Cognitive and Behavioral Skills Exercises Completed by Patients with Major Depression During Smartphone Cognitive Behavioral Therapy: Secondary Analysis of a Randomized Controlled Trial

A strong and growing body of evidence has demonstrated the effectiveness of cognitive behavioral therapy (CBT), either face-to-face, in person, or as self-help via the Internet, for depression. However, CBT is a complex intervention consisting of several putatively effective components, and how each...

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Bibliographic Details
Published in:JMIR mental health 2018-01, Vol.5 (1), p.e4
Main Authors: Furukawa, Toshi A, Horikoshi, Masaru, Fujita, Hirokazu, Tsujino, Naohisa, Jinnin, Ran, Kako, Yuki, Ogawa, Sei, Sato, Hirotoshi, Kitagawa, Nobuki, Shinagawa, Yoshihiro, Ikeda, Yoshio, Imai, Hissei, Tajika, Aran, Ogawa, Yusuke, Akechi, Tatsuo, Yamada, Mitsuhiko, Shimodera, Shinji, Watanabe, Norio, Inagaki, Masatoshi, Hasegawa, Akio
Format: Article
Language:English
Subjects:
Behavior modification
Clinical trials
Cognition & reasoning
Cognitive ability
Cognitive therapy
Medical research
Mental depression
Original Paper
Patients
Psychotherapy
Smartphones
Telemedicine
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Summary:A strong and growing body of evidence has demonstrated the effectiveness of cognitive behavioral therapy (CBT), either face-to-face, in person, or as self-help via the Internet, for depression. However, CBT is a complex intervention consisting of several putatively effective components, and how each component may or may not contribute to the overall effectiveness of CBT is poorly understood. The aim of this study was to investigate how the users of smartphone CBT use and benefit from various components of the program. This is a secondary analysis from a 9-week, single-blind, randomized controlled trial that has demonstrated the effectiveness of adjunctive use of smartphone CBT (Kokoro-App) over antidepressant pharmacotherapy alone among patients with drug-resistant major depressive disorder (total n=164, standardized mean difference in depression severity at week 9=0.40, J Med Internet Res). Kokoro-App consists of three cognitive behavioral skills of self-monitoring, behavioral activation, and cognitive restructuring, with corresponding worksheets to fill in. All activities of the participants learning each session of the program and completing each worksheet were uploaded onto Kokoro-Web, which each patient could use for self-check. We examined what use characteristics differentiated the more successful users of the CBT app from the less successful ones, split at the median of change in depression severity. A total of 81 patients with major depression were allocated to the smartphone CBT. On average, they completed 7.0 (standard deviation [SD] 1.4) out of 8 sessions of the program; it took them 10.8 (SD 4.2) days to complete one session, during which they spent 62 min (SD 96) on the app. There were no statistically significant differences in the number of sessions completed, time spent for the program, or the number of completed self-monitoring worksheets between the beneficiaries and the nonbeneficiaries. However, the former completed more behavioral activation tasks, engaged in different types of activities, and also filled in more cognitive restructuring worksheets than the latter. Activities such as "test-drive a new car," "go to a coffee shop after lunch," or "call up an old friend" were found to be particularly rewarding. All cognitive restructuring strategies were found to significantly decrease the distress level, with "What would be your advice to a friend who has a similar problem?" found more helpful than some other strategies. The CBT program
ISSN:2368-7959
2368-7959
DOI:10.2196/mental.9092