Message-Based Psychotherapy and Digital Treatment Sequences for Depression

Message-Based Psychotherapy and Digital Treatment Sequences for Depression

This partnership between Talkspace and the University of Washington (UW) ALACRITY Center will determine how effective unlimited text-based psychotherapy for depression is when compared to once-a-week psychotherapy. This study will also determine what the best treatment options are for people who are not responding well to either unlimited texting or weekly psychotherapy. The results of this study will be a new product version of message-based care that can tailor psychotherapy intensity based on the needs of future consumers with depression.

This is a fast track Small Business Innovation Research (SBIR) proposal that will (1) test the effectiveness of daily, message-based psychotherapy (MBP) for depression, compared to traditionally delivered, video-chat psychotherapy (VCP) and (2) develop an evidence-based treatment sequence for those who do not respond to either daily MBP or VCP.

Phase 1 consists of a pilot study to determine the best incentive model to retain a sample of people 18 years old and older with depression into a SMART trial. Information from this pilot will inform the retention strategy for Phase 2.

Phase 2 is a 12-week, randomized clinical trial using a SMART design to test the following aims: 1. Determine the relative effectiveness of daily MBP compared to weekly VCP in treating symptoms of depression and improving social functioning; 2. For those who fail to respond to 6 weeks of weekly VCP only, determine whether the addition of daily messaging, or a switch to monthly video-chat plus daily messaging improves depression and functional outcomes; and 3. For those who fail to respond to 6 weeks of daily MBP, whether the addition of monthly video-chat or weekly video-chat improves outcomes. Participants will provide data on mood, activity, and functioning, and we will collect data on use of treatment (texts and sessions), and working alliance.

Inclusion and exclusion criteria are the same for Phase 1 and Phase 2.

Inclusion Criteria:

• 18 years old or older
• English or Spanish speaking
• Live in the United States
• Score of 10 or greater on the Patient Health Questionnaire-9 (PHQ-9) screening
• Receive a diagnosis of depression from a Talkspace intake clinician

Exclusion Criteria:

• Under the age of 18
• Non-English or Spanish speaking
• Do not meet criteria for a depressive disorder
• Participants with active suicidal ideation or with a primary diagnosis of psychosis will also be excluded and referred to intensive care.