Automated Text Messaging as an Adjunct to Cognitive Behavioral Therapy for Depression: A Clinical Trial
Open accessAbstract
BACKGROUND: Cognitive Behavioral Therapy (CBT) for depression is efficacious, but effectiveness is limited when implemented in low-income settings due to engagement difficulties including nonadherence with skill-building homework and early discontinuation of treatment. Automated messaging can be used in clinical settings to increase dosage of depression treatment and encourage sustained engagement with psychotherapy. OBJECTIVES: The aim of this study was to test whether a text messaging adjunct (mood monitoring text messages, treatment-related text messages, and a clinician dashboard to display patient data) increases engagement and improves clinical outcomes in a group CBT treatment for depression. Specifically, we aim to assess whether the text messaging adjunct led to an increase in group therapy sessions attended, an increase in duration of therapy attended, and reductions in Patient Health Questionnaire-9 item (PHQ-9) symptoms compared with the control condition of standard group CBT in a sample of low-income Spanish speaking Latino patients. METHODS: Patients in an outpatient behavioral health clinic were assigned to standard group CBT for depression (control condition; n=40) or the same treatment with the addition of a text messaging adjunct (n=45). The adjunct consisted of a daily mood monitoring message, a daily message reiterating the theme of that week's content, and medication and appointment reminders. Mood data and qualitative responses were sent to a Web-based platform (HealthySMS) for review by the therapist and displayed in session as a tool for teaching CBT skills. RESULTS: Intent-to-treat analyses on therapy attendance during 16 sessions of weekly therapy found that patients assigned to the text messaging adjunct stayed in therapy significantly longer (median of 13.5 weeks before dropping out) than patients assigned to the control condition (median of 3 weeks before dropping out; Wilcoxon-Mann-Whitney z=-2.21, P=.03). Patients assigned to the text messaging adjunct also generally attended more sessions (median=6 sessions) during this period than patients assigned to the control condition (median =2.5 sessions), but the effect was not significant (Wilcoxon-Mann-Whitney z=-1.65, P=.10). Both patients assigned to the text messaging adjunct (B=-.29, 95% CI -0.38 to -0.19, z=-5.80, P<.001) and patients assigned to the control conditions (B=-.20, 95% CI -0.32 to -0.07, z=-3.12, P=.002) experienced significant decreases in depressive symptom severity over the course of treatment; however, the conditions did not significantly differ in their degree of symptom reduction. CONCLUSIONS: This study provides support for automated text messaging as a tool to sustain engagement in CBT for depression over time. There were no differences in depression outcomes between conditions, but this may be influenced by low follow-up rates of patients who dropped out of treatment.
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Previous studies show that receiving simple text messaging reminders increases attendance to face-to-face treatment sessions among people of color.
“The feasibility of this approach is supported by previous studies showing that receiving simple text messaging reminders increases attendance to face-to-face treatment sessions among POC [54,55].”
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 [54]
The Methods (Intervention; page unavailable) describe weekly texts reminding patients to attend group psychotherapy, and the Results (Outcomes; page unavailable) report that the texting group attended more sessions on average, but the difference was not statistically significant. The intervention also included other messages, so the study does not establish that simple reminders themselves increased attendance. (LLM, conf=0.89)
Experimental — accuracy not yet measuredText 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 [54]
The Discussion (Principal Findings and Conclusions; page unavailable) reports decreased attrition and later dropout among low-income, Spanish-speaking Latino patients receiving texts alongside group CBT. But the intervention included more than reminders, so the trial does not establish that reminders themselves caused the improvement. The app-based mindfulness clause is cited to a different source [49], not this paper. (LLM, conf=0.87)
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“On the other hand, SMS text messaging interventions have had a significant effect on the likelihood or severity of current suicidal ideation [5] but has been found ineffective in improving depressive symptoms in another study [7].”
Schuster, R., Fischer, E., Jansen, C., Napravnik, N., Rockinger, S., Steger, N., & Laireiter, A.-R. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100551 · Cited by 15 · see citing works
“, 2018), and depression (Aguilera et al., 2017), with most interventions exhibiting a comparably short treatment duration of less than ten weeks.”
BackgroundDinesh, D., Rao, M. N., & Sinha, C. (2024) · Digital Health · doi:10.1177/20552076241255616 · Cited by 15 · see citing works
“21 However, despite the openness to DMHIs, it has been found that many digital health apps have poor retention rates.”
BackgroundFigueroa, C. A., Hernandez-Ramos, R., Boone, C. E., Pathak, L. E., Yip, V., Luo, T. C., de la Sierra, V. Q., Xu, J., Chakraborty, B., Darrow, S. M., et al. (2020) · JMIR Research Protocols · doi:10.2196/23592 · Cited by 15 · see citing works
“HealthySMS has been successfully used with various low-income, adult populations in English and Spanish [11-13].”
Self-citationRamos, G., Aguilera, A., Montoya, A., Lau, A., Wen, C. Y., Cruz Torres, V., & Chavira, D. (2022) · JMIR Research Protocols · doi:10.2196/35196 · Cited by 12 · see citing works
“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].”
BackgroundResultSelf-citationExamining the Effectiveness of the Fathers and Babies Intervention: A Pilot Study
Tandon, S. D., Hamil, J. L., Gier, E. E., & Garfield, C. F. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.668284 · Cited by 15 · see citing works
Schwebel, F. J., & Larimer, M. E. (2020) · Digital Health · doi:10.1177/2055207620965052 · Cited by 13 · see citing works
“One pilot study investigated the use of text message reminders as an adjunct to cognitive-behavioral therapy (CBT) for depression among an outpatient, adult Latino population.(50) All participants received a 16-week manualized CBT treatment for depression.”
MethodHamil, J. L., Gier, E. E., Garfield, C. F., & Tandon, S. D. (2021) · American Journal of Men s Health · doi:10.1177/15579883211044306 · Cited by 11 · see citing works
“HealthySMS (www.healthysms.org) (Aguilera et al., 2017) is a web-based platform designed to deliver healthrelated text messages.”
BackgroundHaro‐Ramos, A. Y., Rodríguez, H. P., & Aguilera, A. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104318 · Cited by 12 · see citing works
Self-citationEffect of Mobile Health on In-person Service Use Among People With Serious Mental Illness
Ben‐Zeev, D., Buck, B., Hallgren, K. A., & Drake, R. E. (2019) · Psychiatric Services · doi:10.1176/appi.ps.201800542 · Cited by 12 · see citing works
Marthick, M., Janssen, A. L., Cheema, B. S., Alison, J. A., Shaw, T. J., & Dhillon, H. M. (2019) · JMIR Cancer · doi:10.2196/15539 · Cited by 12 · see citing works
“There has been a recent interest, and promising results, in the use of automated messaging, such as those sent through SMS, to drive health behavior change within certain populations, such as for people with diabetes and depression [21,22].”
BackgroundBarrera, A. Z., Hamil, J. L., & Tandon, S. D. (2021) · JMIR Formative Research · doi:10.2196/30995 · Cited by 11 · see citing works
“HealthySMS [39] is a web-based platform designed to send health-related SMS text messages.”
BackgroundExpanding, improving, and understanding behaviour research and therapy through digital mental health
Cohen, Z. D., & Schueller, S. M. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104358 · Cited by 10 · see citing works
Malgaroli, M., Hull, T. D., & Schultebraucks, K. (2021) · Psychiatric Annals · doi:10.3928/00485713-20201203-01 · Cited by 12 · see citing works
Biswal, B., Gandhi, Y., Singla, D. R., Velleman, R. D. B., Zhou, B., Fernandes, L., Patel, V., Prina, M. A., Sequeira, M., Garg, A., et al. (2024) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2024.94 · Cited by 13 · see citing works
“These messages were tailored in collaboration with patients (Furber et al., 2014; Aguilera et al., 2017; Alfonsson etal., 2019) or were interactive (Furber et al., 2014).”
BackgroundMethodInfluentialOpen trial of an adaptation of cognitive processing therapy for message-based delivery.
Stirman, S., Song, J., Hull, T. D., & Resick, P. (2021) · Technology, Mind, and Behavior · doi:10.1037/tmb0000016 · Cited by 10 · see citing works
“Studies have shown that as an adjunct to face-to-face cognitive behavioral therapy, messaging is associated with greater retention in psychotherapy (Aguilera et al., 2017).”
BackgroundAreán, P. A., Hull, D., Pullmann, M. D., & Heagerty, P. J. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-046958 · Cited by 11 · see citing works
Kravitz, R. L., Aguilera, A., Chen, E. J., Choi, Y. K., Hekler, E. B., Karr, C. J., Kim, K. K., Phatak, S. S., Sarkar, S., Schueller, S. M., et al. (2020) · Frontiers in Public Health · doi:10.3389/fpubh.2020.00260 · Cited by 11 · see citing works
Self-citationVázquez, Y. G., Sexto, C. F., & Villamayor, M. J. G. (2020) · Social Sciences · doi:10.3390/socsci9050063 · Cited by 10 · see citing works
“Secondly, we decided to use the final questionnaire that measures the degree of satisfaction with text messages (FQTM), which is an instrument validated by Aguilera et al. (2017).”
BackgroundMethodInfluentialHernandez-Ramos, R., Altszyler, E., Figueroa, C. A., Avila-Garcia, P., & Aguilera, A. (2021) · Behaviour Research and Therapy · doi:10.1016/j.brat.2021.104027 · Cited by 10 · see citing works
Self-citationVázquez, Y. G., Sexto, C. F., Rocha, Á., & Aguilera, A. (2018) · Health Informatics Journal · doi:10.1177/1460458218792688 · Cited by 10 · see citing works
“Journal Health informatics journal, 25(4)”
Self-citationFigueroa, C. A., DeMasi, O., Hernandez-Ramos, R., & Aguilera, A. (2020) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2019.0248 · Cited by 9 · see citing works
“11 The texting was programmed to start during the first week of GCBT.”
Self-citationVázquez, Y. G., Sexto, C. F., Aguilera, A., & Avila-Garcia, P. (2017) · Journal of Technology in Human Services · doi:10.1080/15228835.2017.1345672 · Cited by 8 · see citing works
“The entire process was in accordance with the guidelines of the Bioethics Committees of the University of Santiago de Compostela and the University of California, Berkeley.”
BackgroundMethodInfluentialSelf-citationLeng, L., Avalos, M. R. A., Aguilera, A., & Lyles, C. R. (2025) · JMIR mhealth and uhealth · doi:10.2196/64296 · Cited by 5 · see citing works
“The advent of cost-effective mHealth apps has been effective in helping patients engage in healthy behaviors, such as increased physical activity and lowered HbA 1c levels [10].”
Self-citationAreán, P. A., Pullmann, M. D., Fillipo, I. G., Wu, J., Mosser, B. A., Chen, S., Heagerty, P. J., & Hull, T. D. (2024) · Psychiatric Services · doi:10.1176/appi.ps.20230176 · Cited by 6 · see citing works
Cottrell‐Daniels, C., Jones, D. M., Bell, S. A., Bandlamudi, M., & Spears, C. A. (2021) · American Journal of Qualitative Research · doi:10.29333/ajqr/11427 · Cited by 6 · see citing works
“supports the use of text messaging for improving engagement with depression treatment (Aguilera et al., 2017) and obesity treatment (Woolford et al.”
BackgroundMartindale-Adams, J. L., Clark, C. D., Martin, J. R., Henderson, C. R., & Nichols, L. O. (2022) · Journal of Participatory Medicine · doi:10.2196/35318 · Cited by 6 · see citing works
“SMS text messaging improves patient engagement in treatment and outcomes [15,16] and adherence to treatment regimens and medications [17-20].”
BackgroundHaack, L. M., Armstrong, C. C., Travis, K., Aguilera, A., & Darrow, S. M. (2024) · JMIR Mental Health · doi:10.2196/49317 · Cited by 5 · see citing works
“The addition of HealthySMS to CBT for adults with depression in a public sector treatment setting was associated with an increased number of sessions attended and a longer duration of treatment [48].”
Self-citationWright, L. A., Majid, M., Shajan, G., Momoh, G., Patil, R., Rawsthorne, M., Purewal, D., Patel, S., & Morriss, R. K. (2025) · npj Digital Medicine · doi:10.1038/s41746-025-02118-8 · Cited by 5 · see citing works
“Thesewide-rangingprotocolsofteninclude additionalfeaturestoambulatoryassessment 18,19 and there is uncertainty about whether these components are valued by people with depression.”
İnce, B. Ü., Gökçay, D., Riper, H. M., & Cuijpers, P. J. (2019) · JMIR Research Protocols · doi:10.2196/13239 · Cited by 5 · see citing works
“The rationale behind using notifications in the mobile app is to avoid dropouts as indicated [30,31].”
EMMA: An Emotionally Intelligent Personal Assistant for Improving Wellbeing.Preprint
Ghandeharioun, A., McDuff, D., Czerwinski, M. P., & Rowan, K. (2018) · arXiv (Cornell University) · Cited by 5 · see citing works
Emotion-aware Human–Robot Interaction and Social Robots
Tian, L., Oviatt, S. L., Muszyński, M., Chamberlain, B. C., Healey, J., & Sano, A. (2022) · ACM eBooks · doi:10.1145/3502398.3502407 · Cited by 4 · see citing works
Blended Therapies and Mobile Phones for Improving the Health of Female Victims of Gender Violence
Vázquez, Y. G., & Sexto, C. F. (2022) · Healthcare · doi:10.3390/healthcare10030445 · Cited by 4 · see citing works
“In addition, we used the validated instrument named Final Questionnaire on Text Messaging (FQTM) for each woman to evaluate her experience [12]; we asked questions about the positive, the negative, and the effectiveness of the intervention, their opinion on the number of messages received, changes in their daily lives…”
MethodChang, D., Carlo, A. D., Khor, S., Drake, L., Lee, E. S., Avery, M., Unützer, J., & Flum, D. R. (2020) · Journal of General Internal Medicine · doi:10.1007/s11606-020-06136-y · Cited by 4 · see citing works
Wright, L. A., Roe, J., Guo, B., & Morriss, R. K. (2026) · JMIR Mental Health · doi:10.2196/83765 · Cited by 3 · see citing works
Ospina‐Pinillos, L., Krausz, R. M., & Hickie, I. B. (2021) · Springer eBooks · doi:10.1007/978-3-030-57296-9_128 · Cited by 3 · see citing works
Platt, R. E., Polk, S., Barrera, A. Z., Lara-Cinisomo, S., Hirschhorn, L. R., Graham, A. K., Musci, R. J., Hamil, J. L., Echavarria, D. M., Cooper, L., et al. (2024) · Trials · doi:10.1186/s13063-024-08423-z · Cited by 3 · see citing works
“We will send text messages 24–72 h apart via the HealthySMS system, a web-based platform used to deploy text messages in previous MB studies [45] and other studies of mental health interventions [46, 47].”
MethodGhods, N., Barney, M., & Kirschner, J. (2019) · Cambridge University Press eBooks · doi:10.1017/9781108649636.014 · Cited by 3 · see citing works
Wright, L. A., Monk-Cunliffe, J., Guo, B., & Morriss, R. K. (2025) · JMIR Mental Health · doi:10.2196/79500 · Cited by 2 · see citing works
“%) of the 77 studies [61,82] explicitly reported an absence of adverse events.”
Meyer, K., Dorai, C., Perales‐Puchalt, J., Puga, F., Zauszniewski, J., Rodriguez, R. A., Rodriguez, M. G., Cola, P., & Benton, D. (2025) · The Gerontologist · doi:10.1093/geront/gnaf305 · Cited by 2 · see citing works
Simmonds‐Buckley, M., Kellett, S., Hague, J., & Waller, G. (2025) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x24000412 · Cited by 2 · see citing works
Text-based psychotherapy: analyzing opportunities and challenges beyond the session
Flaherty, H. B., & Beckerman, N. L. (2025) · Social Work in Mental Health · doi:10.1080/15332985.2025.2468277 · Cited by 2 · see citing works
“Another study of outpatient psychiatric patients was conducted to learn the potential for texting as a psychological support in between CBT sessions ( n = 40) who did not receive texting and those ( n = 45) who received text messaging adjunct to in-person psychotherapy (Aguilera et al., 2017).”
Carcamo, A., Kemper, F., & Mauricio, D. (2021) · IEEE Sciences and Humanities International Research Conference (SHIRCON) · doi:10.1109/shircon53068.2021.9652293 · Cited by 2 · see citing works
Walters, C., Gratzer, D., Dang, K., Laposa, J. M., Knyahnytska, Y., Ortiz, A., Gonzalez‐Torres, C., Moore, L. P., Chen, S., Ma, C., et al. (2024) · JMIR Formative Research · doi:10.2196/40275 · Cited by 2 · see citing works
“Aguilera et al [18], for example, found that adjunctive text messaging to ICBT for depression was associated with increased attendance and adherence, and reduced depressive symptoms during a 16-week group intervention.”
BackgroundInfluentialIntroduction to Applied Affective Computing
Tian, L., Oviatt, S. L., Muszyński, M., Chamberlain, B. C., Healey, J., & Sano, A. (2022) · ACM eBooks · doi:10.1145/3502398.3502400 · Cited by 1 · see citing works
Emotion Recognition in the Wild
Tian, L., Oviatt, S. L., Muszyński, M., Chamberlain, B. C., Healey, J., & Sano, A. (2022) · ACM eBooks · doi:10.1145/3502398.3502404 · Cited by 2 · see citing works
Jamora, C. W., Brie, M. S., Bracci, P. M., Smith, E. M., Luks, T. L., Phan, S., Braunstein, S. E., Oberheim-Bush, N. A., Butowski, N. A., Clarke, J. L., et al. (2025) · Neuro-Oncology Practice · doi:10.1093/nop/npaf073 · Cited by 1 · see citing works
“26,27 We hypothesized that individuals with LrGG would (1) be interested in one-on-one, app-based, or psychoeducational text messages; (2) recruitment, enrollment, and adherence would be adequate; and (4) participants would report satisfaction with the intervention.”
Self-citationDondanville, K. A., Calloway, A. L., Stade, E. C., Hull, T. D., Jo, B., Huang, S., Hall‐Clark, B. N., LoSavio, S. T., Schuhmann, B. B., Elhusseini, S. A., et al. (2025) · Contemporary Clinical Trials · doi:10.1016/j.cct.2025.108149 · Cited by 1 · see citing works
Ospina‐Pinillos, L., Krausz, R. M., Gorban, C., & Hickie, I. B. (2026) · Springer eBooks · doi:10.1007/978-3-319-70134-9_128-2 · Cited by 1 · see citing works
Reinforcement Learning and Affective Computing
Tian, L., Oviatt, S. L., Muszyński, M., Chamberlain, B. C., Healey, J., & Sano, A. (2022) · ACM eBooks · doi:10.1145/3502398.3502405 · Cited by 1 · see citing works
Darrow, S. M., Ironside, M. L., Armstrong, C. C., Travis, K., Aguilera, A., & Haack, L. M. (2023) · Evidence-Based Practice in Child and Adolescent Mental Health · doi:10.1080/23794925.2023.2224112 · Cited by 1 · see citing works
Self-citationObuobi-Donkor, G., Shalaby, R., Agyapong, B., Nkrumah, S. O., Adu, M. K., Eboreime, E., Wozney, L., & Agyapong, V. I. O. (2025) · Digital Health · doi:10.1177/20552076251361236 · Cited by 1 · see citing works
“37 This improvement may be due to the unique way text-based interventions offer coping strategies that help reinforce healthy sleep habits by increasing self-assurance in addressing mental health challenges effectively.”
Interactive rank testing by bettingPreprint
Duan, B., Ramdas, A., & Wasserman, L. (2020) · arXiv (Cornell University) · doi:10.48550/arxiv.2009.05892 · Cited by 1 · see citing works
“The problem of testing whether a treatment has any effect in a randomized experiment without parametric assumptions is frequently encountered in biology, medical research, and social sciences (see, for example, Aguilera et al. [2017]; Olive et al.”
BackgroundInfluentialExploring User Perspectives on Brief Reflective Questioning Activities for Stress ManagementPreprint
Bhattacharjee, A., Chen, P., Mandal, A., Zhou, L., Aggarwal, J., Hsu, A., O'Leary, K., Mariakakis, A. T., & Williams, J. J. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4057942 · Cited by 1 · see citing works
Ospina-Pinillos, L., Davenport, T., Diaz, A. M., Navarro-Mancilla, A., Scott, E., & Hickie, I. (2019) · doi:10.2196/preprints.14127 · Cited by 1 · see citing works
Schwebel, F. J. (2019) · ResearchWorks at the University of Washington (University of Washington)
Ospina-Pinillos, L., Krausz, R. M., & Hickie, I. (2020) · Innovations in Global Mental Health · doi:10.1007/978-3-319-70134-9_128-1 · Cited by 2 · see citing works
Text Messaging Platforms in Mental Health Computerised-based Therapy: A Review
Rahman, T. F. A., & Nayan, N. M. (2021) · Pertanika journal of science & technology · doi:10.47836/pjst.29.3.41
“As shown in Table 5, depression was the highest (n = 12) to be the variable measured (Aguilera et al., 2017; Agyapong et al., 2017; Almeida et al., 2018; Anstiss & Davies, 2015; Arean et al., 2016; Islam et al., 2019; García et al., 2019; Kraft et al., 2017; Menezes et al., 2019; Renfrew et al., 2020; Wolf et al., 201…”
BackgroundResultInfluentialFuture of Affective Computing and Applied Affective Computing
Tian, L., Oviatt, S. L., Muszyński, M., Chamberlain, B. C., Healey, J., & Sano, A. (2022) · ACM eBooks · doi:10.1145/3502398.3502411 · Cited by 1 · see citing works
Multimodal Data Collection and Processing for Applied Affective Computing
Tian, L., Oviatt, S. L., Muszyński, M., Chamberlain, B. C., Healey, J., & Sano, A. (2022) · ACM eBooks · doi:10.1145/3502398.3502403
- Authors
- Aguilera, A., Bruehlman-Senecal, E., Demasi, O., & Avila, P.
- Affiliations
- University of California, Berkeley (US)
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2017-05-08
- Volume
- 19
- Issue
- 5
- Pages
- e148
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC5440738
- OpenAlex
- W2612408532
- Cited by
- 122
- References
- 40
- Citations by year
- 2026: 5 · 2025: 14 · 2024: 12 · 2023: 9 · 2022: 22 · 2021: 20 · 2020: 12 · 2019: 16 · 2018: 9 · 2017: 3
- FWCI
- 12.52
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute of Mental Health (K23MH094442)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- depression, cognitive behavioral therapy, text messaging, mobile health, mood tracking, treatment engagement, medication adherence, group therapy, low-income patients, clinician dashboard, PHQ-9, school dropout prevention, homework adherence
- MeSH terms
- Depression, Female, Humans, Male, Middle Aged, Cognitive Behavioral Therapy, Telemedicine, Text Messaging
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