Text messaging as an adjunct to CBT in low-income populations: A usability and feasibility pilot study.
Open accessAbstract
This article outlines the development and usability-feasibility testing of an automated text-messaging adjunct to cognitive- behavioral therapy (CBT) for depression in a public sector clinic serving low-income patients. The text-messaging adjunct is aimed at increasing homework adherence, improving self-awareness, and helping track patient progress. Daily text messages were sent to patients, inquiring about their mood. Additional daily messages corresponded to themes of a manualized group CBT intervention. These included (1) thought tracking (both positive and negative), (2) tracking of pleasant activities, (3) tracking of positive and negative contacts, and (4) tracking of physical well-being. We tested the adjunct in 2 CBT groups (1 English & 1 Spanish) consisting of 12 patients total during and after treatment. Participants responded at a rate of 65% to text messages, and they reported overall positive experiences. We propose that text messaging has the potential to improve mental health care broadly, and among low-income populations specifically, with cost-effective means.
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Text messaging reminders have proven effective in increasing treatment adherence among POC community samples, including those in app-based mindfulness meditation studies.
“Text messaging reminders have proven effective in increasing treatment adherence among POC community samples [54-56,63], including those in app-based mindfulness meditation studies [49].”
From App-Based Mindfulness Meditation for People of Color Who Experience Race-Related Stress: Protocol for a Randomized Controlled Trial (2022) · cites this paper as [56]
The Methods (Participants; page not provided) describe a low-income CBT sample that included Latino and African American patients. But the Abstract and Discussion describe the text-messaging adjunct as feasible and potentially helpful for adherence, not as proven to increase it. The app-based mindfulness clause has a separate citation and is not attributed to this paper. (LLM, conf=0.88)
Experimental — accuracy not yet measuredText messaging reminders as an engagement strategy are well tolerated by participants.
“Importantly, this engagement strategy is well tolerated by participants [56].”
From App-Based Mindfulness Meditation for People of Color Who Experience Race-Related Stress: Protocol for a Randomized Controlled Trial (2022) · cites this paper as [56]
Receiving a text messaging adjunct increases attendance in group CBT.
“and that receiving this text messaging adjunct increases attendance.”
From Ecological momentary interventions for depression and anxiety (2017) · cites this paper as Aguilera & Munoz, 2011
EMIs have been used as an adjunct to therapy to increase homework adherence and reinforce therapeutic concepts in real-world settings.
“Indeed, EMIs have been used as an adjunct to therapy to increase homework adherence and reinforce therapeutic concepts in realworld settings.”
From Ecological momentary interventions for depression and anxiety (2017) · cites this paper as Aguilera & Munoz, 2011
Evidence from other studies suggests that app adherence and, thus, efficacy might be improved by extending program prompts and psychoeducational messaging beyond the original 6-week intervention period and/or providing mobile-friendly prompts (eg, text messages and app notifications) in addition to the emails utilized here.
“evidence from other studies suggests that app adherence and, thus, efficacy might be improved by extending program prompts and psychoeducational messaging beyond the original 6-week intervention period and/or providing mobile-friendly prompts (eg, text messages and app notifications) in addition to the emails utilized here [65,90].”
From MoodHacker Mobile Web App With Email for Adults to Self-Manage Mild-to-Moderate Depression: Randomized Controlled Trial (2016) · cites this paper as [65]
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Mobile Phone–Based Mood Ratings Prospectively Predict Psychotherapy Attendance
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“Text messaging reminders have proven effective in increasing treatment adherence among POC community samples [54-56,63], including those in app-based mindfulness meditation studies [49].”
BackgroundSelf-citationProvision Increases Reported PPE Use for Mexican Immigrant Farmworkers
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Mobile Phone Apps for Behavioral Interventions for At-Risk Drinkers in Australia: Literature Review
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Homework Completion via Telephone and In-Person Cognitive Behavioral Therapy Among Latinos
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- Authors
- Aguilera, A., & Muñoz, R. F.
- Affiliations
- San Francisco General Hospital (US)
- Venue
- Professional Psychology: Research and Practice
- Published
- 2011-12
- Volume
- 42
- Issue
- 6
- Pages
- 472-478
- ISSN
- 0735-7028 (ISSN-L)
- 1939-1323
- PMC
- PMC4267577
- OpenAlex
- W2019528246
- Cited by
- 159
- References
- 39
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 4 · 2023: 4 · 2022: 8 · 2021: 12 · 2020: 6 · 2019: 11 · 2018: 11 · 2017: 19 · 2016: 21 · 2015: 26 · 2014: 10 · 2013: 12 · 2012: 7
- FWCI
- 12.41
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Professional Psychology Research and Practice (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (K23MH094442)
- National Institute on Minority Health and Health Disparities (L60 MD003465)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- text messaging, cognitive behavioral therapy, depression, low-income populations, homework adherence, self-monitoring, mood tracking, automated intervention, Spanish-language intervention
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