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This study aims to asses whether adding automated text messaging to group cognitive behavioral therapy for depression increases engagement which may lead to improved outcomes.
Background: Cognitive Behavioral Therapy (CBT) for depression is efficacious, but effectiveness is limited when implemented in low-income settings due to engagement difficulties including nonadherence with skill-building homework and early discontinuation of treatment. Automated messaging can be used in clinical settings to increase dosage of depression treatment and encourage sustained engagement with psychotherapy.
Objectives: The aim of this study was to test whether a text messaging adjunct (mood monitoring text messages, treatment-related text messages, and a clinician dashboard to display patient data) increases engagement and improves clinical outcomes in a group CBT treatment for depression. Specifically, the investigators aim to assess whether the text messaging adjunct led to an increase in group therapy sessions attended, an increase in duration of therapy attended, and reductions in Patient Health Questionnaire-9 item (PHQ-9) symptoms compared with the control condition of standard group CBT in a sample of low-income Spanish speaking Latino patients.
Methods: Patients in an outpatient behavioral health clinic were assigned to standard group CBT for depression (control condition; n=40) or the same treatment with the addition of a text messaging adjunct (n=45). The adjunct consisted of a daily mood monitoring message, a daily message reiterating the theme of that week's content, and medication and appointment reminders. Mood data and qualitative responses were sent to a Web-based platform (HealthySMS) for review by the therapist and displayed in session as a tool for teaching CBT skills.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group CBT for Depression with MoodText' | Experimental | Group cognitive behavioral therapy utilizing the BRIGHT manual for depression along with automated text messaging for mood monitoring and reminder of session content |
|
| Group CBT for Depression | Active Comparator | Standard group cognitive behavioral therapy utilizing the BRIGHT manual for depression |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Group CBT for Depression with MoodText | Behavioral | Mobile phone based text messaging to inquire about mood, cognitions, and behaviors on a daily basis. |
|
| Measure | Description | Time Frame |
|---|---|---|
| PHQ-9 Depression Symptoms | The PHQ-9 (Patient Health Questionnaire - 9) is commonly used to screen for depression and to monitor progression of depressive symptoms over time. The scores represent the following depression severity: 0-4: minimal depression, 5-9: mild depression, 10-14: moderate depression, 15-19: moderately severe, 20-27: severe. A score of 10 is often recommended as the cut-off score for diagnosing an episode of depression that may require treatment. | 16 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Attendance | Number of sessions attended | 16 weeks |
| Duration of Therapy Attended | Number of weeks until patients dropped out of therapy |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Adrian Aguilera, Ph.D. | University of California, San Francisco | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| San Francisco General Hospital | San Francisco | California | 94110 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 25373390 | Derived | Aguilera A, Berridge C. Qualitative feedback from a text messaging intervention for depression: benefits, drawbacks, and cultural differences. JMIR Mhealth Uhealth. 2014 Nov 5;2(4):e46. doi: 10.2196/mhealth.3660. |
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| ID | Title | Description |
|---|---|---|
| FG000 | Group CBT With Text Messaging Adjunct | Group CBT for Depression with MoodText: Mobile phone based text messaging to inquire about mood, cognitions, and behaviors on a daily basis. |
| FG001 | Group CBT for Depression | Group CBT for Depression: Standard group CBT for depression using BRIGHT manual |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Group CBT With Text Messaging Adjunct | Group CBT for Depression with MoodText: Mobile phone based text messaging to inquire about mood, cognitions, and behaviors on a daily basis. |
| BG001 | Group CBT for Depression |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | PHQ-9 Depression Symptoms | The PHQ-9 (Patient Health Questionnaire - 9) is commonly used to screen for depression and to monitor progression of depressive symptoms over time. The scores represent the following depression severity: 0-4: minimal depression, 5-9: mild depression, 10-14: moderate depression, 15-19: moderately severe, 20-27: severe. A score of 10 is often recommended as the cut-off score for diagnosing an episode of depression that may require treatment. | The number of participants analyzed in this intention-to-treat analyses represents the number of participants that provided PHQ-9 scores at the end of the study period, at 16 weeks. Because the PHQ-9 was filled in during psychotherapy sessions, this number is smaller than the original sample (n=44, n=38) due to patient drop-out of psychotherapy. | Posted | Mean | Standard Deviation | units on a scale | 16 weeks |
|
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Group CBT With Text Messaging Adjunct | Group CBT for Depression with MoodText: Mobile phone based text messaging to inquire about mood, cognitions, and behaviors on a daily basis. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Adrian Aguilera | University of California, Berkeley | 510-642-8564 | aguila@berkeley.edu |
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| ID | Term |
|---|---|
| D003863 | Depression |
| ID | Term |
|---|---|
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |
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|
| Group CBT for Depression | Behavioral | Standard group CBT for depression using BRIGHT manual |
|
| 16 weeks |
Group CBT for Depression: Standard group CBT for depression using BRIGHT manual
| BG002 | Total | Total of all reporting groups |
| Participants |
|
| Age, Continuous | Mean | Standard Deviation | years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| PHQ-9 | The PHQ-9 (Patient Health Questionnaire - 9) is commonly used to screen for depression and to monitor progression of depressive symptoms over time. The scores represent the following depression severity: 0-4: minimal depression, 5-9: mild depression, 10-14: moderate depression, 15-19: moderately severe, 20-27: severe. A score of 10 is often recommended as the cut-off score for diagnosing an episode of depression that may require treatment. | Mean | Standard Deviation | units on a scale |
|
Group CBT for Depression with MoodText: Mobile phone based text messaging to inquire about mood, cognitions, and behaviors on a daily basis.
| OG001 | Group CBT for Depression | Group CBT for Depression: Standard group CBT for depression using BRIGHT manual |
|
|
| Secondary | Attendance | Number of sessions attended | For the attendance analyses, 3 patients (1 in the intervention and 2 in the control) were excluded, because the study ended before these patients had been offered 16 sessions of psychotherapy. | Posted | Median | Standard Deviation | sessions | 16 weeks |
|
|
|
| Secondary | Duration of Therapy Attended | Number of weeks until patients dropped out of therapy | For the duration of therapy analyses, 3 patients (1 in the intervention and 2 in the control) were excluded, because the study ended before these patients had been offered 16 sessions of psychotherapy. | Posted | Median | Full Range | weeks | 16 weeks |
|
|
|
| 0 |
| 45 |
| 0 |
| 45 |
| EG001 | Group CBT for Depression | Group CBT for Depression: Standard group CBT for depression using BRIGHT manual | 0 | 40 | 0 | 40 |
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