Comparative effectiveness of remote digital gamified and group CBT skills training interventions for anxiety and depression among college students: Results of a three-arm randomised controlled trial

IF 4.2 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy Pub Date : 2024-05-03 DOI:10.1016/j.brat.2024.104554

Jason Bantjes , Xanthe Hunt , Pim Cuijpers , Alan E. Kazdin , Chris J. Kennedy , Alex Luedtke , Ivana Malenica , Maria Petukhova , Nancy Sampson , Nur Hani Zainal , Charl Davids , Munita Dunn-Coetzee , Rone Gerber , Dan J. Stein , Ronald C. Kessler

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Abstract

Digital interventions can enhance access to healthcare in under-resourced settings. However, guided digital interventions may be costly for low- and middle-income countries, despite their effectiveness. In this randomised control trial, we evaluated the effectiveness of two digital interventions designed to address this issue: (1) a Cognitive Behavioral Therapy Skills Training (CST) intervention that increased scalability by using remote online group administration; and (2) the SuperBetter gamified self-guided CBT skills training app, which uses other participants rather than paid staff as guides. The study was implemented among anxious and/or depressed South African undergraduates (n = 371) randomised with equal allocation to Remote Group CST, SuperBetter, or a MoodFlow mood monitoring control. Symptoms were assessed with the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Intention-to-treat analysis found effect sizes at the high end of prior digital intervention trials, including significantly higher adjusted risk differences (ARD; primary outcome) in joint anxiety/depression remission at 3-months and 6-months for Remote Group CST (ARD = 23.3–18.9%, p = 0.001–0.035) and SuperBetter (ARD = 12.7–22.2%, p = 0.047–0.006) than MoodFlow and mean combined PHQ-9/GAD-7 scores (secondary outcome) significantly lower for Remote Group CST and SuperBetter than MoodFlow. These results illustrate how innovative delivery methods can increase the scalability of standard one-on-one guided digital interventions.

Preregistration international standard randomised controlled trial number (isrtcn) submission #

47,089,643.

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针对大学生焦虑症和抑郁症的远程数字游戏化和小组 CBT 技能培训干预的效果比较：三臂随机对照试验结果

在资源不足的环境中，数字干预可以提高医疗服务的可及性。然而，对于中低收入国家来说，有指导的数字化干预措施尽管有效，但成本可能很高。在这项随机对照试验中，我们评估了旨在解决这一问题的两种数字干预措施的有效性：（1）认知行为疗法技能培训（CST）干预措施，该措施通过使用远程在线小组管理提高了可扩展性；（2）SuperBetter 游戏化自我指导 CBT 技能培训应用程序，该应用程序使用其他参与者而不是有偿工作人员作为向导。该研究在焦虑和/或抑郁的南非大学生（n = 371）中实施，他们被随机等额分配到远程小组CST、SuperBetter或MoodFlow情绪监测对照组。症状通过广泛性焦虑症-7（GAD-7）和患者健康问卷-9（PHQ-9）进行评估。意向治疗分析发现，远程组 CST 的效应大小达到了之前数字干预试验的高端水平，包括 3 个月和 6 个月时焦虑/抑郁联合缓解的调整风险差异（ARD；主要结果）明显更高（ARD = 23.3-18.9%，p = 0.001-0.035）和 SuperBetter（ARD = 12.7-22.2%，p = 0.047-0.006）均高于 MoodFlow，远程小组 CST 和 SuperBetter 的 PHQ-9/GAD-7 平均综合评分（次要结果）显著低于 MoodFlow。这些结果表明，创新的实施方法可以提高标准的一对一指导数字干预的可扩展性。国际标准随机对照试验预注册号（isrtcn）提交号为47,089,643。

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来源期刊

Behaviour Research and Therapy PSYCHOLOGY, CLINICAL-

CiteScore

7.50

自引率

7.30%

发文量

148

期刊介绍： The major focus of Behaviour Research and Therapy is an experimental psychopathology approach to understanding emotional and behavioral disorders and their prevention and treatment, using cognitive, behavioral, and psychophysiological (including neural) methods and models. This includes laboratory-based experimental studies with healthy, at risk and subclinical individuals that inform clinical application as well as studies with clinically severe samples. The following types of submissions are encouraged: theoretical reviews of mechanisms that contribute to psychopathology and that offer new treatment targets; tests of novel, mechanistically focused psychological interventions, especially ones that include theory-driven or experimentally-derived predictors, moderators and mediators; and innovations in dissemination and implementation of evidence-based practices into clinical practice in psychology and associated fields, especially those that target underlying mechanisms or focus on novel approaches to treatment delivery. In addition to traditional psychological disorders, the scope of the journal includes behavioural medicine (e.g., chronic pain). The journal will not consider manuscripts dealing primarily with measurement, psychometric analyses, and personality assessment.