Category: Technology

Symposium

Automated Text Messaging to Improve Engagement in CBT for Depression: Outcomes and User Feedback

Keywords: Technology / Mobile Health | Depression | Hispanic Americans
Presentation Type: Symposium

Presenter(s)

• AA

  Adrian Aguilera, Ph.D.

  University of California, Berkeley

  Annum Health: Consultant/Advisory Board
  CareMessage: Consultant/Advisory Board

CBT for depression is efficacious, but effectiveness is more limited when implemented in low-income and Latino populations due to engagement difficulties such as sporadic attendance. We tested whether an automated text-messaging adjunct for the treatment of depression improved attendance in this population and led to greater recovery in depressive symptoms.  We also conducted patient interviews to inform future improvements to this adjunct.

Patients in an outpatient behavioral health clinic were assigned to standard group CBT for depression (control condition; n = 40) or the same treatment with the addition of a text-messaging adjunct (n = 45). The adjunct consisted of a daily mood-monitoring message, a daily message reiterating CBT content, as well as medication and appointment reminders.  A subsample of patients receiving the adjunct were interviewed at the end of treatment to explore barriers to engagement and methods of improving future iterations of the adjunct.

Using “intent-to-treat” analyses, patients assigned to the text-messaging adjunct stayed in therapy significantly longer before dropping out than patients assigned to the control (median of 13.5 vs. 3 weeks, respectively, Wilcoxon-Mann-Whitney z = -2.21, p = .027). Patients assigned to the text-messaging adjunct also attended more therapy sessions than those assigned to the control (median of 6 vs. 2.5 sessions), although this difference was not statistically significant (Wilcoxon-Mann-Whitney z = -1.65, p = .099). There were no condition differences in the extent of depressive symptom recovery (B = -.10, 95% CI [-.27, .06], z = -1.25, p = .212). Patients also provided qualitative feedback that is useful in further iterations of this and similar interventions. 

Our findings provide support for automated text messaging as a tool to improve engagement with CBT for depression by stabilizing attendance over time, and point to methods of improving engagement with mobile adjuncts to CBT. We also report feedback from participants using user centered design (UCD) methods.