Integrating technology into cognitive behavior therapy for adolescent depression: a pilot study
Open accessAbstract
BACKGROUND: Rapid advances in information technology and telecommunications have resulted in a dramatic increase in the use of mobile devices and the internet to enhance and facilitate access to treatment. Cognitive behavior therapy (CBT) is an empirically based treatment that is well suited for enhancement by new technologies, particularly with youth. To facilitate the dissemination of this evidence-based treatment, we developed a technology-enhanced CBT intervention for the treatment of adolescent depression consisting of (1) online therapist training (2) in-session use of tablets for teaching clients CBT concepts and skills, and (3) text messaging for between session homework reminders and self-monitoring. METHODS: Eighteen licensed clinicians (social workers n = 7, psychologists n = 9) were randomized to have their patients receive either the intervention (CBT) or treatment as usual (TAU). Each clinician treated four adolescents for 12 weeks. Clinicians in the CBT arm completed an online tutorial on CBT treatment of adolescent depression, then received an iPad with access to patient education materials for teaching CBT concepts to patients during sessions. Individualized text messages were integrated into treatment for homework reminders, support, and outcomes measurement. Outcome measures included a 49-item multiple choice test for tutorial effectiveness; the system usability scale (SUS) for user satisfaction; quick inventory of depressive symptomatology-adolescent version (QIDS-A-Pat); and clinician and patient ratings on the therapeutic alliance scale for adolescents (TASA). RESULTS: A significant increase in knowledge of CBT concepts was found after completing the tutorial, t(8) = 7.02, p < 0.001. Clinician and patient ratings of user satisfaction were high for both the iPad teaching tools, and the text messaging. Ninety-five percent of teens said reviewing their text messages with their therapist was helpful, and all said they would use text messaging in treatment again. Ratings of the therapeutic alliance were higher in the CBT arm t(131) = 4.03, p = 0.001. A significant reduction in depression was found in both groups [t(34) = 8.453, p < 0.001 and t(29) = 6.67, p < 0.001 for CBT and TAU, respectively). Clinical ratings of improvement were greater on all outcome measures for the CBT arm; however, none reached statistical significance. Effect sizes (Cohen's d) ranged from small (QIDS-A) to large (TASA). CONCLUSIONS: Results support the feasibility of this technology-enhanced CBT intervention as a means of improving CBT treatment of adolescent depression and may help address the critical shortage of therapists trained on empirically based treatments.
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Most studies reported the technologies as acceptable (67%) with high satisfaction.
“Most studies reported the technologies as acceptable (67%) with high satisfaction [56,61,63,72]”
From eMental Healthcare Technologies for Anxiety and Depression in Childhood and Adolescence: Systematic Review of Studies Reporting Implementation Outcomes (2018) · cites this paper as [61]
Four studies (40%) reported high helpfulness.
“Four studies (40%) reported high helpfulness [57,60-62]”
From eMental Healthcare Technologies for Anxiety and Depression in Childhood and Adolescence: Systematic Review of Studies Reporting Implementation Outcomes (2018) · cites this paper as [61]
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- Authors
- Kobak, K. A., Mundt, J. C., & Kennard, B.
- Affiliations
- Center for Telepsychology (US)
- The University of Texas Southwestern Medical Center (US)
- Corresponding author
- Kobak, Kenneth A.
- Venue
- Annals of General Psychiatry
- Published
- 2015-11-03
- Volume
- 14
- Issue
- 1
- Pages
- 37-37
- ISSN
- 1744-859X (ISSN-L)
- PMC
- PMC4630889
- OpenAlex
- W2140292911
- Cited by
- 63
- References
- 73
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 4 · 2023: 5 · 2022: 2 · 2021: 10 · 2020: 8 · 2019: 8 · 2018: 10 · 2017: 5 · 2016: 5
- FWCI
- 10.81
- Type
- journal article
- Language
- en
- Update notices
- correction (2016-01-15)
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Annals of General Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Health and Human Services
- Small Business Innovation Research
- National Institutes of Health
- National Institute of Mental Health (R44MH086152)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- cognitive behavioral therapy, adolescent depression, text messaging, self-monitoring, therapeutic relationship, dissemination of evidence-based treatment, feasibility, TasA, mobile health, telemedicine
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