Use of a fully automated internet-based cognitive behavior therapy intervention in a community population of adults with depression symptoms: Randomized controlled trial

Mark B. Schure, Janet C. Lindow, John H. Greist, Paul A. Nakonezny, Sandra J. Bailey, William L. Bryan, Matthew J. Byerly

Research output: Contribution to journalArticle

Abstract

Background: 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.

Original languageEnglish (US)
Article numbere14754
JournalJournal of medical Internet research
Volume21
Issue number11
DOIs
StatePublished - Nov 1 2019

Keywords

  • CBT
  • Depression symptoms
  • ICBT
  • Internet-based cognitive behavior therapy
  • RCT
  • Randomized controlled trial
  • Rural populations

ASJC Scopus subject areas

  • Health Informatics

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