt;.001; <italic>d</italic>=0.47), work/social functioning (<italic>P</italic>&lt;.001; <italic>d</italic>=0.39), and resilience (<italic>P</italic>&lt;.001; <italic>d</italic>=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. CLINICALTRIAL ClinicalTrials.gov NCT03244878; https://clinicaltrials.gov/ct2/show/NCT03244878

scholarly journals Telehealth Cognitive Behavior Therapy for Co-Occurring Insomnia and Depression Symptoms in Older Adults

2013 ◽  
Vol 69 (10) ◽  
pp. 1056-1065 ◽  
Author(s):  
Kenneth L. Lichstein ◽  
Forrest Scogin ◽  
S. Justin Thomas ◽  
Elizabeth A. DiNapoli ◽  
Haley R. Dillon ◽  
...  
Keyword(s):  
Older Adults ◽  
Behavior Therapy ◽  
Cognitive Behavior Therapy ◽  
Depression Symptoms ◽  
Cognitive Behavior
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