Text message therapy for depression works in young adults

Young adults with depression have been treated effectively with a cognitive behavioural therapy (CBT) course – delivered via text message – in a pilot study conducted by researchers in the US.

The trial looked at a four-week CBT course adapted from a face-to-face programme to work via text messages, followed by a four-week follow-up period, in around 100 young adults in the US with at least one symptom of moderate depression and no recent history of antidepressant therapy.

The subjects were recruited using social media (Facebook and Instagram) and underwent an assessment for depression at enrolment and follow-up using the Beck Depression Inventory II scale.

They were then randomised to either the CBT-txt course – a total of 16 individualised, tailored text conversations delivered every other day – or a 'waiting list' to get access to the course at the end of the study.

Those who completed screening, baseline, the course, and the one-month follow-up received $125 in Amazon e-gift cards as an incentive, according to the investigators, led by University of Tennessee researcher Michael Mason.

At the end of the study, subjects in the CBT-txt arm were three times as likely to have minimal or mild depression symptoms compared to waiting list participants, with a 14.5-point reduction in BDI-II scores described by the investigators as "particularly encouraging."

The treatment was particularly helpful for those with severe depressive symptoms at baseline, according to researchers, who have published the results as a pre-press paper in the journal Behaviour Therapy.

The effect appeared after the first month, but started to wane, however, as the follow-up period neared its end, which the researchers said is not uncommon with digitally delivered CBT interventions .

"Producing a three-fold increase in the probability of having minimal or mild depressive symptoms for treatment participants relative to controls provides support for this efficient, cost-effective approach toward addressing young adult depression," they write.

"Targeting those with the most severe depression with CBT-txt may provide fast symptom relief, which then could be followed-up by a clinician."

The pilot study's results tie in with an increasing awareness that digital CBT has an important role to play in depression, particularly in young people.

In 2019, for example, UK health technology assessment (HTA) NICE recommended the use of CBT delivered via mobile phones, tablets, or computers as a first-line intervention for this patient group alongside psychotherapy and group mindfulness sessions. NICE now also backs the use of digital CBT for adults with mild to moderate depression.

While the study used a bespoke CBT approach adapted by the academic team, a range of off-the-shelf digital health programmes are already being offered to patients, from the likes of Happify Health, Orexis, and Limbix.