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Behavioural activation versus mindfulness-based guided self-help treatment administered through a smartphone application: a randomised controlled trial
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
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2014 (English)In: BMJ Open, ISSN 2044-6055, Vol. 4, no 1, e003440- p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Evaluating and comparing the effectiveness of two smartphone-delivered treatments: one based on behavioural activation (BA) and other on mindfulness.

DESIGN: Parallel randomised controlled, open, trial. Participants were allocated using an online randomisation tool, handled by an independent person who was separate from the staff conducting the study.

SETTING: General community, with recruitment nationally through mass media and advertisements.

PARTICIPANTS: 40 participants diagnosed with major depressive disorder received a BA treatment, and 41 participants received a mindfulness treatment. 9 participants were lost at the post-treatment.

INTERVENTION BA: An 8-week long behaviour programme administered via a smartphone application. Mindfulness: An 8-week long mindfulness programme, administered via a smartphone application.

MAIN OUTCOME MEASURES: The Beck Depression Inventory-II (BDI-II) and the nine-item Patient Health Questionnaire Depression Scale (PHQ-9).

RESULTS: 81 participants were randomised (mean age 36.0 years (SD=10.8)) and analysed. Results showed no significant interaction effects of group and time on any of the outcome measures either from pretreatment to post-treatment or from pretreatment to the 6-month follow-up. Subgroup analyses showed that the BA treatment was more effective than the mindfulness treatment among participants with higher initial severity of depression from pretreatment to the 6-month follow-up (PHQ-9: F (1, 362.1)=5.2, p<0.05). In contrast, the mindfulness treatment worked better than the BA treatment among participants with lower initial severity from pretreatment to the 6-month follow-up (PHQ-9: F (1, 69.3)=7.7, p<0.01); BDI-II: (F(1, 53.60)=6.25, p<0.05).

CONCLUSIONS: The two interventions did not differ significantly from one another. For participants with higher severity of depression, the treatment based on BA was superior to the treatment based on mindfulness. For participants with lower initial severity, the treatment based on mindfulness worked significantly better than the treatment based on BA.

TRIAL REGISTRATION: Clinical Trials NCT01463020.

Place, publisher, year, edition, pages
BMJ Publishing Group , 2014. Vol. 4, no 1, e003440- p.
Keyword [en]
Behavioral Activation, Depression, Mindfulness, Smartphone Application
National Category
URN: urn:nbn:se:liu:diva-104626DOI: 10.1136/bmjopen-2013-003440ISI: 000334311200010PubMedID: 24413342OAI: diva2:698012
Available from: 2014-02-19 Created: 2014-02-19 Last updated: 2015-02-05Bibliographically approved
In thesis
1. Use of a Smartphone Application in the Treatment of Depression: The New Wave of Digital Tools in Psychological Treatment
Open this publication in new window or tab >>Use of a Smartphone Application in the Treatment of Depression: The New Wave of Digital Tools in Psychological Treatment
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Internet-delivered programs based on cognitive behavior therapy (CBT) have during the past decade shown to work in an effective way for the treatment of depression. Due to its accessibility and independence of time and location, smartphone-based CBT might represent the next generation of digital interventions. Depression is an affective disorder that affects as many as 350 million people worldwide. However, with CBT, depression can be treated, but access to this treatment is scarce due to limited health care resources and trained therapists. As a result of this, health care could highly benefit from the use of smartphones for delivering cost-effective treatment that can be made available to a large part of the population who suffer from depression. One treatment that should be especially suitable for the smartphone format is behavioral activation (BA), since it has strong empirical support as well as the benefits of being flexible and rather simple.

The overall aim of the thesis was to test and further develop a BA smartphone application, as well as to build a method for how this smartphone application could be used in a comprehensive and effective way in depression treatment. To fulfill this aim, four studies were conducted. The results showed that smartphones have the ability to be used in an effective way in the treatment of depression, including as an add-on to traditional face-to-face sessions. The results also showed that the smartphone format was experienced as a portable and flexible way of accessing the treatment – and thus could be more present in everyday life.

In conclusion, there is reason to believe that smartphones will be integrated even further in society and therefore may serve an important role in future mental health care. Since the first indications reveal that depression can be treated by means of a supported smartphone application, it is highly possible that applications for other mental health problems will follow. Furthermore, in this thesis, the same smartphone application has been tested in three different ways and there is potential to apply smartphones in a range of other formats, such as in relapse prevention and as a way to intensify treatment during periods when needed. From a psychiatric research point of view, as my research group has been doing trials on guided internet treatment for more than 15 years, it is now time to move to the next generation of information technology – smartphones.

Abstract [sv]

Internetbaserad kognitiv beteendeterapi (KBT) har under det senaste decenniet visat sig fungera effektivt i behandling av depression. På grund av dess tillgänglighet och flexibilitet i tid och plats har smartphonebaserad KBT potential att bli nästa generation av digitala behandlingar. Depression är en affektiv sjukdom som drabbar så många som 350 miljoner människor världen över. Med hjälp av KBT kan depression behandlas. Dock är tillgången till denna behandling knapp på grund av begränsade resurser i form av utbildade terapeuter. Därmed skulle sjukvården kunna dra stor nytta av användningen av smartphones för att leverera kostnadseffektiv behandling, som kan göras tillgänglig för människor som lider av depression. En behandling som kan vara särskilt lämplig för smartphone-formatet är beteendeaktivering (BA), eftersom den har starkt empiriskt stöd samtidigt som den är flexibel och relativt enkel. Det övergripande syftet med avhandlingen var att testa och vidareutveckla en smartphone-applikation baserad på BA, samt att bygga en behandlingsmetod för denna smartphone-applikation som skulle kunna användas för att effektivt behandla depression. För att uppnå detta syfte genomfördes fyra studier. Resultaten visade att smartphones kan användas på ett effektivt sätt i behandling av depression, bland annat som komplement till traditionella live-sessioner. Resultaten visade också initiala indikationer på att smartphoneformatet upplevdes som ett portabelt och flexibelt sätt att komma åt behandlingen - och därmed blev mer närvarande i vardagen.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 103 p.
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 640Linköping Studies in Behavioural Science, ISSN 1654-2029 ; 188
Behavioral activation, depression, smartphone, application, mobile app, internetadministered, digitally administered, blended treatment, Beteendeaktivering, depression, smartphone, applikation, mobilapp, internetadministrerad, digital behandling, blandform
National Category
urn:nbn:se:liu:diva-113996 (URN)10.3384/diss.diva-113996 (DOI)978-91-7519-136-2 (print) (ISBN)
Public defence
2015-03-06, VAL, Hus Vallfarten, Campus Valla, Linköpings universitet, Linköping, 13:00 (English)
Available from: 2015-02-05 Created: 2015-02-05 Last updated: 2015-02-05Bibliographically approved

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