Use of a Fully Automated Internet-Based Cognitive Behavior Therapy Intervention in a Community Population of Adults With Depression Symptoms: Randomized Controlled Trial
AuthorSchure, Mark B
Lindow, Janet C
Greist, John H
Nakonezny, Paul A
Bailey, Sandra J
Bryan, William L
Byerly, Matthew J
AffiliationUniv Arizona, Coll Med, Dept Psychiat
internet-based cognitive behavior therapy
randomized controlled trial
MetadataShow full item record
PublisherJMIR PUBLICATIONS, INC
CitationSchure MB, Lindow JC, Greist JH, Nakonezny PA, Bailey SJ, Bryan WL, Byerly MJ Use of a Fully Automated Internet-Based Cognitive Behavior Therapy Intervention in a Community Population of Adults With Depression Symptoms: Randomized Controlled Trial J Med Internet Res 2019;21(11):e14754 URL: http://www.jmir.org/2019/11/e14754/ doi: 10.2196/14754
Rights©Mark B Schure, Janet C Lindow, John H Greist, Paul A Nakonezny, Sandra J Bailey, William L Bryan, Matthew J Byerly. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 17.11.2019. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.
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AbstractBackground: Although internet-based cognitive behavior therapy (iCBT) interventions can reduce depression symptoms, large differences in their effectiveness exist. Objective: The aim of this study was to evaluate the effectiveness of an iCBT intervention called Thrive, which was designed to enhance engagement when delivered as a fully automated, stand-alone intervention to a rural community population of adults with depression symptoms. Methods: Using no diagnostic or treatment exclusions, 343 adults with depression symptoms were recruited from communities using an open-access website and randomized 1:1 to the Thrive intervention group or the control group. Using self-reports, 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 than the control group (n=162; 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 (odds ratio 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, stand-alone intervention.
NoteOpen access journal
VersionFinal published version
SponsorsNational Institute of General Medical Sciences of the National Institutes of Health, United States Department of Health & Human Services, National Institutes of Health (NIH) - USA NIH National Institute of General Medical Sciences (NIGMS) [P20GM103474, U54GM115371, 5P20GM104417]