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Smartphone-supported versus full behavioural activation for depression: 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, 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.
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2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, article id e0126559Article in journal (Refereed) Published
Abstract [en]

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 measures (within-group Cohen’s d=1.35; CI [−0.82, 3.52] to d=1.58; CI [0.51, 2.65]; between group d=−0.13 CI [−2.37, 2.09] to d=0.05 CI [−1.18, 1.27]). 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 applica¬tion 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.

Place, publisher, year, edition, pages
Public Library of Science , 2015. Vol. 10, no 5, article id e0126559
Keyword [en]
Behavioural activation, major depression, smartphone application, mobile app, blended treatment
National Category
Psychology Interaction Technologies
Identifiers
URN: urn:nbn:se:liu:diva-113994DOI: 10.1371/journal.pone.0126559ISI: 000355183900033PubMedID: 26010890OAI: oai:DiVA.org:liu-113994DiVA, id: diva2:786247
Funder
Swedish Research Council, 2011-2476EU, FP7, Seventh Framework Programme, ICT4Depression Consortium
Available from: 2015-02-05 Created: 2015-02-05 Last updated: 2018-05-24Bibliographically 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. p. 103
Series
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 640Linköping Studies in Behavioural Science, ISSN 1654-2029 ; 188
Keyword
Behavioral activation, depression, smartphone, application, mobile app, internetadministered, digitally administered, blended treatment, Beteendeaktivering, depression, smartphone, applikation, mobilapp, internetadministrerad, digital behandling, blandform
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-113996 (URN)10.3384/diss.diva-113996 (DOI)978-91-7519-136-2 (ISBN)
Public defence
2015-03-06, VAL, Hus Vallfarten, Campus Valla, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2015-02-05 Created: 2015-02-05 Last updated: 2015-02-05Bibliographically approved
2. Blended cognitive behavior therapy: efficacy and acceptability for treating depression in the adult and adolescent population
Open this publication in new window or tab >>Blended cognitive behavior therapy: efficacy and acceptability for treating depression in the adult and adolescent population
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Blended kognitiv beteendeterapi : acceptans och klinisk effekt för depression hos vuxna och unga
Abstract [en]

Depression is the most burdensome disorder worldwide in terms of health loss. The potential of internet and technologies to scale up psychological treatment resources is substantial. A blended treatment approach, reducing therapist time and combining sessions with online self-help components, could enhance availability of psychological treatment, while maintaining and possibly enhancing effect of treatment. The aim of this thesis was to develop and investigate the blended treatment approach, in terms of acceptance among key stakeholders, and clinical effect in treatment of depression in the adult and adolescent population.

Study I investigated acceptance of the blended treatment approach among mental health care stakeholders by means of a European survey. The results demonstrated that the majority readily accepted blended treatment for management of mild and moderate depression.

Study II evaluated blended treatment compared to standard face-toface psychotherapy in treatment of adult depression in a controlled non-inferiority trial. The results showed a similar decrease in depression from both interventions at post-treatment, with decreased levels maintained over six months. Non-inferiority for the blended treatment could not be statistically established.

Study III was a controlled non-inferiority trial evaluating blended treatment compared to treatment as usual. The results indicated superiority for the blended treatment at post-treatment and partly at six months. After twelve months the outcomes in the two conditions were similar.

Study IV evaluated blended treatment for adolescent depression in a controlled superiority trial, where the therapist time was not reduced, but sessions delivered via chat for improved reach and efficiency. Compared to attention control, the blended treatment significantly reduced depression symptoms, with effects indicated to be maintained over six months.

Study V was a controlled superiority trial, evaluating an improved version of the blended treatment used in Study IV to similar methods and in a similar population. In comparison to minimal attention control, the blended treatment significantly reduced depression symptoms at post-treatment, corresponding to a large treatment effect.

Across Study II to V, estimates indicated that the amount of therapist time that could be saved in blended treatment, compared to standard psychological treatment, was around 40%.

In conclusion, a gradual, blended integration of technology into psychological treatment i) performed well in treatment of adult and adolescent populations, ii) could substantially reduce therapist time in comparison to standard face-to-face psychological treatment, and iii) was accepted by patients as well as other mental health care stakeholders.

The thesis demonstrates the potentials of technology-assisted blended treatment models to deliver treatment of depression in the young and adult population in accordance with the current, urgent need to increase availability of psychological treatment as well as increase acceptance of technology-assisted mental health interventions.  

Abstract [sv]

Depression är en av vår tids största folksjukdomar. I Sverige och internationellt är behandlingsresurserna otillräckliga. Psykologisk behandling där terapisessioner kombineras med, och delvis ersätts av digitala självhjälpskomponenter – så kallad blended-terapi – kan vara ett sätt att öka tillgängligheten av behandling, samtidigt som individuella behandlarträffar fortfarande ingår. Denna avhandling syftar till att utvärdera acceptansen för, och effekten av, blended-terapi för depression.

Studie I var en europeisk enkätstudie som undersökte acceptansen för blended-terapi bland organisationer inom hälso- och sjukvård. Majoriteten av de medverkande organisationerna visade sig positivt inställda till behandlingsformen och föredrog den framför ren internetterapi. Studie II, III, IV och V var randomiserade kontrollerade studier som undersökte effekten av blended-terapi baserad på kognitiv beteendeterapi (KBT) för depression hos vuxna och hos tonåringar. Blended KBT utvärderades gentemot sedvanlig psykologisk behandling, uppmärksamhets- kontroll, samt interventioner representativa för primärvården. Resultaten i studierna visade genomgående stöd för att blended KBT som behandlingsmetod kan minska depression hos vuxna och tonåringar. Därutöver så indikerade resultaten att den totala tiden för behandlaren skulle kunna minskas betydligt i blended KBT, jämfört med sedvanlig psykologisk behandling.

Utifrån resultaten i Studie I-V så kan det konkluderas att blended-terapi baserad på KBT i) kan vara effektiv för att minska depression hos vuxna och unga individer, ii) har potential att minska behandlartid jämfört med traditionell behandling, iii) är en behandlingsform som ser ut att kunna uppnå acceptans hos såväl patienter som hos organisationer inom hälso- och sjukvård. Sammanfattningsvis visar resultaten på potentialen i blended-terapi vad gäller möjligheten att öka tillgängligheten av psykologisk behandling, på ett sätt som är kliniskt relevant och som kan främja acceptansen för digitala behandlingsformat.  

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2018. p. 107
Series
Linköping Studies in Arts and Sciences, ISSN 0282-9800 ; 740Linköping Studies in Behavioural Science, ISSN 1654-2029 ; 206
Keyword
acceptance, adolescents, adults, blended treatment, cognitive behavioral therapy, depression, digital, internet-delivered, e-mental health, stakeholders, technology-assisted, acceptans, blended, kognitiv beteendeterapi, KBT, depression digital, internetbehandling
National Category
Applied Psychology
Identifiers
urn:nbn:se:liu:diva-148016 (URN)9789176852972 (ISBN)
Public defence
2018-05-31, I:101, Hus I, Campus Valla, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2018-05-24 Created: 2018-05-24 Last updated: 2018-05-24Bibliographically approved

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