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Effects of Smartphone-Based Behavioral Activation Therapy on Depression and Behavior Change: An Exploratory Randomized Controlled Study
ABSTRACT
Background:
The use of internet-based behavioral activation (iBA) as a treatment strategy for depression has garnered growing interest. Two examples of this approach are ZOO REPO©, a behavioral activation application incorporating gamification, and “BEARS,” a behavioral activation application offering guidance.
Objective:
This study aimed to explore the potential benefits of ZOO REPO© and BEARS for people with some depressive symptoms but not experiencing any disruption in their social lives.
Methods:
A prospective, randomized, three-arm study was conducted. Individuals aged 18–29 years with a depressive symptom severity score (on the Patient Health Questionnaire-9 (PHQ-9)) of 5 to 19 were randomly allocated to one of three groups. The ZOO REPO group was asked to use the “ZOO REPO©” for one month; the BEARS group was asked to use the “BEARS” for one month; and the control group was asked to continue living their normal lives without using any application. Psychological scores were assessed at the following time points: pre-intervention (T1); Week 1 (T2), Week 2 (T3), Week 3 (T4), and Week 4 (T5) after commencing application use; and two weeks after intervention completion (T6). The primary outcome was pre-specified as changes in depressive symptoms (PHQ-9) between T1 and T5. Secondary outcomes included scores on the Environmental Reward Observation Scale and Fatigue Severity Scale between T1 and T5.
Results:
A total of 67 participants were randomly allocated to the ZOO REPO group (n=22), BEARS group (n=23), and control group (n=22). The differences in changes in PHQ-9 scores relative to the control group were –0.4 (95% CI –1.6 to 0.7) for the ZOO REPO group and –2.4 (95% CI –3.4 to –1.5) for the BEARS group. Five participants met the study discontinuation criteria. Two discontinued due to elevated PHQ-9 scores, although no causal relationship with the interventions was identified. Three participants discontinued due to insufficient adherence, all in the BEARS group, while no adherence-related discontinuations occurred in the ZOO REPO group.
Conclusions:
The results suggest that iBA is a feasible approach and may be effective as a therapeutic option for young people with mild to moderate/severe depressive symptoms. However, larger studies are needed to confirm these findings. Clinical Trial: University Hospital Medical Information Network UMIN000053619
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