Adaptive Messaging for Depression

Overseen By Rachel F Kornfield, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Northwestern University

Disqualifiers: Severe mental health, High suicide risk, Psychotherapy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

Duration: 8 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how text messaging can assist in managing depression. It tests two types of messaging: one adapts based on user feedback (Adaptive Messaging Intervention), while the other sends random messages (Non-Adaptive Messaging Intervention). Another group receives links to educational resources (Psychoeducation-Only Control). Individuals with moderate depression symptoms who own a smartphone may be suitable for this trial. The goal is to determine which method most effectively reduces symptoms and improves engagement. As an unphased trial, this study provides a unique opportunity to contribute to innovative research that could enhance depression management for many.

Do I need to stop my current medications to join the trial?

The trial does not specify if you need to stop your current medications, but you cannot join if you've changed your psychiatric medication dose in the past 4 weeks or plan to change it during the trial.

What prior data suggests that this adaptive messaging intervention is safe for managing depression?

Research has shown that text messaging programs for depression are generally safe. In studies of similar programs, participants received messages without major problems. For programs that adjust messages based on user feedback, one study found that over 99% of participants received the messages as planned, indicating the system works well and is well-liked.

Programs that send the same messages to everyone also appear safe. In one study, participants' depression symptoms improved, demonstrating the messages were helpful and did not cause harm. No major negative events were reported in these studies.

Overall, current research suggests that both types of messaging programs are safe. Participants did not report serious side effects, and the programs were generally well-received. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these messaging interventions for depression because they leverage technology in a new way to enhance treatment engagement. Unlike traditional methods, such as medication and therapy, these interventions use daily SMS text messages to encourage the use of cognitive and behavioral strategies. The Adaptive Messaging Intervention is particularly groundbreaking because it utilizes reinforcement learning to tailor message styles to individual users, potentially increasing user engagement and effectiveness. This personalized approach could offer a more flexible and accessible option for managing depression, especially for individuals who might struggle with conventional therapy settings.

What evidence suggests that this trial's messaging interventions could be effective for depression?

This trial will compare different messaging interventions for depression. Research has shown that personalized messaging can assist people with depression. One study found that 42.4% of participants in a personalized messaging program experienced improved depression symptoms, compared to 32.2% in a standard program. In this trial, the Adaptive Messaging Intervention uses smart technology to customize messages, potentially increasing user engagement and effectiveness. The Non-Adaptive Messaging Intervention, which represents standard messaging, also demonstrated some improvement in mental health, but it may not be as effective as the personalized approach. Both methods can help reduce depression, but the personalized system might better engage users and improve outcomes. ^{1 2 3 6 7}

Are You a Good Fit for This Trial?

This trial is for individuals experiencing elevated symptoms of depression. Participants will be recruited digitally and must be willing to engage with text messaging interventions over an 8-week period, followed by a 6-month post-treatment follow-up.

Inclusion Criteria

US citizen or resident

Has a smartphone

Is able to speak and read English

Exclusion Criteria

I am currently in psychotherapy or plan to start within 8 weeks.

High suicide risk (has ideation, plan, and intent)

Reports diagnosis with a severe mental health problem (e.g., psychotic, bipolar) for which participation in this trial is inappropriate

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants receive 8 weeks of daily text messaging interventions, either adaptive or non-adaptive, or a psychoeducation-only intervention

8 weeks

Daily text messages

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments at 3-month and 6-month intervals

6 months

Assessments at 3-month and 6-month intervals

What Are the Treatments Tested in This Trial?

Interventions

• Adaptive Messaging Intervention
• Non-Adaptive Messaging Intervention
• Psychoeducation-Only Control

Trial Overview The study tests three approaches: adaptive text messaging that evolves based on user engagement, non-adaptive random messaging, and a control group receiving psychoeducation links. The goal is to see which method best supports depression self-management.

How Is the Trial Designed?

Group I: Non-Adaptive Messaging Intervention Experimental Treatment 1 Intervention

The intervention involves 8 weeks of daily text messaging. Messages will arrive throughout the day via SMS to prompt learning and applying cognitive and behavioral self-management strategies, representing a variety of self-management strategies and message tones. Daily messaging styles will be randomly selected.

Group II: Adaptive Messaging Intervention Experimental Treatment 1 Intervention

The intervention involves 8 weeks of daily text messaging. Messages will arrive throughout the day via SMS to prompt learning and applying cognitive and behavioral self-management strategies, representing a variety of self-management strategies and message tones. The intervention will apply reinforcement learning to select daily messaging styles to maximize user engagement.

Group III: Psychoeducation-only control Active Control 1 Intervention

The 8-week intervention involves receiving several text messages per week that include weblinks to access psychoeducation information about cognitive and behavioral self-management strategies.

Who Is Running the Clinical Trial?

Northwestern University

Lead Sponsor

Trials

1,674

Recruited

989,000+

Published Research Related to This Trial

In a study of 1,089 mildly to moderately depressed individuals undergoing a six-week Internet-based cognitive-behavioral intervention, both standardized and individualized feedback resulted in similar patterns of symptom improvement.

Two distinct groups were identified: immediate improvers (62.5%) who showed significant symptom reduction early on, and delayed improvers (37.5%) who improved later, suggesting that managing expectations and enhancing social support could help those at risk for slower recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

How individuals change during internet-based interventions for depression: A randomized controlled trial comparing standardized and individualized feedback. Zagorscak, P., Heinrich, M., Bohn, J., et al.[2021]

This study aims to evaluate the effectiveness of different reminder methods (text messages, reminder calls, or both) in increasing the use of service referrals among 300 participants from community outreach programs.

The research will help determine how mobile phone-based interventions can enhance community engagement and service utilization, potentially guiding future reminder protocols for similar programs across the country.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Research Protocol to Test the Effectiveness of Text Messaging and Reminder Calls to Increase Service Use Referrals in a Community Engagement Program. Varma, DS., Hart, M., McIntyre, DS., et al.[2020]

A study involving 73 patients with Major Depressive Disorder found that receiving supportive text messages twice daily for 3 months significantly improved depression scores compared to a control group, with a notable effect size of 0.67.

The intervention also led to better self-rated quality of life scores, indicating that supportive text messaging could be an effective and accessible psychological intervention for depression, particularly in underserved populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomized controlled pilot trial of supportive text messages for patients with depression. Agyapong, VIO., Juhás, M., Ohinmaa, A., et al.[2018]

The study involved 68 participants who received individually tailored text messages alongside telephone-based psychotherapy, but there were no significant differences in clinical outcomes compared to a historical control group of 157 participants who only received psychotherapy.

While both groups showed improvement over time, the SMS intervention did not enhance clinical outcomes, and the study suggests that further research with a larger sample size is needed to better assess the potential benefits of text messaging in psychotherapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparison between phone-based psychotherapy with and without text messaging support in between sessions for crisis patients. Furber, G., Jones, GM., Healey, D., et al.[2021]

A smartphone-based intervention (SBI) combining group psychoeducation and 14 days of app training showed high usability and engagement among participants, indicating it is user-friendly and well-received.

The pilot trial with 16 individuals suggested that the SBI effectively reduced depressive symptoms compared to a waitlist control, providing preliminary evidence for its efficacy in treating depression.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Blending group-based psychoeducation with a smartphone intervention for the reduction of depressive symptoms: results of a randomized controlled pilot study. Lukas, CA., Berking, M.[2021]

The TeleCoach intervention significantly improved adherence to the web-based moodManager program, leading to more frequent logins and greater engagement with the content compared to self-directed use.

While TeleCoach+moodManager showed lower depressive symptoms compared to a waitlist control at week 6, there were no significant differences in symptom reduction when compared to self-directed moodManager, highlighting ongoing challenges with adherence in web-based depression treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized controlled trial evaluating a manualized TeleCoaching protocol for improving adherence to a web-based intervention for the treatment of depression. Mohr, DC., Duffecy, J., Ho, J., et al.[2022]

A study involving 226 individuals with Major Depressive Disorder showed that a text-message-based maintenance intervention (TMMI-D) using standardized messages significantly reduced the increase in depressive symptoms compared to a waitlist control group.

Interestingly, the individualized message version of TMMI-D did not show the same effectiveness, suggesting that standardized messages focusing on adaptive emotion regulation may be more beneficial for sustaining treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of a text-message-based maintenance intervention for Major Depressive Disorder after inpatient cognitive behavioral therapy. Schlicker, S., Ebert, DD., Middendorf, T., et al.[2018]

A review of 55 studies on Internet and mobile-based psychoeducational interventions for depression found that most programs primarily used websites and emphasized communication tools, but less effective methods like interactive technologies were underutilized.

Higher clinician involvement in these interventions was associated with better treatment compliance, suggesting that optimizing technology features could enhance effectiveness while reducing clinician workload.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Systematic review of the information and communication technology features of web- and mobile-based psychoeducational interventions for depression. Zhao, D., Lustria, MLA., Hendrickse, J.[2018]

A study involving 340 adults undergoing routine psychotherapy showed that adding an Internet intervention (Deprexis) significantly reduced depression symptoms and improved quality of life, with lasting effects observed at a 6-month follow-up.

The combined treatment approach led to greater therapeutic progress and higher rates of clinical improvement, regardless of the type of face-to-face therapy used, suggesting that blended treatment strategies can enhance outcomes for patients with mild to moderate depression.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Immediate and long-term effectiveness of adding an Internet intervention for depression to routine outpatient psychotherapy: Subgroup analysis of the EVIDENT trial. Schuster, R., Laireiter, AR., Berger, T., et al.[2022]

An automated text-messaging system was developed to support cognitive-behavioral therapy (CBT) for depression, focusing on enhancing homework adherence and tracking patient progress among low-income patients.

In a feasibility test with 12 participants in two CBT groups, the system achieved a 65% response rate to daily mood inquiries and received positive feedback, suggesting it could be a cost-effective tool to improve mental health care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Text Messaging as an Adjunct to CBT in Low-Income Populations: A Usability and Feasibility Pilot Study. Aguilera, A., Muñoz, RF.[2022]

A randomized controlled trial involving 525 participants showed that both an interactive cognitive behavior therapy website and a psychoeducation website significantly reduced symptoms of depression compared to a control group.

The cognitive behavior therapy intervention (MoodGYM) not only decreased depressive symptoms but also reduced dysfunctional thinking and improved knowledge about cognitive behavior therapy, while the psychoeducation site (BluePages) enhanced understanding of effective treatments for depression.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Delivering interventions for depression by using the internet: randomised controlled trial. Christensen, H., Griffiths, KM., Jorm, AF.[2022]

Citations

1. clinicaltrials.gov clinicaltrials.gov/study/NCT06458192

Adaptive Messaging to Support Depression Self ... H3: Adaptive messaging will reduce depression relative to non-adaptive messaging by producing greater objective and subjective engagement. Detailed Description.

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11261690/

Assessing the effectiveness of internet-based interventions for ... Five studies reported the dropout rate for depressive disorders, culminating in a combined rate of 47.59% (5981/12 567). Adherence was reported ...

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0165032723013083

Small Steps over time: A longitudinal usability test of an ... This paper examines the Small Steps SMS program, an 8-week, automated, adaptive text message-based intervention for depression and anxiety.

4. nature.com nature.com/articles/s41591-024-02864-4

Self-help mobile messaging intervention for depression ... In the intervention arm, 109 of 257 (42.4%) participants had an improved depressive symptomatology, compared with 87 of 270 (32.2%) participants ...

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10105646/

Effectiveness and implementation of a text messaging ... A 60-day text messaging program based on cognitive behavioral therapy (CBT), was developed to help adults cope with depressive and anxiety symptoms during the ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12035677/

The Text4Health controlled clinical pilot trial In this initial controlled pilot feasibility trial, a 12-week, adaptive TMI was feasible and well-accepted, with participants receiving over 99% ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10511778/

A text messaging intervention to support the mental health ... We designed an intervention that imparts strategies for self-managing mental health symptoms through interactive text messaging dialogues and engages users.