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The Center for Neuroscience and Regenerative Medicine (CNRM) Clinical Trials Unit has developed the first cognitive-behavioral therapy (CBT) digital therapeutic (DTx) mobile application to counteract depressive symptoms in military service members and veterans with a history of mild traumatic brain injury (mTBI). This trial will assess the efficacy of the novel CBT-DTx for depression following mTBI compared to an educational comparison DTx.
This trial is a single-blind, randomized, controlled interventional trial of current and former military personnel with symptoms of depression and a history of mTBI. The study will be conducted remotely.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| CBT DTx | Experimental | Participants randomized to active intervention will access a structured, cognitive behavioral therapy (CBT) intervention. |
|
| Psychoeducations DTx | Active Comparator | Participants randomized to the comparison group will access an unstructured educational DTx. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| CNRM DTx | Device | A mobile application intervention adapted from the CBT for Depression and CBT for TBI manuals. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Change of the mean difference in Patient Health Questionnaire (PHQ-9) total score | Self-report measure of depression symptom severity; range 0-27; higher score indicates greater severity | Week 12 and Week 16 compared to Baseline |
| Change of the mean difference in Patient Health Questionnaire (PHQ-9) total scores of participants who complete all treatment modules compared to those who do not | Self-report measure of depression symptom severity; range 0-27; higher score indicates greater severity | Week 12 compared to Baseline |
| Change of the mean difference in Patient Health Questionnaire (PHQ-9) total scores of participants who report history of depression prior to mTBI compared to those who do not | Self-report measure of depression symptom severity; range 0-27; higher score indicates greater severity | Week 12 compared to Baseline |
| Change of the mean difference in Patient Health Questionnaire (PHQ-9) total scores of participants who report family history of depression compared to those who do no | Self-report measure of depression symptom severity; range 0-27; higher score indicates greater severity | Week 12 compared to Baseline |
| Change of the mean difference in Patient Health Questionnaire (PHQ-9) total scores, comparison between depression severity group | Self-report measure of depression symptom severity; range 0-27; higher score indicates greater severity | Week 12 compared to Baseline |
| Measure | Description | Time Frame |
|---|---|---|
| Change of the mean difference in Traumatic Brain Injury-Quality of Life (TBI-QOL) total score | Computerized adaptive test that measures post-concussive symptoms and quality of life across multiple domains | Week 12 and Week 16, compared to Baseline |
| Change of the mean difference in Posttraumatic Stress Disorder Checklist (PCL-5) total score |
| Measure | Description | Time Frame |
|---|---|---|
| User Version of the Mobile Application Rating Scale (uMARS) | Self-report measure that assess user opinion in 4 objective quality subscales: engagement, functionality, aesthetics, information quality; 1 subjective quality subscale; and 1 scale that measures the perceived impact of the app being evaluated | Week 12 |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| David Brody, MD | Uniformed Services University of the Health Sciences | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Remote Recruitment: Center for Neuroscience and Regenerative Medicine | Bethesda | Maryland | 20851 | United States |
Identifier-free participant data sets will be shared with the Uniformed Services University Center for Neuroscience and Regenerative Medicine Data Repository. Identifier-free data sets may also be shared with the Federal Interagency Traumatic Brain Injury Research (FITBIR) Data Repository.
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After study completion, data sets will be de-identified and shared with the repositories. De-identified data sets will be stored in the repositories indefinitely.
Access to the CNRM Data Repository will be determined b the CNRM Data Quality, Access, and Publication Committee. Investigators requesting access to the data will provide a list of investigators and collaborators who will have access to the data, documentation of Ethical Conduct of Research and Human Participants Protection Training, and documentation of Institutional Review Board Approval of the research project.
Access to FITBIR will follow FITBIR Access Criteria
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| ID | Term |
|---|---|
| D003863 | Depression |
| D001924 | Brain Concussion |
| ID | Term |
|---|---|
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |
| D000070642 | Brain Injuries, Traumatic |
| D001930 | Brain Injuries |
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| Psychoeducation Comparison | Other | A mobile application that consists of psychoeducational material regarding depression and brain injury. |
|
Self-report measure of PTSD severity; range 0-80; higher score indicates greater severity |
| Week 12 and Week 16, compared to Baseline |
| Change of the mean difference in Insomnia Severity Index (ISI) total score | Self-report measure of insomnia severity; range 0-28; higher score indicates greater severity | Week 12 and Week 16, compared to Baseline |
| Change in Credibility and Expectancy Questionnaire (CEQ) | Self-report measure of participation expectation of benefit | Week 12 and Week 16, compared to Baseline |
| Blinding Efficacy | Participant blinding questionnaire | Week 12 and Week 16, compared to Baseline |
| Mobile Agnew Relationship Measure (mARM) Questionnaire |
Self-report measure of therapeutic alliance with mobile health intervention |
| Week 12 |
| HEXACO Personality Inventory-Revised (HEXACO-PI-R) | Self-report personality inventory that measures 6 dimensions of personality: honesty-humility, emotionality, eXtraversion, agreeableness (versus anger), conscientiousness, openness to experience | Baseline |
| D001927 |
| Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D006259 | Craniocerebral Trauma |
| D020196 | Trauma, Nervous System |
| D016489 | Head Injuries, Closed |
| D014947 | Wounds and Injuries |
| D014949 | Wounds, Nonpenetrating |