Accepted for/Published in: JMIR Mental Health
Date Submitted: Jun 10, 2020
Date Accepted: Jul 29, 2020
Reduction in Depression and Anxiety in a Digital Cognitive Behavior Therapy Intervention: A Retrospective Study
ABSTRACT
Background:
Digital health intervention (DHI) is a scalable solution that reduces barriers to seeking care for clinical depression and anxiety.
Objective:
In the present study, we examined the effectiveness of a 12-week therapist supported, app-based Cognitive Behavioral Therapy (CBT) program in improving symptoms of depression and anxiety within 9 months.
Methods:
136 participants with mild to moderately severe depression and/or anxiety at baseline were enrolled in a 12-week digital CBT program. The program included structured lessons and tools (i.e., exercises and practices) as well as one-on-one weekly counseling sessions with a licensed therapist for 12 weeks and monthly check-in sessions for 1 year. The clinically validated Patient Health Questionnaire (PHQ-8) and Generalized Anxiety Disorder Scale (GAD-7) were used to assess depression and anxiety respectively. Linear mixed effects modeling (MLM) was employed to examine changes in depression and anxiety over time.
Results:
We observed a significant positive effect of program time on improvement in depression (ꞵ = -.12, P < 0.001) and anxiety scores (ꞵ = -.10, P < 0.001. At the end of the 12-week program intervention, we observed an average reduction of 3.76 points (95% CI -4.76 to -2.76) in PHQ-8 scores. Further reductions in depression were seen at program month 6 (4.75-point reduction, 95% CI -6.61 to -2.88) and by program month 9 (6.42-point reduction, 95% CI -8.66 to -6.55, P < .001). A similar pattern of improvement emerged for anxiety, with a 3.17-point reduction at the end of the 12-week intensive phase (95% CI -4.21 to -2.13). These improvements were maintained at program month 6 (4.87-point reduction, 95% CI -6.85 to -2.87) and at program month 9 (5.19-point, 95% -6.85 to 4.81). In addition, greater program engagement during in the first 12-weeks predicted greater reductions in depression (ꞵ = -.29, P < 0.001)
Conclusions:
The results demonstrate that digital interventions can foster sustained and clinically meaningful improvements in depression and anxiety. Furthermore, it appears that strong, initial DMHI engagement may facilitate this effect. However, the study is limited by post-intervention participant attrition as well as a retrospective, observational study design.
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