Effectiveness of a brief blended cognitive behavioral therapy (bCBT) program for the treatment of depression and anxiety in university students: A feasibility trial (Preprint)

Abstract

Blended cognitive behavioral therapy (bCBT)—the combination of CBT and digital mental health applications—has been increasingly used to treat depression and anxiety disorders. As a resource-efficient treatment approach, bCBT appears promising for addressing the growing need for mental healthcare services, for example, as early interventions before chronification of symptoms. Yet, further research into the efficacy and feasibility of integrated bCBT interventions is needed.

This study aimed to evaluate the effectiveness of a novel bCBT program comprising short (25-minutes) weekly face-to-face therapy sessions combined with a smartphone-based digital health application for treating mild to moderate symptoms of depression or anxiety.

This prospective uncontrolled trial comprised two measurement points (pre- and post-treatment) and two intervention groups. We recruited university students with mild to moderate symptoms of depression or anxiety. Based on primary symptoms, subjects were assigned either to a depression intervention group (N = 67 completers) or an anxiety intervention group (N = 33 completers). Participants in each group received six weekly individual psychotherapy sessions via videoconference and completed modules tailored to their respective symptoms in the smartphone-based digital health application.

The depression group displayed medium to large improvements in symptoms of depression (d = -.70 to -.90, ps < .001). The anxiety group experienced large improvements in symptoms of generalized anxiety assessed with the Generalized Anxiety Disorder Scale-7 (d = -.80, p < .001), but not in symptoms of anxiety assessed with the Beck Anxiety Inventory (d = -.35, p = .058). Additionally, both groups experienced significant improvements in their perceived self-efficacy (d = .50 in the depression group, d = .71 in the anxiety group, ps < .001) and quality of life related to psychological health (d = .87, p < .001 in the depression group; d = .40, p = .035 in the anxiety group). Work and social adjustment of patients improved significantly in the depression (d = -.49, p < .001) but not in the anxiety sample (d = -.06, p = .719). Patients' mental health literacy improved in the anxiety sample (d = .45, p = .017) but not in the depression sample (d = .21, p = .103). Patient satisfaction with the bCBT program and ratings of the usability of the digital application were high in both treatment groups.

This study provides preliminary evidence for the feasibility and effectiveness of a novel brief bCBT intervention. The intervention effects generalized across a broad spectrum of patient-reported outcomes. Hence, the newly developed bCBT intervention appears promising for treating mild to moderate depression and anxiety in young adults.