Cognitive Behavior Therapy, Major Depressive Disorder, Text Messaging
Conditions
Keywords
Depression, CBT, Texting, SMS
Brief summary
The primary goal of the pilot is to test the feasibility and utility of using a text-messaging system to engage adolescents in improved homework adherence during cognitive-behavioral therapy (CBT) for major depressive disorder.
Detailed description
Adolescent major depressive disorder leads to recurrent episodes, increased rates of attempted and completed suicides, and persistent social impairment between episodes (Weissman et al 1999). Cognitive behavioral therapy (CBT) is an accepted first-line therapy for mild-moderate depression in adolescents. Integral to CBT is homework as it enhances mastery of newly learned coping strategies, facilitates generalization of skills to novel situations, increases self-efficacy, and ultimately reduces vulnerability to relapse (Detweiler et al 1999). Adherence to homework is a recognized problem in adults, and is similarly problematic in adolescents. One method of implementing CBT homework in a manner that is centric to current youth culture is through text messaging. By using a modern modality that many adolescents rely on for daily communication, there is the likelihood that they will find it more engaging than traditional modalities. Thus the potential that a text message system can help improve homework compliance in adolescents is significant, because improved homework adherence may ultimately be linked to improved clinical outcomes for these disorders with high rates of chronic morbidity and mortality.
Interventions
BEHAVIORALPaper and pen homework
Homework will be standardized through the use of Judith Beck's dysfunctional thought record (DTR), which is a primary tool for patients to evaluate and respond in writing to their automatic thoughts (Beck 126). The homework will be done on a preprinted form which is assigned weekly and reviewed with their therapists at weekly sessions for 4 weeks.
DEVICEText message system homework.
Homework will be standardized through the use of Judith Beck's dysfunctional thought record (DTR), which is a primary tool for patients to evaluate and respond in writing to their automatic thoughts (Beck 126). The novel text-messaging system allows homework to be submitted directly through an adolescent's cellular phone, includes text-messaged homework reminder prompts, and collates all homework for therapists to review with patients during therapy sessions. This is assigned and reviewed weekly for 4 weeks.
Sponsors
American Academy of Child Adolescent Psychiatry.
University of Pittsburgh
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
13 Years to 17 Years
Healthy volunteers
No
Inclusion criteria
* major depressive disorder * own a cellular phone with text messaging capabilities
Exclusion criteria
* history of psychosis * history of mental retardation * active suicidal ideation or intent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Therapy Homework Compliance: Percent Homework Completed | 1 month | Number of thought logs completed over the course of the 4 week trial. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Exit Interview | 1 month | Verbal interview |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Paper and Pen Homework Treatment as usual: therapy homework is completed by paper and pen.
Paper and pen homework: Homework will be standardized through the use of Judith Beck's dysfunctional thought record (DTR), which is a primary tool for patients to evaluate and respond in writing to their automatic thoughts (Beck 126). The homework will be done on a preprinted form which is assigned weekly and reviewed with their therapists at weekly sessions for 4 weeks. | 4 |
| Text-message Homework Experimental treatment: therapy homework is completed by text messaging.
Text message system homework.: Homework will be standardized through the use of Judith Beck's dysfunctional thought record (DTR), which is a primary tool for patients to evaluate and respond in writing to their automatic thoughts (Beck 126). The novel text-messaging system allows homework to be submitted directly through an adolescent's cellular phone, includes text-messaged homework reminder prompts, and collates all homework for therapists to review with patients during therapy sessions. This is assigned and reviewed weekly for 4 weeks. | 5 |
| Total | 9 |
Baseline characteristics
| Characteristic | Paper and Pen Homework | Text-message Homework | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 4 Participants | 5 Participants | 9 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Region of Enrollment United States | 4 participants | 5 participants | 9 participants |
| Sex: Female, Male Female | 4 Participants | 4 Participants | 8 Participants |
| Sex: Female, Male Male | 0 Participants | 1 Participants | 1 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 |
Outcome results
Primary
Therapy Homework Compliance: Percent Homework Completed
Number of thought logs completed over the course of the 4 week trial.
Time frame: 1 month
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Paper and Pen Homework | Therapy Homework Compliance: Percent Homework Completed | Week 1 | .44 homework sheets completed | Standard Deviation 0.27 |
| Paper and Pen Homework | Therapy Homework Compliance: Percent Homework Completed | Week 2 | 0.47 homework sheets completed | Standard Deviation 0.39 |
| Paper and Pen Homework | Therapy Homework Compliance: Percent Homework Completed | Week 3 | 0.37 homework sheets completed | Standard Deviation 0.35 |
| Paper and Pen Homework | Therapy Homework Compliance: Percent Homework Completed | Week 4 | 0.27 homework sheets completed | Standard Deviation 0.24 |
| Text-message Homework | Therapy Homework Compliance: Percent Homework Completed | Week 4 | 0 homework sheets completed | Standard Deviation 0 |
| Text-message Homework | Therapy Homework Compliance: Percent Homework Completed | Week 1 | 0 homework sheets completed | Standard Deviation 0 |
| Text-message Homework | Therapy Homework Compliance: Percent Homework Completed | Week 3 | 0 homework sheets completed | Standard Deviation 0 |
| Text-message Homework | Therapy Homework Compliance: Percent Homework Completed | Week 2 | 0.25 homework sheets completed | Standard Deviation 0.4 |
Secondary
Exit Interview
Verbal interview
Time frame: 1 month
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Paper and Pen Homework | Exit Interview | 4 participants |
| Text-message Homework | Exit Interview | 5 participants |