Accepted for/Published in: JMIR Formative Research
Date Submitted: Jun 16, 2022
Open Peer Review Period: Jun 13, 2022 - Aug 8, 2022
Date Accepted: Sep 19, 2023
(closed for review but you can still tweet)
The Use of Text Messaging as an Adjunct to Internet-Delivered Cognitive Behavioural Therapy for Major Depressive Disorder in Youth: A Secondary Analysis
ABSTRACT
Background:
Online Cognitive Behaviour Therapy (CBT) can be effective in treating Major Depressive Disorder (MDD). Text messaging is frequently used in Online CBT and is the most preferred communication format for young adults.
Objective:
To examine the relationship between the contents/frequencies of the text messages sent by participants to therapists, and depressive symptom reductions in a 24-week online CBT intervention for MDD in young adults. We assessed the relationship between the text messages sent by participants who responded beneficially to the online CBT versus the text messages sent by participants who had no beneficial responses.
Methods:
Participants in a Randomized Controlled Trial (RCT) were randomly allocated to experimental and control groups that received standard psychiatric care. Participants in the online (experimental) group also received access to NexJ Connected Wellness (NCW), a cloud-based digital platform that was used to securely text therapists, track steps on wearable devices, and access 24 workbook chapters. Participant text messages were securely transmitted, encrypted and stored per privacy-security requirements and participant consent. The message contents sent by participants to therapists were coded per procedures identified by Svartvatten et al. (2015). All messages from intervention participants (n = 22) were coded and grouped to reflect thematic categories. Univariate linear regression was used to test associations between the number of texts sent per category and Beck Depression Inventory-II change score. Multi-variable linear regression further tested associations, adjusting for participant sex, age, Brief Pain Inventory score, Beck Anxiety Inventory score, total texts sent and texts sent per category. Backwards variable selection was used to determine a most parsimonious model
Results:
No significant associations were found between baseline participant characteristics and the content/frequency of text messages of N=20 participants. The univariate effects of total texts sent (TTS) and the effects of the three text categories on BDI-II improvement were not significant (ps > .391). The univariate effects of age, baseline Brief Pain Inventory scale, and baseline Beck Anxiety Inventory were also not significantly associated with BDI-II improvement (ps > .201). None of the models developed indicated a significant adjusted relationship between text messaging categories and BDI-II improvement: more text messages, in general and in specific categories, were not related to depression symptom reduction.
Conclusions:
Results indicate that greater text message frequencies in the derived categories, and generally, were not significantly associated with BDI-II symptom reductions. While our results don’t indicate that benefits were not derived from text message communications, they represent the absence of a relationship between more texts sent and greater symptom reductions. It is appears that participants might benefit more by sending less text messages beyond a certain threshold number. Clinical Trial: NCT03406052
Citation
Per the author's request the PDF is not available.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.