JMIR Publications

ABSTRACT

Background:

Rising rates of depression and anxiety among university students, with strained college counseling centers, have underscored the need for digital interventions, such as cognitive-behavioral therapy combined with mindfulness-based practices (iCBT-M). Stand-alone internet-based interventions tend to have poor retention among college students, while coach-assisted or guided internet-based interventions have reported improved engagement and symptom improvement.

Objective:

We evaluated the efficacy of an 8-week therapist-guided internet-based iCBT-M intervention with Fitbit trackers vs. traditional face-to-face CBT (t-CBT) in reducing wait times, improving therapy retention, and reducing depression and anxiety among university students in a naturalistic quality improvement pilot study.

Methods:

Over one academic year, university students presenting with mental health challenges at the college clinic were offered iCBT-M with a Fitbit tracker vs. traditional CBT (t-CBT), and students chose the therapy modality. Depression and anxiety symptoms were assessed using the PHQ-9 and GAD-7 at baseline, week 4, and week 8. Participants in the iCBT-M arm received 30-minute weekly online coaching with a therapist, daily messages, mindfulness videos, and weekly modules via the app. Wait-times to start therapy, step counts and engagement were recorded. Data was analyzed using linear mixed effects model, and Cohen's d effect sizes.

Results:

iCBT-M completers (N=11 of 11; mean age 22; predominantly female) waited significantly less time to begin treatment (M=26 days) than t-CBT completers (N=11 of 17; M=82 days). Pre-post reductions in PHQ-9 and GAD-7 were larger in the iCBT-M group (bPHQ-9 = -4.18, bGAD-7 = -3.18) compared to the t-CBT group (bPHQ-9 = -2.39, bGAD-7 = -1.29). Mean reductions were significant for the iCBT-M group (ps ≤ . 020) but not the t-CBT group (ps ≥ .186). Average rates of improvement were faster in iCBT-M versus t-CBT: PHQ-9 reduced 4.21 points over 64.27 days versus 2.03 points over 82.73 days; GAD-7 reduced 3.04 points over 64.27 days versus 1.31 points over 82.73 days. Each additional 10 days in iCBT-M was associated with a 0.66-point improvement in PHQ-9 (p = .008) and a 0.47-point improvement in GAD-7 (p = .020) whereas each additional 10 days in t-CBT was associated with a 0.25-point PHQ-9 improvement (p = .214) and a 0.16-point GAD-7 improvement (p = .265).

Conclusions:

Our findings suggest that the eight-week therapist-guided iCBT-M is an effective treatment to manage mild-moderate depression and anxiety among university students. Importantly, it shortens wait times for therapy and fastens symptom improvement. Future research into its scalability by health coach training of peer supporters on campus, its cost-effectiveness, and impact on academic outcomes is warranted.