Digital cognitive behavior therapy intervention for depression and anxiety: retrospective study
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Abstract
BACKGROUND: Digital mental health interventions offer a scalable solution that reduces barriers to seeking care for clinical depression and anxiety. OBJECTIVE: We aimed to examine the effectiveness of a 12-week therapist supported, app-based cognitive behavioral therapy program in improving symptoms of depression and anxiety within 9 months. METHODS: A total of 323 participants with mild to moderately severe depression or anxiety were enrolled in a 12-week digital cognitive behavior therapy program. The analysis was restricted to participants who provided at least one follow-up assessment after baseline. As a result, 146 participants (45.2%) were included in the analysis-74 (50.7%) participants completed assessments at 3 months, 31 participants (21.2%) completed assessments at 6 months, and 21 participants (14.4%) completed assessments at 9 months. The program included structured lessons and tools (ie, exercises and practices) as well as one-on-one weekly video counseling sessions with a licensed therapist for 12 weeks and monthly check-in sessions for 1 year. The clinically validated Patient Health Questionnaire (PHQ-8) and Generalized Anxiety Disorder Scale (GAD-7) were used to assess depression and anxiety, respectively. Linear mixed-effects modeling was employed to examine changes in depression and anxiety over time. RESULTS: We observed a significant positive effect of program time on improvement in depression (β=-0.12, P<.001) and anxiety scores (β=-0.10, P<.001). At the end of the 12-week intervention, we observed an average reduction of 3.76 points (95% CI -4.76 to -2.76) in PHQ-8 scores. Further reductions in depression were seen at program month 6 (4.75-point reduction, 95% CI -6.61 to -2.88) and program month 9 (6.42-point reduction, 95% CI -8.66 to -6.55, P<.001). A similar pattern of improvement emerged for anxiety, with a 3.17-point reduction at the end of the 12-week intervention (95% CI -4.21 to -2.13). These improvements were maintained at program month 6 (4.87-point reduction, 95% CI -6.85 to -2.87) and program month 9 (5.19-point, 95% -6.85 to 4.81). In addition, greater program engagement during the first 12 weeks predicted a greater reduction in depression (β=-0.29, P<.001). CONCLUSIONS: The results suggest that digital interventions can support sustained and clinically meaningful improvements in depression and anxiety. Furthermore, it appears that strong initial digital mental health intervention engagement may facilitate this effect. However, the study was limited by postintervention participant attrition as well as the retrospective observational study design.
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CBT-DHI programmes often require consistent use, and high attrition rates have limited their efficacy in research.
“CBT-DHI programmes often require consistent use, and high attrition rates have limited their efficacy in research.47”
From Mixed-methods feasibility outcomes for a novel ACT-based video game ‘ACTing Minds’ to support mental health (2024) · cites this paper as [47]
The Results (Engagement) associate greater program engagement with greater improvement, and the Introduction and Discussion (Limitations) describe attrition as a continuing challenge. However, the paper says attrition limits the study and leaves overall effectiveness uncertain; it does not establish that high attrition has reduced the programmes’ efficacy. (LLM, conf=0.84)
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- Authors
- Venkatesan, A., Rahimi, L., Kaur, M., & Mosunic, C.
- Corresponding author
- Venkatesan, Aarathi
- Venue
- JMIR Mental Health
- Publisher
- JMIR Publications Inc.
- Published
- 2020-08-26
- Volume
- 7
- Issue
- 8
- Pages
- e21304
- ISSN
- 2368-7959 (ISSN-L)
- PMC
- PMC7481876
- OpenAlex
- W3046189340
- Cited by
- 47
- References
- 32
- Citations by year
- 2026: 8 · 2025: 11 · 2024: 10 · 2023: 7 · 2022: 8 · 2021: 2 · 2020: 1
- FWCI
- 4.07
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Mental Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- depression, anxiety, mental health apps, video counseling, PHQ-8, GAD-7, symptom improvement over time, digital mental health interventions, barriers to mental health care
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