Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: May 18, 2019
Open Peer Review Period: May 21, 2019 - Jul 16, 2019
Date Accepted: Oct 22, 2019
(closed for review but you can still tweet)
A Randomized Controlled Trial of a Fully Automated Internet-Based Cognitive Behavior Therapy Intervention in a Community Population of Adults with Depression Symptoms
ABSTRACT
Background:
Internet-based cognitive behavior therapy (iCBT) interventions can reduce depression symptoms; yet, large differences in their effectiveness exist.
Objective:
The aim of this study was to evaluate the effectiveness of an iCBT intervention called Thrive that is designed to enhance engagement when delivered as a fully automated intervention to a rural community population of adults with depression symptoms.
Methods:
Using no diagnostic or treatment exclusions, adults with depression symptoms were recruited from communities and randomized to the Thrive intervention group or the control group. Participants were evaluated at baseline, and 4 and 8 weeks for the primary outcome of depression symptom severity and secondary outcome measures of anxiety symptoms, work and social adjustment, psychological resilience, and suicidal ideation.
Results:
Over the 8-week follow-up period, the intervention group (n=181) had significantly lower depression symptom severity compared to control (n=161) (P<.001) with a moderate treatment effect size (d = 0.63). Moderate to near-moderate effect sizes favoring the intervention group were observed for anxiety symptoms (P <.001; d = 0.47), work/social functioning (P <.001; d = 0.39), and resilience (P <.001; d = 0.55). Although not significant, the intervention group was 45% less likely than the control group to experience increased suicidal ideation (OR = 0.55).
Conclusions:
These findings suggest that the Thrive intervention was effective in reducing depression and anxiety symptom severity and improving functioning and resilience among a mostly rural community population of US adults. The effect sizes associated with Thrive were generally larger than those of other iCBT interventions delivered as a fully automated, intervention. Clinical Trial: NCT03244878
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