Major depressive disorder (MDD) is a common and highly debilitating form of mood disorder with a lifetime prevalence of approximately 16%. MDD presents individual sufferers and their families with significant psychosocial challenges and is associated with a substantial burden of disability, reduced productivity, and sizeable strains on health care resources. Without follow-up maintenance treatment, MDD has a recurrence rate of about 80%. Cognitive-behavioral therapy (CBT) is a highly effective treatment for unipolar depression, but relapse rates are still high, ranging from 25-70% over two years. Homework assignments (HA) negotiated in therapy sessions are widely recognized as a core component of CBT and as crucial to positive treatment outcomes, yet remain one of the most poorly understood aspects of the intervention. A major goal of this study is to leverage the enormous therapeutic potential inherent in HA. We propose to evaluate the effects on CBT outcomes of a highly innovative mobile therapy system representing a next generation advance in our ability to personalize and contextualize the delivery of HA. This translational research effort represents a first step focused on evaluating the effectiveness of CBT when combined with a mobile smartphone system designed to enhance the acquisition of two overarching skill sets: a) behavioral activation (e.g., more pleasurable activities, increased accomplishment, reduced avoidance) and b) systematic testing and reformulation of automatic thoughts resulting in reduced depressogenic thinking. This project will examine the extent to which personalization and contextualization improve the efficacy of CBT by comparing CBT for depression personalized with a mobile therapy smartphone system (eCBT;n=45) with standard CBT (n=45) in a community sample of clients seeking treatment for depression (MDD). Personalization of CBT will include programming the mobile therapy system to track client behaviors and automatically detect where a client is and who else is there (social context) and then deliver situation- appropriate strategies for challenging or testing the maladaptive automatic thinking that these contexts elicit. Using client and therapist input, the eCBT device will also cue and track HAs, provide a menu of tailored interventions from which the client can choose, and record moods on an ongoing basis as well as before and after specific interventions. CBT for depression personalized with a mobile therapy smartphone system (eCBT) will be compared with standard CBT on treatment outcome measures collected at baseline, 8 weeks (mid-treatment), 12-16 weeks (immediately post-treatment), and 6-month post-treatment (follow-up). We predict that eCBT will be associated with greater reductions in symptomatic moods, thoughts, and behaviors and more positive trajectories at these assessment points. Day-by-day changes in moods and behaviors will also be monitored and compared across conditions. If successful, the results of this study may have a significant impact on how the `bridges between sessions'(i.e., HA) are utilized in CBT for depression. The findings of this study may inform the design of interventions that produce more rapid treatment gains with greater resiliency against relapse. Public Health Relevance: Major Depressive Disorder presents individual sufferers and their families with significant psychosocial challenges and is associated with a substantial burden of disability and reduced productivity. Cognitive- behavioral therapy (CBT) has been shown to be a highly effective treatment for unipolar depression, however, relapse estimates for CBT range from 25-70% over two years and from 15-50% within one. If successful, the results of this study may have a significant impact on how the `bridge-between sessions'are utilized in CBT for depression and will inform the design of interventions that produce more rapid treatment gains with greater resiliency against relapse.
Major Depressive Disorder presents individual sufferers and their families with significant psychosocial challenges and is associated with a substantial burden of disability and reduced productivity. Cognitive- behavioral therapy (CBT) has been shown to be a highly effective treatment for unipolar depression, however, relapse estimates for CBT range from 25-70% over two years and from 15-50% within one. If successful, the results of this study may have a significant impact on how the `bridge-between sessions'are utilized in CBT for depression and will inform the design of interventions that produce more rapid treatment gains with greater resiliency against relapse.
