JMIR Publications

ABSTRACT

Background:

Effective treatments for depression are available, yet many patients do not respond to treatment or experience relapse. Cognitive bias modification aims to ameliorate cognitive biases that contribute to the development and maintenance of the disorder.

Objective:

This study examines the efficacy of a novel mobile approach-avoidance bias modification training with socio-emotional cues for depression.

Methods:

In this randomized clinical superiority trial, 75 inpatients with depression underwent six sessions of either active or sham approach-avoidance bias modification training with socio-emotional cues over the course of two weeks alongside inpatient treatment-as-usual. The primary outcome was self-reported depressive symptoms, secondary outcomes included approach-avoidance bias based on reaction time and response force, anhedonia, and positivity. Outcomes were assessed before and after the training, and again at 2-week and 6-month follow-up. The primary hypothesis was that active training would lead to a stronger decrease in symptoms of depression at end of training.

Results:

Both groups improved in depressive symptoms from baseline to end-of-training assessment but did not differ in this regard, B = -1.14 [-5.65, 3.41], t(188.61) = -0.47, p = .638, d = -0.09 [-0.46, 0.28]. Changes in anhedonia, positivity, and approach-avoidance bias were also not different between training groups, neither at end of training, all ps > .159, nor at 2-week follow-up, all ps > .692. However, the active training group showed a significantly greater reduction in depressive symptoms from baseline assessment to 6-month follow-up, B = 7.26 [2.53, 11.93], t(190.54) = 2.95, p = .004, d = 0.58 [0.20, 0.96]. Permuted split-half reliability of the mobile assessment of approach-avoidance bias ranged from 0.77 to 0.94 for reaction times and from 0.81 to 0.93 for response force. Approach-avoidance bias was not altered by the training and did not mediate the training effects.

Conclusions:

Mobile approach-avoidance bias modification training with socio-emotional cues did not reduce depressive symptoms in the short term, but in the long term. Mobile training and assessment versions may be more feasible in the future, as they require no joystick setup and can be conducted on patients’ smartphones. Future work needs to further examine short- and long-term efficacy and the mechanisms driving long-term symptom change in larger multi-center trials. Clinical Trial: This study’s design was prospectively registered at the German Clinical Trials Register [https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00022447]