@article{1a5a7ccd194b48a08f535e625c68da08,
title = "Use of a fully automated internet-based cognitive behavior therapy intervention in a community population of adults with depression symptoms: Randomized controlled trial",
abstract = "Background: Although internet-based cognitive behavior therapy (iCBT) interventions can reduce depression symptoms, large differences in their effectiveness exist. Objective: The aim of this study was to evaluate the effectiveness of an iCBT intervention called Thrive, which was designed to enhance engagement when delivered as a fully automated, stand-alone intervention to a rural community population of adults with depression symptoms. Methods: Using no diagnostic or treatment exclusions, 343 adults with depression symptoms were recruited from communities using an open-access website and randomized 1:1 to the Thrive intervention group or the control group. Using self-reports, participants were evaluated at baseline and 4 and 8 weeks for the primary outcome of depression symptom severity and secondary outcome measures of anxiety symptoms, work and social adjustment, psychological resilience, and suicidal ideation. Results: Over the 8-week follow-up period, the intervention group (n=181) had significantly lower depression symptom severity than the control group (n=162; P<.001), with a moderate treatment effect size (d=0.63). Moderate to near-moderate effect sizes favoring the intervention group were observed for anxiety symptoms (P<.001; d=0.47), work/social functioning (P<.001; d=0.39), and resilience (P<.001; d=0.55). Although not significant, the intervention group was 45% less likely than the control group to experience increased suicidal ideation (odds ratio 0.55). Conclusions: These findings suggest that the Thrive intervention was effective in reducing depression and anxiety symptom severity and improving functioning and resilience among a mostly rural community population of US adults. The effect sizes associated with Thrive were generally larger than those of other iCBT interventions delivered as a fully automated, stand-alone intervention.",
keywords = "CBT, Depression symptoms, ICBT, Internet-based cognitive behavior therapy, RCT, Randomized controlled trial, Rural populations",
author = "Schure, {Mark B.} and Lindow, {Janet C.} and Greist, {John H.} and Nakonezny, {Paul A.} and Bailey, {Sandra J.} and Bryan, {William L.} and Byerly, {Matthew J.}",
note = "Funding Information: JHG previously held a financial interest in Waypoint Health Innovations, which developed the Thrive intervention evaluated in this work. He no longer has a direct financial interest in Waypoint Health Innovations but does retain a small interest in Waypoint Health Innovations through Healthcare Technology Systems where he is CEO and a shareholder. Waypoint Health Innovations also pays him a royalty based on revenue from Thrive use. He is also a consultant to Waypoint on projects outside of the grant supporting this study. The terms of JHG{\textquoteright}s financial relationship with Waypoint Health Innovations have been reviewed by Montana State University, and his involvement with this research project has been approved in accordance with its conflict of interest policies. Funding Information: 1Department of Health & Human Development, Montana State University, Bozeman, MT, United States 2Center for Mental Health Research and Recovery, Montana State University, Bozeman, MT, United States 3Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States 4Biomedical Research and Education Foundation of Southern Arizona, Tucson, AZ, United States 5Southern Arizona VA Health Care System, Tucson, AZ, United States 6School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States 7Healthcare Technology Systems, Madison, WI, United States 8Department of Cell Biology and Neuroscience, Montana State University, Bozeman, MT, United States 9Department of Population and Data Science, University of Texas Southwestern Medical Center, Dallas, TX, United States 10Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States 11Montana State University Extension, Bozeman, MT, United States 12One Montana, Bozeman, MT, United States Funding Information: At the time of the trial, JL and MB were affiliated with the Center for Mental Health Research and Recovery at Montana State University, Bozeman, Montana. JL is currently affiliated with the Department of Psychiatry at the University of Arizona, the Biomedical Research and Education Foundation of Southern Arizona, and the Southern Arizona VA Health Care System, Tucson, Arizona. MB is currently affiliated with the Department of Psychiatry at the University of Arizona and the Southern Arizona VA Health Care System, Tucson, Arizona. Funding Information: Research reported in this publication was supported by the National Institute of General Medical Sciences of the National Institutes of Health (P20GM103474, U54GM115371, and 5P20GM104417). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: {\textcopyright} Mark B Schure, Janet C Lindow, John H Greist, Paul A Nakonezny, Sandra J Bailey, William L Bryan, Matthew J Byerly.",
year = "2019",
month = nov,
day = "1",
doi = "10.2196/14754",
language = "English (US)",
volume = "21",
journal = "Journal of Medical Internet Research",
issn = "1439-4456",
publisher = "Journal of medical Internet Research",
number = "11",
}