TY - JOUR AU - Walters, Clarice AU - Gratzer, David AU - Dang, Kevin AU - Laposa, Judith AU - Knyahnytska, Yuliya AU - Ortiz, Abigail AU - Gonzalez-Torres, Christina AU - Moore, Lindsay P AU - Chen, Sheng AU - Ma, Clement AU - Daskalakis, Zafiris AU - Ritvo, Paul PY - 2024 DA - 2024/5/31 TI - The Use of Text Messaging as an Adjunct to Internet-Based Cognitive Behavioral Therapy for Major Depressive Disorder in Youth: Secondary Analysis JO - JMIR Form Res SP - e40275 VL - 8 KW - online intervention KW - randomized controlled trial KW - major depressive disorder KW - text message KW - online KW - cognitive KW - behavior therapy KW - treatment KW - depression KW - disorder KW - symptoms KW - young adults KW - wellness KW - procedure KW - anxiety KW - model AB - Background: As an established treatment for major depressive disorder (MDD), cognitive behavioral therapy (CBT) is now implemented and assessed in internet-based formats that, when combined with smartphone apps, enable secure text messaging. As an adjunct to such internet-based CBT (ICBT) approaches, text messaging has been associated with increased adherence and therapeutic alliance. Objective: This study analyzed data from the intervention arm of a randomized control trial evaluating 24-week ICBT for MDD (intervention arm) against standard-care psychiatry (waitlist control). The aim of this secondary analysis was to assess MDD symptom improvement in relation to the frequency and content of text messages sent by ICBT participants to Navigator-Coaches during randomized control trial participation. Higher text frequency in general and in 3 conceptual categories (appreciating alliance, alliance building disclosures, and agreement confirmation) was hypothesized to predict larger MDD symptom improvement. Methods: Participants were young adults (18-30 years) from the Centre for Addiction and Mental Health. The frequencies of categorized texts from 20 ICBT completers were analyzed with respect to MDD symptom improvement using linear regression models. Texts were coded by 2 independent coders and categorized using content analysis. MDD symptoms were measured using the Beck Depression Inventory-II (BDI-II). Results: Participants sent an average of 136 text messages. Analyses indicated that BDI-II improvement was negatively associated with text messaging frequency in general (β=–0.029, 95% CI –0.11 to 0.048) and in each of the 3 categories: appreciating alliance (β=–0.096, 95% CI –0.80 to 0.61), alliance building disclosures (β=–0.098, 95% CI –0.28 to 0.084), and agreement confirmation (β=–0.076, 95% CI –0.40 to 0.25). Altogether, the effect of text messaging on BDI-II improvement was uniformly negative across statistical models. More text messaging appeared associated with less MDD symptom improvement. Conclusions: The hypothesized positive associations between conceptually categorized text messages and MDD symptom improvement were not supported in this study. Instead, more text messaging appeared to indicate less treatment benefit. Future studies with larger samples are needed to discern the optimal use of text messaging in ICBT approaches using adjunctive modes of communication. Trial Registration: Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052 SN - 2561-326X UR - https://formative.jmir.org/2024/1/e40275 UR - https://doi.org/10.2196/40275 UR - http://www.ncbi.nlm.nih.gov/pubmed/38820586 DO - 10.2196/40275 ID - info:doi/10.2196/40275 ER -