Smartphone-Supported versus Full Behavioural Activation for Depression: A Randomised Controlled Trial

Kien Hoa Ly, Naira Topooco, Hanna Cederlund, Anna Wallin, Jan Bergström, Olof Molander, Per Carlbring, Gerhard Andersson, Kien Hoa Ly, Naira Topooco, Hanna Cederlund, Anna Wallin, Jan Bergström, Olof Molander, Per Carlbring, Gerhard Andersson

Abstract

Background: There is need for more cost and time effective treatments for depression. This is the first randomised controlled trial in which a blended treatment--including four face-to-face sessions and a smartphone application--was compared against a full behavioural treatment. Hence, the aim of the current paper was to examine whether a blended smartphone treatment was non-inferior to a full behavioural activation treatment for depression.

Methods: This was a randomised controlled non-inferiority trial (NCT01819025) comparing a blended treatment (n=46) against a full ten-session treatment (n=47) for people suffering from major depression. Primary outcome measure was the BDI-II, that was administered at pre- and post-treatment, as well as six months after the treatment.

Results: Results showed significant improvements in both groups across time on the primary outcome measure (within-group Cohen's d=1.35; CI [-0.82, 3.52] to d=1.47; CI [-0.41, 3.35]; between group d=-0.13 CI [-2.37, 2.09] and d=-0.10 CI [-2.53, 2.33]). At the same time, the blended treatment reduced the therapist time with an average of 47%.

Conclusions: We could not establish whether the blended treatment was non-inferior to a full BA treatment. Nevertheless, this study points to that the blended treatment approach could possibly treat nearly twice as many patients suffering from depression by using a smartphone application as add-on. More studies are needed before we can suggest that the blended treatment method is a promising cost-effective alternative to regular face-to-face treatment for depression.

Trial registration: Cognitive Behavioral Therapy Treatment of Depression With Smartphone Support NCT01819025.

Conflict of interest statement

Competing Interests: KHL develops a related version of the smartphone application for the open market. OM is an employee of Wemind Psykiatri Stockholm. There are no further patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Participant flow and reasons for…
Fig 1. Participant flow and reasons for dropping out throughout the trial.
Fig 2. Description of session content for…
Fig 2. Description of session content for blended treatment.
Fig 3. Description of session content for…
Fig 3. Description of session content for full BA treatment.
Fig 4. Assessment of the Beck Depression…
Fig 4. Assessment of the Beck Depression Inventory-II, BDI-II (including 95% confidence intervals).

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Source: PubMed

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