Assessment and Disruption of Ruminative Episodes to Enhance Mobile CBT Just-in-Time Adaptive Interventions in Clinical Depression: Pilot Randomized Controlled Trial (Preprint)

Abstract

A just-in-time adaptive intervention (JITAI) is "designed to address the dynamically changing needs of individuals via the provision of the type/amount of support needed, at the right time… when needed." If and how Rumination Focused Cognitive Behavior Therapy (RFCBT), “the gold standard”, blocks emotional cascades underlying rumination is unclear. Further, CBT has been successfully used as a mobile variant (MCBT) but RFCBT has neither been adapted for a mobile variant (MRFCBT) nor for a JITAI variant.

To pilot-test a fully automated JITAI intervention, leveraging rumination-focused CBT (RFCBT), and ways to identify and block cascading depressive rumination.

Patients in therapy for clinical depression were recruited for the randomized controlled trial (RCT). After consenting to be part of the RCT, they were randomly assigned to a mobile version of RFCBT condition personalized to the individual’s own rumination timing patterns (JITAI- MRFCBT) or a no-treatment control condition through a double-blind procedure. All were recruited and participated through their smartphone and received five text-message reminders per each of 35 days to self-report their rumination-related symptoms (e.g. rumination episodes and durations). In the JITAI-MRFCBT condition, they also received treatment materials. The first 7-days provided a rumination baseline; the last 7-days a post-intervention rumination value. Out of 59 volunteers, 25 were eligible and provided their phone numbers. Five out of 25 of volunteers never replied to the text-message reminding them to start the RCT. Among the twenty participants who logged on the RCT. Eighteen of the remaining 20 accomplished the current RCT (i.e., finishing, as pre-specified, 80% of the questionnaires and training tasks) and were therefore included in the analysis. The intensive within-person design measures daily rumination symptoms and change within each of the 18 individuals.

Using independent t-tests with bootstrapping, results showed that participants in the JITAI-MRFCBT, compared to the control condition, reported greater reduction of counts of rumination episodes (M=-25.28, SD=14.50 versus M=1.44, SD=4.12, p<.01, 95 CI [14.25, 33.67]) and in average time (minutes) spent in rumination (M=-21.53, SD=17.6, versus M=1.47, SD=1.5; p=.04, 95 CI [10.58, 32.00]). Results using Group Iterative GIMME suggest that compared to the control, those in the JITAI-MRFCBT condition reduced ruminative carryover from one episode to the next .

Results suggest that JITAI-MRFCBT may reduce negative rumination by providing RFCBT just-in-time following rumination and by, thereby, blocking the next rumination episode with the same trigger. This study supports a subsequent, full-scale JITAI intervention, and the importance of leveraging mobile smartphone technology with MRFCBT to curb depressive symptoms.

NCT04554706