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Cited by 57Digital Mental Health InterventionsTelemedicine and Telehealth ImplementationAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

A randomized noninferiority trial evaluating remotely-delivered stepped care for depression using internet cognitive behavioral therapy (CBT) and telephone CBT

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Mohr, David C., Lattie, Emily G., Tomasino, Kathryn Noth, Kwasny, Mary J., Kaiser, Susan M., Gray, Elizabeth L., Alam, Nameyeh, Jordan, Neil +1 more·2019·Behaviour Research and Therapy
DOI 10.1016/j.brat.2019.103485PMC PMC6916718
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Abstract

This trial examined whether a stepped care program for depression, which initiated treatment with internet cognitive behavioral therapy, including telephone and messaging support, and stepped up non-responders to telephone-administered cognitive behavioral therapy (tCBT), was noninferior, less costly to deliver, and as acceptable to patients compared to tCBT alone. Adults with a diagnosis of major depressive episode (MDE) were randomized to receive up to 20 weeks of stepped care or tCBT. Stepped care (n = 134) was noninferior to tCBT (n = 136) with an end-of-treatment effect size of d = 0.03 and a 6-month post-treatment effect size of d = -0.07 [90% CI 0.29 to 0.14]. Therapist time in stepped care was 5.26 (SD = 3.08) hours versus 10.16 (SD 4.01) for tCBT (p < 0.0001), with a delivery cost difference of $-364.32 [95% CI $-423.68 to $-304.96]. There was no significant difference in pre-treatment preferences (p = 0.10) or treatment dropout (39 in stepped care; 27 in tCBT; p = 0.14). tCBT patients were significantly more satisfied than stepped care patients with the treatment they received (p < 0.0001). These findings indicate that stepped care was less costly to deliver, but no less effective than tCBT. There was no significant difference in treatment preference or completion, however satisfaction with treatment was higher in tCBT than stepped care. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01906476.

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Authors
Mohr, D. C., Lattie, E. G., Tomasino, K. N., Kwasny, M. J., Kaiser, S. M., Gray, E. L., Alam, N., Jordan, N., & Schueller, S. M.
Affiliations
Northwestern University (US)
Corresponding author
Mohr, David C.
ORCID
Venue
Behaviour Research and Therapy
Publisher
Elsevier BV
Published
2019-12
Volume
123
Pages
103485
ISSN
0005-7967 (ISSN-L)
DOI
10.1016/j.brat.2019.103485
PMC
PMC6916718
OpenAlex
W2977706610
Cited by
57
References
61
Citations by year
2026: 3 · 2025: 7 · 2024: 5 · 2023: 8 · 2022: 13 · 2021: 11 · 2020: 8 · 2019: 2
FWCI
9.60
Type
journal article
Language
en
Open access
Licence
Locations
  • Behaviour Research and Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • US National Institute of Mental Health (R01 MH095753)
  • Northwestern University Clinical and Translational Science
  • National Institutes of Health's National Center for Advancing Translational Sciences (UL1TR001422)
  • EGL (K08 MH112878)
  • National Institute of Mental Health (R25 MH08091607)
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
depression, stepped care, internet-based cognitive behavioral therapy, major depressive episode, non-inferiority, treatment costs, treatment satisfaction, treatment preferences, treatment discontinuation
MeSH terms
Adult, Major Depressive Disorder, Female, Patient Care, Humans, Male, Patient Dropouts, Telephone, Cognitive Behavioral Therapy, Treatment Outcome, Health Care Costs, Patient Satisfaction, Telemedicine, Internet, Young Adult

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