One-year outcomes of a therapist-supported, smartphone-based intervention for elevated symptoms of depression and anxiety

Abstract

Depression is common and severely impacts physical, psychological and social functioning. To address access barriers to care, we developed Ascend - a smartphone-delivered, therapist-supported, 8-week intervention based on several evidence-based psychological treatments for depression and anxiety. We examined whether the previously-reported, end-of-treatment improvements among 102 adults with elevated symptoms of depression extended up to 12 months post-treatment for depression symptoms (measured by the Patient Health Questionnaire [PHQ-9]), and up to 6 months post-treatment for anxiety symptoms (added to the intervention later, and measured by the Generalized Anxiety Disorder scale [GAD-7]). An intention-to-treat analysis showed that participants maintained clinically significant improvements in depression (mean PHQ-9 reduction=6.67, Hedges’ g = 1.14 [0.78 to 1.49]) and in anxiety (mean GAD-7 reduction=4.26, Hedges’ g = 0.91 [0.54 to 1.28]) at follow-up. Also, 60% of participants above the cutoff for major depression at baseline (PHQ ≥ 10) experienced ≥ 50% reduction in PHQ-9 score and had PHQ-9 < 10 at follow-up. Future randomized trials are warranted to test Ascend as a scalable solution to the treatment of depression and/or symptoms of anxiety.

Feasibility and Efficacy of the Addition of Heart Rate Variability Biofeedback to a Remote Digital Health Intervention for Depression

“…The standard Meru Health intervention has been described in detail previously (Economides et al 2019;Goldin et al 2019). Briefly, the intervention consists of 8 modules delivered sequentially over an 8-week period, that include content derived from evidence-based practices such as Mindfulness-Based Stress Reduction (MBSR) (Kabat-Zinn 1994), Mindfulness-Based Cognitive Therapy (MBCT) (Morgan 2003), Cognitive-Behavioral Therapy (CBT) (Beck 1979), and Behavioral Activation Therapy (BAT) (Jacobson et al 2001).…”

“…Content delivered in the weekly modules is derived from several evidence-based treatments for depression including Mindfulness-Based Meditation (MM) (Kabat-Zinn 1994;Morgan 2003), Cognitive-Behavioral Therapy (CBT) (Beck 1979), and Behavioral Activation Therapy (BAT) (Jacobson et al 2001) delivered via texts, videos, and daily practices. Analyses of this program have indicated postintervention clinically significant reductions in depressive symptoms that remain at 6-and 12-month follow-up assessments (Economides et al 2019;Goldin et al 2019).…”

Feasibility and efficacy of the addition of heart rate variability biofeedback to a remote digital health intervention for depression

“…The present study suggests that combining HRV-B with other evidence-based psychological treatments for depression may improve treatment outcomes, even when treatment is delivered remotely. This is particularly promising given that the standard Meru Health intervention (without HRV-B) has already been associated with clinically significant reductions in symptoms of depression that persist for at least one-year post-intervention 18,19 . Although the present study was not a randomized trial, and we thus cannot be sure that the difference between groups was causally related to HRV-B, the fact that participants who engaged with a higher volume of HRV-B practice were also likely to experience larger reductions in depression symptoms lends further support to the idea that HRV-B may be an effective component of depression treatment.…”

“…The standard Meru Health intervention has been described in detail previously 18,19 . Briefly, the The intervention also includes anonymous peer support via a group discussion board, and support by a licensed Meru Health-employed remote therapist.…”

“…Content delivered in the weekly modules is derived from several evidence-based treatments for depression including Mindfulness-Based Meditation (MM) 14,15 , Cognitive-Behavioral Therapy (CBT) 16 , and Behavioral Activation Therapy (BAT) 17 delivered via texts, videos, and daily practices. Analyses of this program have indicated post-intervention clinically significant reductions in depressive symptoms that remain at 6-and 12-month follow-up assessments 18,19 .…”